New to Cushings- 12yr old Cocker/Poodle Mix just began treatment

[Poppy'sDad]

Hello. My name is Greg and my little 'Ol Man' Poppy has recently started treatment for PDH. He had gradually shown signs which started with loss of tail hair about 18 months ago. Over time, he changed from beginning years of practically free feeding and never finishing a bowl of food, to current days of a ravenous appetite out of control and waking even after just two hours at night to beg for food. His drinking and urination have never really changed, which I think threw my vet in the beginning. Continued hair loss on tail and his curly poodle coat turned more straight, thin and dry. Many wart-like growths on sking would come and go. Got the pot-bellied look and seemed to bulk up without ever changing diet. Excessive panting almost always, and couldn't do walks without stopping frequently. After reading a lot (a ton on this site-Thank You!) on the subject and being persistent with telling vet "something was not right", we finally did a Low Dose Dex on him:
Pre Dex was 6.3ug/dL
Post 8hr was 5.4ug/dL

Decision was made to start Lysodren. With his weight of 42lbs, his dose was 500mg/2x per day with both morning and evening meals. Dosed at that rate for 10 days. At the 9th and 10th days, for the first time in a year he actually paused during his meal. Walked into kitchen and went back to and finished his bowl. At first I didn't think anything of it, but after much reading I realized this might mean something, especially since literally inhaling his food and anything else he could get a hold of.
Had an ACTH done, which was 12 days after loading dose started. Results were:
Pre test of 5.5ug/dL
Post ACTH 16ug/dL

Test was IDEXX. I know they recommend continuing loading until post is lowered further, but really nervous about crashing him. It has been a "miracle" to me to finally sleep for almost 6 hours straight without the poor guy waking up to want to eat. He seems much more relaxed, not panting and back to being more of a couch potato that he used to be without frantically searching for food.

Vet is thinking to continue loading dose for another 10 days, but she knows my concern and gave the option of reducing by half, so 500mg 1x/daily and seeing what happens in 10 days. I would rather this approach and was wondering if it is detrimental and I should stay the course of loading, go with the single daily dose, or jump to maintenance dosing?

Thanks to all for this tremendous site. For all of the time you all dedicate to it, it is truly great to see such a dedicated bunch to such a worthy cause of helping others!

[Dixie'sMom]

Greg, welcome to you and Poppy! I'm glad you found us. I am a fairly new Cushpup Mom and have no experience with Lysodren so I will let the experts guide you. It sounds like other than the crazy appetite, which I am all too familiar with, Poppy basically is feeling fine and doing well with treatment. Others will be along soon to welcome you and chime in with their thoughts. This is a great group of folks who will embrace you and Poppy as one of their own immediately. It sounds like you are doing a good job so far, so keep on keeping on, and again, WELCOME.

[Harley PoMMom]

Hi Greg,

Welcome to you and Poppy, so glad you decided to join our family and post about your sweet boy!


After reading a lot (a ton on this site-Thank You!) on the subject and being persistent with telling vet "something was not right", we finally did a Low Dose Dex on him:
Pre Dex was 6.3ug/dL
Post 8hr was 5.4ug/dL

The low dose dexamethasone suppression (LDDS) test has three result numbers; a baseline (pre/resting); a 4 hour number, and an 8 hour number, I see that the 4 hour result is missing, could you check and see if that is listed and then post it here for us?


Decision was made to start Lysodren. With his weight of 42lbs, his dose was 500mg/2x per day with both morning and evening meals.

Was the 500mg given twice a day for a total of 1000mg? If so, than that would of been an adequate loading dose for his weight of 42 lbs.


Dosed at that rate for 10 days. At the 9th and 10th days, for the first time in a year he actually paused during his meal. Walked into kitchen and went back to and finished his bowl. At first I didn't think anything of it, but after much reading I realized this might mean something, especially since literally inhaling his food and anything else he could get a hold of.
Had an ACTH done, which was 12 days after loading dose started. Results were:
Pre test of 5.5ug/dL
Post ACTH 16ug/dL

How long after the last dose of Lysodren was given was the ACTH stimulation test performed? Great job knowing that the slight hesitation in eating could be a sign of Poppy being loading, and I'm surprised in 10 days that he is not loaded, but every dog is different.


Test was IDEXX. I know they recommend continuing loading until post is lowered further, but really nervous about crashing him. It has been a "miracle" to me to finally sleep for almost 6 hours straight without the poor guy waking up to want to eat. He seems much more relaxed, not panting and back to being more of a couch potato that he used to be without frantically searching for food.

Vet is thinking to continue loading dose for another 10 days, but she knows my concern and gave the option of reducing by half, so 500mg 1x/daily and seeing what happens in 10 days. I would rather this approach and was wondering if it is detrimental and I should stay the course of loading, go with the single daily dose, or jump to maintenance dosing?

With Lysodren treatment the therapeutic ranges are 1 ug/dl - 5 ug/dl, since Poppy's post number was 16 ug/dl I believe that a mini load is in order here, what that pertains to is continuing with the loading dose of 500mg twice a day but only for a short time, maybe 2 or 3 days or stopping when he shows signs of being loaded, but not 10 days. Has the vet prescribed Prednisone for Poppy to keep on hand in case his cortisol would go too low?


Thanks to all for this tremendous site. For all of the time you all dedicate to it, it is truly great to see such a dedicated bunch to such a worthy cause of helping others!

Aww thanks Greg, We are happy to help in any way we can. I, also, wanted to provide you with a link from our Resource thread where info is found regarding Lysodren: Lysodren loading Instructions and related tips (http://www.k9cushings.com/forum/showthread.php?t=181)

If you have any questions at all please do not hesitate to ask them. ;)

Hugs, Lori

[My sweet Ginger]

- Vet is thinking to continue loading dose for another 10 days. -

No, please no, you never do mini loads for 10 days.:eek::eek::eek:
As Lori said you usually reload for 2-3 days and after 48 hours another ACTH stim test.
Please do let us know and check with us of his future loading(s).

Can you tell us when was the last dose of Lysodren and how many hours after the ACTH stim test was done, please?
Thanks.

[Poppy'sDad]

Thanks Lori and My Sweet Ginger for your quick response,
Answers to your replies:
Concerning the LDDS, that was what I didn't understand. I got a copy of the actual IDEXX test and it only had Pre and 8 hour reads, not 4 hour. Wondering if Vet didn't draw?
I just asked for the copy when I took him for his ACTH Tuesday and Vet was already gone so I have not had a chance to ask her (so I could provide feedback on here!). Now I know to get copies of everything and discuss right then.

Poppy was given 500mg twice a day for ten days. Last dose was Sunday morning, and ACTH was done Tuesday. Injection of Cortrosyn around 10am and blood draw two hours after. So ACTH was done about 48-52 hours after last dose.I do have Prednisone on hand, I made sure I asked for it based on everything I read.

Now for the REAL dilemma and my need for advice. My Vet left for vacation and won't be back until the 29th! She left the instructions for the dosing options (2x/day for another 10 or 1x/day for another 10) with the office. If I continue a load, even for a day or two, I won't have the availability of another Stim test until the 29th! I don't want to really mess him up by not giving any more Lyso unitl she gets back either. UGGh! Hind sight now, bad timing but I think maybe Vet thought he would load before she left? Not that I would expect altered plans, but I wish we could have spoke of a better plan. She has always done very well by me in the past with my labs who have since passed on, and I have not come out and asked her how many Cush dogs she has been successful with or how many she has treated period, but now I'm just questioning everything in my mind!

Each day that goes by Poppy continues to improve symptomatically even though it has been almost a week since last load dose. Last night he slept through the entire night, never getting up to ask to go out or more so for food. I don't remember the last time this has happened. I actually jolted awake because he never woke me during the night and I thought something was wrong, but no...just laying there snoring away! He actually picked up his old dirty ball (his pacifier) and laid down with it like he always used to, which hasn't been in some time. This morning he only ate half his bowl of food and went back to bed! He ate the rest when we got up for good in another hour or so. Never, never, never has he done this. It really scares me now that I know he might be close to where he should be (even though protocol calls for him to be 1-5), and what will the sign be in the next day or so if I start up with 1000mg/day?

Sorry if I'm rambling but really don't know what to do with the little guy. We never even spoke about a firm dose of the Pred, just that "if something happened to call vet and she would tell me how much to administer".

[My sweet Ginger]

I'm really glad you giving us all the details because I think we have to look at his results of ACTH from a different angle. Normally they draw blood twice, once before the stimulating agent and once after one hour but some vets draw a 2nd draw after 2 hours. The results of ACTH we usualy go by on this forum is after one hour. Is there any way you can find out whether your vet drew Poppy's blood after one hour and what that number might be?
That could explain why Poppy is doing better than with the post number is thought to be doing. Meaning his post number after one hour could've been actually lower than after two hours or at least that's what I'm thinking.
Is anyone filling in for your vet while she is away?
I'm so sorry you are left in this position but we will brainstorm together towards Poppy's well being.

[Poppy'sDad]

Unfortunately, no, nobody is filling in but tomorrow when the office is open I am going to call and see if there is a note about the ACTH. For emergencies I think another vet in the area takes the calls, but not comfortable at this point bringing him somewhere else. Although, if I really need to continue with a mini load and get another ACTH I will ask about that. I'm not sure how it was drawn now, so I really want to find out. I know they said she would be calling to check in so if there isn't more information about the test I will ask that they seek that info when they next talk to her.

[Squirt's Mom]

Each day that goes by Poppy continues to improve symptomatically even though it has been almost a week since last load dose. Last night he slept through the entire night, never getting up to ask to go out or more so for food. I don't remember the last time this has happened. I actually jolted awake because he never woke me during the night and I thought something was wrong, but no...just laying there snoring away! He actually picked up his old dirty ball (his pacifier) and laid down with it like he always used to, which hasn't been in some time. This morning he only ate half his bowl of food and went back to bed! He ate the rest when we got up for good in another hour or so. Never, never, never has he done this. It really scares me now that I know he might be close to where he should be (even though protocol calls for him to be 1-5), and what will the sign be in the next day or so if I start up with 1000mg/day?

Based on this info right here ^^, Poppy should be loaded and there is no way I would continue the load nor do a mini load at this time. None. I would stop the Lyso and call Mon for another ACTH asap. If you have continued to give the Lysodren, keep a very close eye on him for signs the cortisol is dropping too low - loss of appetite, loose stools/diarrhea, nausea/vomiting, lethargy. You cannot wait for your regular vet to return for this ACTH or you will lose the load and have to start all over. :(

Really bad timing on the vet's vacation for sure! But you are doing a great job so don't despair...plus you have us by your side now, too. ;) I'm glad you found us and am happy to welcome you and Poppy into our little family here.

Hugs,
Leslie and the gang

[Poppy'sDad]

Uggh...think I took too long in my typing and lost my reply. I'm so glad I found you guys and this forum! I know in my heart if I continued the loading dose I would have crashed him. His symptoms are just so much different (for the better) than they have been on so long. No panting at all. Cool to touch on belly. Totally relaxed and just so much like his old "lazy" self.
I am going to go to the office tomorrow instead of calling. I want to see the report myself. Something struck me as I was racking my brain on this. The receptionist first told me when I called for his ACTH results "keep doing what you're doing, he is in the "normal" range. What did that mean? She should have known I was out of meds awaiting results and further meds.
It wasn't until I asked to speak to a vet tech that I know there and she gave me the dosing instructions and called in the refill. I'm thinking she must have reached out to vet or discussed the original note she left?!?!
Now I'm panicking...could the result have been 1.6 instead of 16? I know on the faxed copy of the IDEXX report on the LDDS it was hard to make out the decimal point in a few spots. I need to get there and see to make sure.
Does anyone know what would happen if I went to maintenance dose if Poppy wasn't fully loaded? Just worrying if I can't get another ACTH quickly, I don't want to do nothing and lose load, or worse, continue meds at wrong dose and crash him ending up in ER! In the Lyso link Lori attached, thanks btw, the very first thing listed about the food is spot on for what happened this morning.

[My sweet Ginger]

I don't think Poppy's result after 2 hrs was 1.6 going by his demeanor.
Can you find another vet so you can do an ACTH and start maintenance if warranted?
Waiting for your vet until 29th and do nothing may throw him right back. Try to find a vet who has experience treating Cushings if you can and I don't think your vet has I lot of that.

Poppy looks so cute.

[Squirt's Mom]

I would ask for another ACTH be performed tomorrow when you go in. I would not wait for the regular vet to return. ;)

[labblab]

Hello and welcome from me, too. Boy, what a mess your vet has left in her absence! :o

For the benefit of all of us, I just want to lay out a timeline to double-check our understanding...

Poppy had his last Lysodren dose a week ago on Sunday.

The ACTH was done on Tuesday, using Cortrosyn. But as has been noted, the second blood draw wasn't done until two hours later? (With Cortrosyn, it should be done after only one hour).

You believe the result after two hours was:
Pre test of 5.5ug/dL
Post ACTH 16ug/dL

Poppy has not had any more Lysodren at all during this intervening week.

Is this all correct?
Marianne

[Poppy'sDad]

Hi Marianne,

Yes, you have it all correct. I just want to verify in the morning that the blood draw was actually 2 hours. The reason I stated that was because when I brought him for the test, they told me to come back in 2 hours. Now I'm really worried because of the 1 hour issue. Why wouldn't the vet have known that protocol? But I see what you mean though. If that were the case I could have come back for him in an hour.
I just keep going back to the fact that he is soo normal right now. This dog has not slept for 6 to 7 hours straight without waking to go out, or without food or drink, or not finished his food in forever.
I will try for another ACTH, but getting another vet to perform on the spot might be a challenge. I will try tomorrow though.

[labblab]

i think the very first thing I would do tomorrow is clarify the previous ACTH testing. Perhaps the testing timeframe actually was correct, but they told you to allow two hours before returning so as to allow enough time to get him prepped and to complete the procedure without you having to wait on him. Secondly, I'd reconfirm the actual test result numbers to make sure there is no confusion.

If the test was done correctly, it is hard to think that Poppy's cortisol would have dropped clear from 16+ down anywhere near the desired therapeutic range during this past week in the absence of any more medication. But if they did erroneously wait a full two hours to test, maybe his cortisol was indeed lower at the one-hour mark. Really, really puzzling! :confused:

Marianne

[My sweet Ginger]

There couldn't have been no blood draw after 1 hr if you brought him home after the injection and took him back after 2 hrs.
Is there a 24hr vet hospital near you? Or I'm sure someone can squeeze you in if you call around tomorrow and explain to them.

[Poppy'sDad]

Thank you...I will get clarification as soon as they open in the morning. I was there when they gave him the injection, so I'm really questioning the 2 hour thing if they would draw after only an hour, but trying to stay calm and not jump to conclusions.

Just panicked about losing load!

I'm just really confused in the fact that if he was 16, more than three times the desired therapeutic range expected, how can he be stopping his meal half way through and going back to bed? Continuous panting for many, many months completely gone!

Again, having no experience with any of this, with almost a week gone by after the initial load and no more drug since, does it continue to build in his system for change of symptoms to be so much improved a week later?

[Poppy'sDad]

My Sweet Ginger,
Maybe I mis spoke in my rambling here. I was there with him when they gave him the injection, but I left him there at there request so they could take the draw. They told me to come back in 2 hours, so I do not know yet if they drew at 1 hour like it appears was supposed to happen, or two hours. Just don't know why they would tell me to come back in two hours if they would draw blood after only 1.
I hope to clarify in the morning. Really, really hoping someone there has that answer for me.

[My sweet Ginger]

Oh I see, then it's not you. I always bring my pup home to ease her anxiety and take her back for one hr draw and I automatically thought the same.:rolleyes:
Yea, you can double check with them when the blood was drawn but he needs another ACTH now regardless to check what his cortisol level is after one week of break from Lysodren. I'm sure you can stay there with him and make sure it gets done correctly. One hr goes by rather quickly.

[Poppy'sDad]

Hello again,

As planned this morning I went to vet office to clarify ACTH test and results. The test as well as the results were in fact correct.

Blood was drawn 1 hour after Cortrosol injection. They just kept him for an extra hour in case he reacted negatively to the injection, something they do as a normal precaution.

The results were as originally stated,
Pre injection was 5.5
Post was 16

At the time of my visit there wasn't anyone there that could offer assistance with getting another ACTH performed locally with the covering vet as they will not have hours until this evening, but I did contact that vet myself and they struggled with the idea of performing another ACTH based on results from Tuesday's test. Like what was mentioned earlier by Marianne, without additional doses of drug Poppy shouldn't have continued to lower during the past week without drug.
They are recommending a continued loading dose for a "few days". They were going to consult with my vet when she called to check in sometime later this evening as it seemed they definitely were not comfortable taking action without her involvement.
I expressed the urgency as I didn't want to lose the "load". I don't know if I already might have as I do not know how long he would stay at the current level.
So now for my continuing HUGE dilemma. Do I continue to load dose for the couple of days, with the couple of days putting me on Christmas day? I am working all week with the exception of Christmas day so he would be alone all day which adds to me anxiety. I don't know what to do!

[Poppy'sDad]

I forgot to add, Poppy is still breaking and walking away from his food. He does go back and finish, and he does still gorge the cat food bowls if he can get to one. He also hangs in the kitchen anxiously awaiting something to hit the floor, but I don't know if it's just habit with him now since he's been so food crazy for so long, or if he is indeed still feeling the effects of the 16 level. I just keep going back to the Lysodren link that listed the "stopping even briefly or walking away from food"...is that just a key that he "might" be getting close? I know at that point they say to really watch carefully as it might be a sign of crashing to come. Again, having to work every day knowing he's there alone just makes me crazy.

[Renee]

Is there an emergency vet in your area?

The reason I ask is because a few weeks ago, when my pug came down sick, we rushed to the ER vet, and they were ready to preform an ACTH at my request, simply because I was worried her cortisol had dropped too low.

Can you do something similar? Take him to an ER vet, and based on his symptoms, request an impromptu ACTH due to concerns for dropping too low?

[Poppy'sDad]

Hey Renee,

Yes, there is one about 30 minutes away. I had quite a bit of interaction with them during the last part of my departed Lab's life so I am familiar with them.

I didn't even think of them as Poppy is not in need or "emergency" care, but definitely an option for sure. I will reach out to them in the meantime while waiting for my vet who is away to call in to covering vet.

I'm still stuck questioning if I should start dosing again. He's now 8 days with no drug. Even if I got an ACTH tonight, then not sure if they could turn results before Christmas or by end of week....? Just kind of panicked.

[Poppy'sDad]

Sorry Renee, manners were lost with my mixed up brain right now...

Thank you for suggesting the Urgent Care group for the test!

[Harley PoMMom]

I'm still stuck questioning if I should start dosing again. He's now 8 days with no drug. Even if I got an ACTH tonight, then not sure if they could turn results before Christmas or by end of week....? Just kind of panicked.

I'm not sure what you should do either:confused: So, in my eyes there are 3 options: 1) is to continue to load; 2) go to maintenance dosing; or 3) do nothing and possibly lose the load.

One thing to remember is that once the Lysodren pill is given you can't take it back, and since you are seeing signs of a dog being loaded (walking away from food) and with the vet being away, to me, continuing to load would not be an option.

Losing the progress you have made just doesn't seem right either.

Now, Lysodren acts to suppress adrenal gland function by eroding the top layers of the adrenal gland that produce corticosteroid hormones, thereby reducing the production of cortisol. So even if you would go to maintenance dosing this doesn't guarantee it will hold that cortisol down, especially if the ACTH stim post number is actually 16 ug/dl.

A couple of questions I have are: do you have prednsione on hand? And, since Poppy's vet is absent right now, is there another vet or emergency clinic lined up for Poppy?

If no is an answer to any one of those questions, then if this were me, I would not give any Lysodren.

Hugs, Lori

[Poppy'sDad]

Hi Lori,

Yes to both of your questions. I do have Pred on hand and there is an emergency provider I have made contact with. They couldn't make a recommendation based on not seeing him prior, but I did get his records to them so if he were to crash or start heading that way they could help if I need.
I couldn't bring myself to continue the loading dose of 1,000mg/day. His eating habit just changed so much from before load period, even though his post ACTH was 16.
I started Poppy on a Maintenance dose this morning. Gave half pill this morning and the other half tonight. I will do the same on Saturday to give him the 1,000 divided over a week.
Your post is kind of in line with how I felt. I didn't want to lose the load and do nothing. Nor did I want to continue to load with this mess of timing I am in with Holiday and Vet away. My thought is even if I can keep him at his current rate/level with the Maintenance dose, I can hopefully not lose the load thus far and if I have to mini load after my Vet gets back next week then that would be the plan.
I hope I made the right decision. I know based on his ACTH I should continue to load, even just for a few days, but I just wasn't comfortable.
Thanks to you and the others who have provided feedback and suggestions. It's nice to know so many folks on here have been through dealing with this horrible disease and stick with this to help others like me!

Greg

[molly muffin]

I think you are doing what you need to do in light of the situation with the holidays. Crud timing. I think the vets need to make sure that we are all aware of their schedules when they plan to be away before starting down the treatment road. It can be very nerve wrecking!!

For instance my vet wanted to raise the vetroyl level and then said she'd be away over Christmas and I was like, yeeeeaaa no. Just give me a refill, we'll stay where we are, retest when you get back and then decide what to do, but not when you're going to be away. I'd be a royal mess trying to do a lysodren load without the vet near. So, I think you have made an excellent choice in a rough situation.

Lets just get through the holidays and then see where we stand. Mini loads are better than losing it completely.

[Poppy'sDad]

Thanks Sharlene,
Just didn't know what else to do. Just hope I don't lose the load that he achieved even if not where he needs to get to. It's been a full week and two days, and he is still sleeping through the night (So Thankful for that!!) and no longer inhaling his food and crazily panting and begging for food. Trips outside are normal as is water intake. If I can hold that with the maintenance dose for now...that's all I could ask for.
Like you say is my short term goal right now. Get through the next 6 days and see where he is then. Get another ACTH with my Vet back in town and see if more loading is needed.
Fingers crossed.....Greg

[Harley PoMMom]

Greg, that sounds like a great plan, you're doing an excellent job!!

[Poppy'sDad]

Thanks Lori, hoping for the best!

I must add, regardless if Poppy loses load or not and how he does the next 6 days, I wouldn't have even had options if it were not for this forum and all of your input. Being "vetless" during this critical time could have been catastrophic as I now know. All of the input from you guys and the information that has been compiled on this site gives hope, comfort and ability to make more informed decisions to someone like me that is still trying to navigate this tricky disease. I know at 12 Poppy is up in his years, but living out a somewhat "normal" and comfortable life is what I owe him. He has given his all to make me and those around him happy, so at times like this it's my responsibility to step up for him. Without such a great place to come for help and a vet who may not be real strong in treating Cushings, the information I can bring to the conversations with her based on knowledge from you all is invaluable!

Can't thank you all enough for what you do. I'm amazed at some of the post counts below your names....truly a dedicated bunch of folks who really care about making a difference in the lives of our beloved pups! Wishing you all peace, health and happiness through this Holiday season and best of health to all the Cush pups on here!

[My sweet Ginger]

Greg, I'm in total agreement with your plan. That's exactly what I'd have done, trying to keep him where he is until you see the vet, do another ACTH and go from there.
With Lysodren you always have to weigh the consequences of under dosing and overdosing, only then the picture becomes very clear.
Poppy is a very lucky pup to have a dad like you.;)

I'm very bothered by your vet's actions from the get go but this latest action by her really threw me off. For her to leave you and Poppy all alone without providing with another vet while she's gone in the middle of a loading is just inconceivable to me. Especially with an instruction that says do a second loading for 10 days?:eek: She should've given you her phone number if anything else.
Her actions tell me a lot and going by those, she's far from experienced treating Cushings if you ask me. She scares me.

[Squirt's Mom]

This might be a good time to find another vet who knows a bit more about Cushing's and who will work with you better as a team. ;) Teach her to take off just when she is needed most! :D

I would have chosen differently than you but do understand your fear of losing the load, IF he is loaded. Since you have chosen to start maintenance, it needs to be given ONCE a day (not twice as with the load) spread out over a week's time. So he would get 2-4 doses a week, giving the full dose ONCE a day when given. ;)

And please, please, please keep a very close eye on him as always. I am so very glad the ER is close and that you have taken steps to ensure they are familiar with Poppy's history so far. Good job!

[Harley PoMMom]

Good catch on that maintenance dosing, Leslie!


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

Lysodren loading Instructions and related tips (http://www.k9cushings.com/forum/showthread.php?t=181)

The above quote is taken from our Resource section, for loading Poppy was given 1000 mg a day being split, right? If so, than the maintenance dose would be that 1000 mg divided and given throughout the week, so 250 mg could be given 4 times throughout the week or the dosing could be 500 mg being given twice a week.

Sure hope I am making sense and not confusing you more. :confused::eek:

Hugs, Lori

[Poppy'sDad]

Hey guys...Ok, just so I'm straight here.
His weight of 42 lbs or 19kg put him at 1,000mg per day to load. I was dosing his load, 500mg with breakfast and 500 with dinner. He has always eaten twice a day anyway.

So instead of giving him 250 twice a day, two days a week which is what I started; I should give him one dose of 500mg twice a week?

I thought I read that Maintenance could be divided both day and week, but I will change this immediately on his next dose. Saturday I will give him the whole 500mg at once instead of splitting it.

I do hear you on the vet switching thing. There is some history there though as my current vet really helped me years ago with my beloved Chocolate Lab that I ended up having to put down. A vet of many years really steered me wrong and probably cost him his life, and I met her during that time and she really made a difference toward the end of his days and I always remembered that. I have no problem having very candid conversation with her, which will take place next week. But I do understand NOW that another 9-10 days of load was bad news! Truthfully, I think I was not getting proper information from the office as I did find out yesterday that there is another vet that would take her emergencies. Problem is, I DO NOT have ANY confidence in that vet as I know people who have not had the best of experiences there. I would rather go to the ER with Poppy if something were to go wrong than the vet that is covering. Enough of that though...just going to stay positive here and hope for the best.

Thank you for the information on the Maintenance dose...I must have read it wrong initially. No more splitting the daily dose!

Greg

[Squirt's Mom]

Hi Greg,

The maintenance dose is the same amount as the loading dose, just spread out over a week's time. So at 1000mg per DAY for the load, Poppy would get 1000mg per WEEK given 2-4 times a week, NOT once a week. You could give 250mg on Mon, Wed, Fri and Sat to make it easy to divide. Or you could try 500mg on Mon and Thurs. Just as long as he gets 1000mg per WEEK in several doses.

[Poppy'sDad]

Ok...Thanks. My plan was to do Tuesdays and Saturdays just to keep it spaced as evenly as I could for the weekly dose.

Is there any data that favors the two day maint. dose over a four day? I know every dog and situation is probably different, but just wondering if one method is favored over another.

[Harley PoMMom]

With the maintenance dosing, what you are trying to do is keep them adrenal glands from regenerating so fast, and every dog is different. This quote is from our Resource forum:
The maintenance phase of therapy, according to Dr. Feldman, "involves choosing a regimen and altering that regimen as required". It's not exactly the same for each and every dog

If a dog loads quickly, than that would have to be taken in consideration too when deciding a maintenance plan. Lysodren is known to cause some gastric issues, so that's another consideration to take in account; if the dog's tummy is sensitive to the Lysodren giving the maintenance dosing four times in a week rather than two could be easier on the tummy..oh also, giving Pepcid AC 20 -30 minutes before the Lysodren may help in preventing tummy upsets.

One question, Poppy is getting the Lysodren with some fat, right?

[Poppy'sDad]

Hello and Merry Christmas and Happy Holidays!
Yes, well, I think so. I give Poppy his pill wrapped in either a slice of cheese or lunch meat, then immediately feed his meal.
Not sure if that is proper or not???

[judymaggie]

Hi, Greg-the wrapping of the pill is good (cheese probably a better choice than meat as it is fattier) but you need to reverse the steps. You should feed Poppy first. Then, if there are no changes in eating habits, give him his pill. If you give the pill and then food and Poppy doesn't eat or stops eating before all is gone (or even a more subtle change such as looking away from food if he normally just gobbles everything up), you will have already given a dose when, in fact, he is loaded.
My Abbie is on Lysodren and I watched her like a hawk during loading. Like Sharlene said earlier, I kept Feldman's protocol very, very close.

[Squirt's Mom]

That procedure remains the same with maintenance, too. ;) Feed first, then give the pill. The reason being the same as Judi stated - to make sure there have been no changes with the appetite. A loss of appetite is a sign the cortisol may be going too low and once that pill is given it is very difficult if not impossible to get back. So always feed first and as long as the appetite is normal for Poppy, then give the med.

You are doing a great job of thinking to ask about things!

[Poppy'sDad]

Thank you!! I feel stupid now but that makes so much sense to feed first! I will reverse immediately.

Thanks to all for the continued help...I'd be lost without this forum!!!

Greg

[judymaggie]

Greg--absolutely no need to feel like you should have known what to do. If you spend some time reading posts, you will soon realize that many, many vets with years of experience have no clue what to do when faced with a Cushing's pup. We, as laypersons, are trying to follow detailed protocols with lots of technical terms. We would all be lost without the vast knowledge of those members who have learned from first-hand experience with their own dogs. Hang in there -- you absolutely did the right thing by double-checking!

[Poppy'sDad]

Hello all and Happy New Year.
Just wanted to update on where we are with Poppy. To refresh, I had gone to maintenance dose after Vet had gone on vacation and I was worried about continuing to load without ability to follow up with her quickly. After almost a week on Maintenance I starter seeing Poppy revert back to full blown Cush signs...we lost the progress from the Load!! Uggh..
Vet returned and saw us and we went on load again. Monday was 7th full day in and finally showed signs of being loaded, walking away from his food where normally VORACIOUS, and sleeping longer periods at night for the last three nights. I gave last dose this morning; so he is scheduled for ACTH on Thursday morning. I have discussed with vet that I will have her inject, then I will take him home for the hour and bring back for the draw. I really want to rule out any Vet Anxiety playing into the test. He has gotten progressively worse from an anxiety standpoint the last couple of times he has been there so she agreed. He's much better when I'm there and of course when we leave together and he doesn't have to stay behind. We live only a few miles from Vet so all should be good.
I'm a little worried tonight as I got a call from home that he wouldn't eat his dinner. I'm leaving work shortly so I will see how he's doing when I get there. No more meds, so his last dose was about 4:30am this morning. Hoping he doesn't slide off, he seemed fine when I left today.
I will update further once I get results back or if things change, but praying for good numbers Thursday so we can scale back the Lyso.....I do have Pred on hand and my Vet's cell phone if he looks like he is not himself, so hopefully I have everything covered this time! So much regret the bad timing now...wish I could take the first load period back but....looking ahead and trying to stay positive. if anyone sees something I'm missing or should be looking out for in the next 40+ hours prior to test please let me know.

Greg

[Squirt's Mom]

Watch him VERY carefully the next few hours. The Lyso should have been stopped Mon when you saw changes in his appetite. Do you have pred? Do you have an ER nearby or is your vet on call 24/7? He may be fine but the report from home this evening is not encouraging. Please let us know when you can!

[Poppy'sDad]

OK. Still had about half of his kibble in bowl from dinner. He was still hanging in kitchen as usual waiting for a scrap to hit the floor while food was being prepared. I put a little chicken in his bowl and he devoured it along with the kibble that was left. He also is drinking, maybe a touch more than normal, but with the wood stove going it is warm in the house. He does jump up and tail wagging when he saw me go in to fridge when I grabbed a small slice of the cheese he had been getting his meds with. Gulped that down quickly as well.
Only thing I notice is a very slight tremble. Not noticeable all the time, but I did notice it a few times. Otherwise, he is a little quieter than he has been, but nothing drastic.
To answer questions above, yes, I do have Pred on hand. I have Vet's cell and she said to call whenever I needed to. There is also a large ER, about twenty minutes away.
I do hear you on the Monday dose. I was torn but last month during the first load he showed all sign of being loaded, walking away from food, sleeping entire night without asking to go out, and these were drastic changes from many months prior. He did this for a few feedings after meds were stopped even. I was shocked when his ACTH post came back at 16. Yesterday at dinner was his first hint of not gorging his meal. Walked away but went right back and finished.
How would the Pred effect his ACTH if we had to give it to him? Again, not sure right now exactly what to do, but not sure what is the real sign there is a problem of overload. It's been about 16 hours since his last dose, would I be seeing something more severe?
Kind of on edge and torn about making the call to Vet to administer Pred.

[molly muffin]

An overdose causing cortisol to go too low, you will see, not drinking, not eating, possible vomiting, diarrhea, wobbly, can't stand. Some or all of those would be a definite administer pred signal and notify the vet.
If he is still interested in food, still drinking, not wobbly, poops normal, then you are still okay. You'll just want to watch him till time for the test to make sure he remains okay. Cortisol can continue to drop for 48 hours after last dose of lysodren.
He sounds like he is fine right now, so just keep an eye on him.

[Poppy'sDad]

Thank you Sharlene,
Good to know that it can continue to drop. I will keep a close eye on him. Thinking I will stay home with him tomorrow just to play it safe. Just really nervous and hoping I don't mess the poor little guy up. He's gone through enough already and it would crush me if he crashed due to the meds.

[molly muffin]

Loading is one of those things that can drive a person insane, as no one wants a crash and you watch every little thing and always worry about the worse possible. The good news is that so far so good. So, we are hoping this is a successful load and then can sail right into maintenance and put this phase behind you.
You're doing great.

[labblab]

Also want to let you know that prednisone will skew the results of the ACTH testing. So if you should need to give prednisone, you have to wait for at least 24 hours before proceeding with testing. For this reason, you do not want to give prednisone unless a dog is obviously suffering which does not sound to be the case right now.

Marianne

[Squirt's Mom]

Based on descriptions from last nite, Poppy's cortisol was not too low! :D How is he this morning? That last dose will continue to work for about 48 hours so if you don't see any problems today, I would think there won't be any. I hope he is loaded this time as he sure is giving indications he is.

And you haven't "messed him up". As Sharlene said, this is the most nerve-wracking part, walking a tight rope between making sure they *are* loaded and not over-dosed. BUT once this part is over, it is usually smooth sailing from then on with the treatment. So no guilt, ok? ;)

[Poppy'sDad]

Sad to report Poppy crashed last night. Between 9 and midnight he went downhill, wobbly on his feet, dry heaved a couple of times, seemed very uncomfortable and couldn't rest peacefully, weakened state when trying to climb few steps from outside. He was trembling more noticeably and very much not himself. Called vet and she gave the go ahead to dose Pred. He was still drinking and would take a treat, so she didn't think he needed ER care, but we gave him 5mg at midnight and another 5mg this am at 6am.
He finally settled down around 1 am and slept soundly until about 4:30am. I took him outside and he peed, came in and drank some water and went back to his bed.
At first he didn't want breakfast at 6, but when I gave him the pred wrapped in a piece of ham he gobbled it. I cut up some chicken and put it with his kibble and he ate some more, not all of it, but most of it and did drink water. He went out again around 6:30, peed and was struggling to poop. Only a little but vey soft.
He seems much more peaceful now, sleeping in his bed. Been in close contact with Vet. We are staying on schedule for tomorrow morning appointment. If he stays OK today then we should be good to do ACTH if no more Pred? Going to chek back with her around noon to see how he is then and might bring him in to check his electrolytes. He did drink a few times so hoping he is ok.
Running on about 2 hours of broken sleep so I'm a bit off myself, but watching him like a hawk now and really bummed!!!

[Squirt's Mom]

Oh me....I was hoping based on his behavior last nite that he would be alright. You did good to give the pred and contact the vet. Let us know how he's doing thru the day and what the vet has to say. Hang in there!

[Poppy'sDad]

Well, the Lil Ol' Man did good all day! So great to see his little hairless tail wagging again. Last night was the first time it ever stopped, he was not a happy boy. Slept peacefully most of the day, able to get up on his own, went outside a few times and did his business, all good. Walking good, eating his kibble if mixed with a little chicken (I think he has me pegged now:)). Drinking OK, again, not a lot but a few times throughout the day when he was up and about. I did not give another Pred this evening as he is doing fine so we should be all set for ACTH in the morning. His second pred
was 6am and test is tomorrow at 9am.
Now all we need are good numbers so we can move forward. Really hoping we don't need to continue on with loading, now I really see what can happen when things go downhill with that crash....scary stuff for sure. So glad he responded to the two doses of Pred, thinking we caught him just in time.

[Dixie'sMom]

I'm so glad that everything turned out ok. I know it was scary for you - it was scary for me reading it! :) I hope tomorrow goes well and his ACTH shows good numbers. Please let us know how he is doing after his vet visit. (He may be jacked up afterwards!)

[molly muffin]

Oh my goodness. I went to bed and missed all this last night. :( So hoped that wouldn't happen, but glad to hear that the pred fixed him up and his electrolytes don't seem to be off. Keep an eye on him through tonight, just in case.
I don't think you need to be worried about him not being loaded this time. He definitely loaded and then some.
You did good though, real good. You knew what to watch out for and what to do if you saw any of the signals and was able to address it immediately.
Prompt action is key with a crash and you did all the right steps as soon as you saw the signs.
Hope tonight is calm and you both get some much needed rest and are bright and chipper for in the morning's test.

[Squirt's Mom]

How is Poppy today?

[judymaggie]

I hope Poppy had a good night and that ACTH can proceed as planned. My Abbie is on Lysodren and it really was a relief when loading was over. Fingers crossed for good numbers!

[Poppy'sDad]

He did good throughout the night so didn't need another Pred dose...ACTH went off as planned this morning. He didn't gobble his food this am but he did eat some and took water so he was hanging in there. While at the Vet I was telling her about his difficulty breathing during his crash, couldn't rest his head on his chin like he does most often. Almost like his air flow was getting cut off. We decided to take a quick radiograph and low and behold, he has a nodule either right next to or on his trachea:( Now it makes sense as he was really struggling during the episode and seemed to panic him. Not the bit of news I thought would come out of today's visit for sure. Just going to take one step at a time and wait on the ACTH results hopefully tomorrow and go from there. Can't even process the x-ray right now, just really need this loading to be done with.
Very strange though, I think someone mentioned that after the ACTH he would be jacked up, but just the opposite. When we got home he was really sluggish and just wanted to sleep. Is that normal? Wondering if he is still on the back end of the crash, but before the test he was much more himself. No other signs like the other night, but definitely was really subdued.
His electrolytes were good when we went, so looked like not dosing the pred again yesterday was the right thing to do. I was just glad to get the test in as planned.
I didn't leave him for the test, just brought him in for the exam, x-ray and injection then brought him back in the hour. He was much better (no anxiety) and hopefully this proves out accurate results. Don't want to say it, but I don't know what I'm going to do if his numbers aren't in range. These last 48 hours put a hurtin on him and me! Wish I had that first load as a do over with my vet not going away, I just know a mini load would have done the trick, but....can't go backwards so won't dwell on it. I just dread the thought of having to continue load right now....fingers crossed!

[Poppy'sDad]

Oh..one more thing. Poppy's blood pressure was elevated at his visit. Gushing blood from the first draw site cough us off guard! Is high BP to be expected? Could it have been just the visit anxiety? Not remembering him ever having high BP before.
Other thing I don't think I've mentioned in the past, Poppy's carpal ligaments are completely stretched. He actually walks at the second joint on his leg as opposed to his wrist. This just happened in the last few months. Vet said it's indicative of long term Cushings. Anyone hear of or experience this? I know it happens in puppies, and maybe it's just his age?

[Poppy'sDad]

Numbers are in....

Pre- 1.8

Post- 2.1

Poppy is LOADED:D

[Harley PoMMom]

Woot Woot!!!! Good job!!! Now on to the maintenance phase, when did the vet say that should start?

Oh and that high blood pressure, it is known that dogs can have what is called as "white coat syndrome" where their BP is high at the vet's office but not at home. I would keep checking Poppy's BP at the vets, the vet should take 3 readings in a row and average it out. Also, some dogs may feel more comfortable getting their BP taken on a certain leg, the vet may even take the dog's BP in the pet parents car, the point is you want to make the dog feel as comfortable as you can, which can be difficult.

[Squirt's Mom]

:cool::cool::cool: WOOHOO! :cool::cool::cool:

[molly muffin]

So glad to hear this!!! Yippeeee!

[judymaggie]

Great news! :D Now you can take a deep breath and cruise into maintenance.

[Poppy'sDad]

Thanks everyone....so relieved. And seriously, thank you all who invest so much time in sharing your knowledge and helping those (Like me!) who really need it, especially when things go bad! Had it not been for this forum and the ability to read so many real time-real life experiences and reach out for advice and suggestions I would not have know what to do when Poppy crashed, and things could have gone much worse. To be able to have candid, knowledgeable conversations with my vet and know what to ask, what to demand, what to look for, etc has been invaluable!
Hats off and a huge Thank You for everything you do. I was on information overload before finding this site, and once able to read different experiences and see your replies, questions, and the information you share made it all click on so many levels.
I wish I could have found you all more than a year ago when I first started expecting Cushings based on Poppy's signs. When I read a lot of the new folks' posts and follow along it just paints such a clear picture now.
But, now we are here and looks like we are ready to settle down a bit and hopefully provide Poppy with a suitable care plan and happier days to come. Today happens to be my birthday and once the vet tech read me the report over the phone it was the best gift I could have hoped for today!
Stopping by the Vet on the way home and meeting briefly to discuss plan going forward. I'm sure it will be the 1000mg per week for maintenance, just not sure how we should split it up just yet and when to start. He isn't devouring his kibble still, and as I know that's a good thing, I'm just not used to it as he has been in super-Cush mode for so long! Of course he gladly chows down when I add some chicken to his dish, so hopefully we can reach common ground there!:)
Any suggestions for a Smooth transition into Lyso maintenance? His last dose was Tuesday morning at 500mg. I really am so used to getting up every 2 hours and dealing with a crazy pup that last night was actually strange! I woke in a panic at 5am after going to bed at 10:30 thinking something was wrong!
Thanks again to all!:D

[judymaggie]

Happy Birthday!! :D I can think of a couple of options re when to start maintenance: 1) you could give him 500 mg. tomorrow to equal his weekly dose of 1000 mg. or 2) since Poppy's numbers were at the lower end of the acceptable range, you could wait until next week. You could dose twice a week, say Mondays and Thursdays, with 500 mg. each of those mornings. Dosing is going to depend somewhat on the ease of splitting the pills. I liked the twice a week dosing as it gave me some flexibility to change days if necessary, i.e., move the Thursday dose to Friday. Abbie's numbers on her one month ACTH were too high so she is now on a higher dose and is getting her meds Monday, Wednesday and Friday. Keep in mind that you will still need to be looking for reactions but it is less stressful.

[Harley PoMMom]

I'm being lazy here and haven't looked to see what dosage of Lysodren Poppy loaded on, can you tell us that? Thanks! And was this the dose that Poppy crashed on too?

[Poppy'sDad]

Poppy's loading dose was 1000mg per day; 500mg with breakfast and 500mg with dinner. Poppy crashed after the 7th day at this dose.
Again, to recap, this was not the initial loading. The first load attempt was before Christmas, and after 10 days his post ACTH was still 16. Due to bad timing and vet going away, and Poppy showing strong signs of being loaded even though results showed not, instead of continuing a load due to vet being gone, we went to maintenance dose of 1000mg per week hoping to not lose the load but not risk a crash.,...I know...all bad, but that was what was done at the time. When vet returned we ramped back up to load dose and led to where we are today.
Plan is to start maintenance Monday, giving 500mg in morning and again, 500mg on Thursday.
Right now Poppy is probably still on the low side. He is not overly hungry, but will eat his kibble if some chicken is mixed in. Definitely on the lazy side, but that was normal for him prior to Cushings. Drinking OK and finally sleeping through the night which has been such a drastic change!

[Harley PoMMom]

Usually the maintenance dosing doesn't begin until a week after the ACTH stim test shows that the dog is loaded. I'm concerned if the maintenance dose is started on this Monday that the Lysodren will continue to erode the adrenal cortex and Poppy's cortisol will drop too low.

If this were me I would wait until the 14th or 15th to start the maintenance regimen and than after a few weeks on this maintenance dose I would then have another ACTH stim test done to make sure that Poppy is in the therapeutic ranges...this is just my opinion and hopefully the others will give their advice as well.

Hugs, Lori

[My sweet Ginger]

I agree with Lori since his pre and post numbers are on the low end of the range.

[Poppy'sDad]

Thanks guys, I'm glad you chimed in. I actually left a message for my Vet to discuss delaying starting maintenance. He is really really not himself. Very weak in the legs, very inactive and not eating too much, well, at least not if I don't add some enticement to his kibble. Even at that, he will eat the chicken mostly and leave kibble in his dish. I'm so used to Poppy being so ravenous and actually inhaling food that I'm really kind of worried. I know this is more like he was in his pre-cushing days, but now I'm really thinking how long he must have been into this illness. He hasn't displayed "normal" or anything close to today's eating habits for at least two years.
He started to exhibit some of the trembling, although just a few times and slight, that he was when he crashed. I was almost ready to give him a Prednisone, but it stopped fairly quickly.
Not sure if he is just still really low? I know after the first load attempt back before Christmas he seemed to stay "good" for over a week after his last load dose. I really agree and feel that I shouldn't start the 1,000mg/ week just yet.

[judymaggie]

Hi -- I am thinking that your instincts about giving Poppy an emergency dose of prednisone are correct. It might give him just enough "oomph" to get him over this current hurdle. I will let others with more experience in this regard chime in. I totally agree that you shouldn't give him any Lysodren until he is feeling better.

[My sweet Ginger]

I wouldn't either right now. My Ginger showed all those you listed after her 3rd loading leaving only kibble in her bowl etc, and she hasn't had another Lysodren since then which was Nov. of 2013. Within the normal range he should be doing better than what you are describing. I tend to agree you give him a rescue dose prednisone (I think it comes to about 5mg for his weight) and see if he perks up. He may just need a break from Lyso for a short time and can move on to maintenance phase without further complications.

[Harley PoMMom]

Although Poppy's stim numbers are great it could be that he needs his numbers to run just a tad higher. Those stim numbers are really just a "guide" the most important thing is how the dog is feeling. All dogs are different and can react very differently to the same drug, this is true with the ACTH stim numbers, that post of 2.1 ug/dl is an ideal post number but for Poppy it may need to around 3 ug/dl.

How are Poppy's stools? Is he drinking normally?

[Poppy'sDad]

Thanks Lori,
That makes sense. His stools are definitely on the soft side. Sometimes he struggles and struggles to go but nothing. He is drinking when he gets up and moves about, but that's what has me most worried. He is really struggling in his back legs to get up. I don't know if it's from laying around so much or if the sudden drop in his Cortisol has him feeling his aches and pains?
He is eating his "chicken enhanced" kibble, but will leave some behind once chicken is gone.
I'm so used to him being so Jacked up that it's hard to say what's actually going on with him. He was always pretty much a couch potato prior to about 2 years ago when things started to change, but he really just wants to lay around. Have to really prompt him to get up to go out or come for a treat.
I ended up giving him 5mg of Pred yesterday afternoon after Vet called me back. Didn't like the trembling he was showing again a few times. By late evening he was looking more perky and no more signs of trembling, and ate dinner good.

[Harley PoMMom]

You did good with giving him the prednisone, kudos to you for being on top of things ;) In my opinion, since he did perk up with the prednisone he probably does need his cortisol to run a bit higher, and yes, some dogs do go through what's known as cortisol withdrawal. Also, that excess cortisol running through their body can mask arthritic symptoms and when the cortisol has dropped the dog will show signs of the arthritis.

Soft stools worry me when a dog is on treatment for Cushing's so hopefully letting his cortisol increase a bit more will help.

You're doing a fantastic job!!!

Hugs, Lori

[Poppy'sDad]

Thanks...having you guys along for the ride definitely make this much less confusing and nerve wracking! Your comment about arthritis does make some sense. Seems like it really bothers him and until he's up and walking a bit he kind of seems like he's hurting and stiff. Weird though, before the crash episode he would jump up and think nothing of it.
Question: does Poppy's loose stools indicate something of a concern?
I'm really freaked out about starting up the Maintenance dosing for him. A week after last load dose would be this Thursday morning, but....really don't want to do the wrong thing here!:confused:

[Harley PoMMom]

Loose stools are always a concern to me, now, it could just mean that his system has to get used to the Lysodren. One of the reason for spreading out the maintenance dose over a week is to help with that tummy upset. Since you are going into the maintenance mode, which is giving the Lysodren 2 or 3 days in a week, you can better monitor him. Remember feed first than give the Lysodren, if it seems that he is not acting himself or his appetite is off than I wouldn't give him the Lysodren and would probably have his cortisol tested to make sure that it isn't too low.

Hugs, Lori

[judymaggie]

Greg -- if I am tracking your thread correctly, Poppy's last Lysodren dose was on the 8th. If you started seeing soft stools on the 11th or 12th, I am leaning towards thinking this was not related to the Lysodren, especially since you didn't see soft stools at all during his recent loading. Is there anything else that is different? Was he getting chicken in his kibble all along? A new treat? If this started after you gave him the prednisone, that might be the cause.

What did the vet have to say about his rear leg weakness and soft stools? When is he recommending that you start maintenance in light of these symptoms?

My Abbie has had chronic, periodic loose stools/diarrhea since I adopted her. Since I started her on pepcid AC before her meals and metronidazole after meals, she has had firm stools. You might want to ask your vet about trying the metronidazole. You can get the pepcid AC yourself -- I buy the generic in a bottle and it is really inexpensive. If you are going to start the metronidazole, I would recommend that you do so before you start maintenance just so you don't introduce two new things at the same time.

[Poppy'sDad]

OK..let me see if I can get myself straight here. First load attempt was back before Christmas. No signs of loose stool or significant appetite changes after ten days on Lyso. ACTH was still 16 at post. Vet went away, I panicked and stopped the load and went to maintenance. Quickly reverted back to inhaling food and again, no loose stools.
This go round, once we went back to load dose after morning dose of 7th day (January 6th), he crashed. Gave him Pred once that night, and again following day. Still went ahead with ACTH Thursday the 8th because it was 48 hours after last load dose, and it had been 24 since Pred. Post ACTH was 2.1.
Loose stools showed up morning of the crash. So, it was before Pred and before he started with the chicken. Truthfully, this dog was eating EVERYTHING he could get ahold of (and I mean EVERYTHING!) during his super cush mode and never really had stomach issues. The noticeable stool change really seems to be coinciding with the low cortisol, right around when he crashed. He has had maybe one normal stool since, but most of the time very soft and struggles to go. Like he's constipated almost.
Direct link though, when I gave him Pred he got up much easier and didn't exhibit the weakness, stiffness, etc in his back legs. Vet thinks still feeling effects of going so low form being so high for so long. I don't remember if I told her of the loose stools, we only spoke briefly yesterday about administering another Pred. I will touch base wit h her again when I get out of work and wee how he's doing.

[judymaggie]

Just throwing one other thought out there--Abbie has arthritis in her back knees. During a recent stretch of humid weather I noticed that Abbie had difficulty squatting long enough to finish pooping. She would slowly get up with poop still coming out. (Sorry for the visual ...:rolleyes:). It looked like she was straining. Wondering if Poppy's back leg issues are complicating poop issues.

Let us know what the vet says.

[Poppy'sDad]

Quick update on my "Ol' Man". Today he is is acting much more like himself. Actually ate his entire bowl of kibble, (though a little laced with some gravy), but ate the entire bowl. He hasn't done that since before the load dose and subsequent crash. He has perked up, tail wagging and more "up and at em" kind of attitude. Stools have returned somewhat to normal, but still a soft one mixed in here and there with sign of constipation. Still sleeping all night and not asking to go out at all until I wake, which has been a HUGE relief!
But, his aches and pains continue to be problematic. Now instead of just his back legs, he will limp and hobble a bit in his front right as well when he gets up after laying for a while. It's so crazy, it's like he has full blown arthritis all of the sudden. Must have really been masked by the high Cortisol levels. Vet wanted me to start him on some supplements (glucosamine/chondroitin). She prescribed an NSAID for when he really needs it, but I'm going to try the supplement route in hopes he responds. As loose stools are improving without any diet changes, we are thinking it was related to the Lysodren crash. As we get further away from that day he seems to improve each day. If he remains as he is today, the plan is to start the Maintenance Thursday. Today is actually 7 days since his last dose and again, best day he has had so far.

[Harley PoMMom]

Glad to hear that his appetite has picked up, and unfortunately that excess cortisol can mask the symptoms of arthritis. From what I have read the glucosamine/chondroitin are two supplements that are usually given for dogs with arthritis, another medication that some members have used is called Adequan, which is an injectable medication.

As far as the NSAIDs, Rimadyl is one that I'm not fond of because it can cause liver damage in some dogs. I have used Tramadol in the past for my dogs and it has helped.

[molly muffin]

Tramadol is generally used for cush pups for the reason Lori mentioned, not as hard on the liver. Can make them lethargic though, so you want to be careful with the dosage and only use as needed.

Glad the appetite is back, that is a good sign.

[judymaggie]

So glad that Poppy is doing better! Just wanted to add re tramadol--it will help with pain but not with inflammation as it is not an nsaid (like rimadyl or deramaxx). My Maggie (also a Cushing's pup) had good results with Adequan injections. It is usually given as a series of three, a month apart, and then a booster shot once a year. Glucosamine/chondroitin supplements can be helpful but results can take a long time and you might want to give Poppy more immediate relief.