My boy Oscar may have Cushings (Oscar has passed)

[rexifer]

I'm so glad I found this forum. Since I began the process of getting a definite diagnosis for my Dachshund "Oscar" five days ago and I have been a mess! I didn't know how I was going to get through this but just knowing there are others who have been where I am is comforting.
Oscar is a nine year old Dachshund whose blood work at his last check up a year ago was completely normal. About 2 months ago I began to notice excessive water drinking and urinating and trouble jumping up onto the sofa. A trip last Wednesday to the vet for blood tests revealed high liver enzymes and an indication that his gallbladder may not be functioning properly. He had an ultrasound Thursday. Tomorrow I will get the results of the ultrasound and urinalysis and culture. I am sure it's Cushing's. Can you walk me through what to expect next?
What questions to ask? Anything you can tell me would be appreciated. Thank You.

[Harley PoMMom]

Hi and welcome to you and Oscar!

We are so glad you found us, too, and we will help in any way we can, so now...Deep Breaths...in..out..in...out;) One thing I want you to know is that Cushing's is a treatable disease but success in treatment does depend on keen owner observation along with a vet/IMS that is experienced with treating Cushing's and knowledgeable about the proper protocols for Cushing's.

Cushing's is a slow progressing disease which gives a pet parent time to get a confirmed diagnosis for it. Cushing's can be difficult to diagnose and, unfortunately, it is often misdiagnosed. Many of the symptoms associated with Cushing's are shared by other non-adrenal illnesses such as a thyroid problem, liver disease or diabetes. Since there is not one test that is 100% accurate at diagnosing Cushing's a vet needs to perform multiple tests to validate a Cushing's diagnosis.

If you could get copies of all the tests that were done on Oscar and post any abnormal levels listed along with the reference ranges and units of measurement that would be great, i.e...ALT 150 U/L (5-50)...Thanks! We are especially interested in the results of the tests used to diagnose Oscar's Cushing's. The two diagnostic tests generally used for Cushing's are the ACTH stimulation, and the low dexamethasone suppression test (LDDS), did Oscar's vet perform any of these? When you do get the results for the ultrasound, urinalysis and culture, please do post those findings for us...Thanks!!

The two drugs generally prescribed for Cushing's are Lysodren/Mitotane and Trilostane/Vetoryl. These are very strong medications but are life savers for our dogs with Cushing's, however, they should not be started until a diagnosis of Cushing's is confirmed. As for deciding which medication to use, it depends on the vets knowledge, experience and familiarity with the drug s/he uses, how comfortable the pet owner is with the treatment plan, and the dog's general health. Vetoryl/Trilostane is no safer than Lysodren/Mitotane, and vice versa. Adverse effects usually only happen when the proper protocols are not followed.

So, lets get a confirmed diagnosis first and if this does turn out to be Cushing's, you will do fine, we will walk you through this journey, ok ;)

Hugs, Lori

PS: to get your started on your Cushing's education :D

Links to Cushings Websites (especially helpful for new members!) (http://www.k9cushings.com/forum/showthread.php?t=180)

Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185)

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

How to Interpret Tests for Canine Hyperadrenocorticism (Herrtage, Mooney, Bruyette) (http://www.k9cushings.com/forum/showthread.php?t=227)

[rexifer]

Thank you so much! I hope to get all that info from my vet tomorrow and discuss the next step which I suppose will be one or more of the tests you mentioned.I will post all the information when I get it. Meanwhile I will look at the links you sent and continue to educate myself.

[Dixie'sMom]

Hello and welcome to you and Oscar! I have a doxie myself who is 6 years old and I was also a mess when they told me they suspected Cushing's. The folks on this forum helped me get my head together and my nerves calmed, and guided me through the process of testing, diagnosis, treatment, etc. As a result, my little girl has been on medication since September and is doing very well. Their experience was invaluable to me..

You are doing the right thing by seeking guidance and educating yourself. The most confusing thing about this journey is that the vets themselves often aren't up on current protocol and treatment so its great to have the voices of experience chime in with their thoughts and suggestions.

Again, welcome and I look forward to getting to know you and Oscar. :)

[rexifer]

Thank you, thank you. I spoke with the vet today re: his ultra sound. She said everything, liver, gall bladder etc was normal except for his adrenal glands. Both were enlarged, one more than the other which leads her to suspect Cushing's. His urine sample and culture were normal as well.Tomorrow we will do the LDDS test which we both suspect will give us a positive diagnosis. They will also be giving me printed info and instructions about medicine ( Mitotane) administration. She was very informative and explained things. I will ask for a printout of his blood test levels and ultrasound results. I have started a file for all his medical stuff. I will post when I get them and know more.
Actually, now that I have a plan and I've seen so many success stories on this website I am feeling better. So glad you little guy is doing well.

[molly muffin]

Hello and welcome to the forum. If you are starting miotane, then print out the lysodren loading instructions. Most people have those in the kitchen and refer to it constantly. It is definitely the go to for loading.

Welcome again!

[rexifer]

Hello everyone,
Just dropped Oscar off at the vet's for his suppression test. They also gave me loading instructions for the Mitotane. After reading them I am scared to death I will miss the signs of when to stop the meds. How vigilant do I need to be?

Here are the results of the abnormal values of his blood test:

ALP-1685, normal 5-160
ALT- 382, normal 18-21
GGT-66, normal 0-13
Lymphocyte- 787, normal 1060-4950
Eosinophil-14, normal 70-1490
Urinalysis showed slight trace of blood

I should have the results of the suppression test tomorrow.

Thanks everyone

[Squirt's Mom]

Liver and gall bladder looked normal on the ultrasound?

Signs of loading can be very subtle. It can be as subtle as the dog looking up from their feed bowl when before they would not have. It can be eating more slowly instead of inhaling the food. There is a water log chart in the Everything Else section where you can log the amount of water intake daily. A drop in water consumption is a sign of loading. (Use the "search" feature above to find the chart in EE.) Watch your baby carefully for a few days prior to starting the load if you are not familiar with how he eats so you can tell a difference. Do NOT start the load until your vet is done with the Holiday travels so they will be on hand the whole time. ;)

Annnnd, your new family here will be right by your side the whole way. You are going to do just fine, I know. This sounds much scarier than it typically turns out to be. The key is to know what to look for and to be diligent in observing Oscar.

Hugs,
Leslie and the gang

[rexifer]

I feel better now, thanks. Yes, liver and gallbladder were normal thankfully.
I was wondering about starting the medicine during the holidays for just the reasons you mentioned. The vet said they like you to start the meds on a Sunday with a follow up visit scheduled in 9 days. That would mean starting meds the week of New Years which concerns me. I will talk to the vet about it.

[labblab]

Starting New Year's week would concern me, too, because there is no telling how many days it will actually take Oscar to load -- he could be done and need testing in far less than nine days. If it were me, I would definitely wait until January to begin the load.

Marianne

[rexifer]

That is what I was thinking too.
Do you know if it's OK to give him his regular exercise ( walk ) while he ' s loading?

[Harley PoMMom]

Do you know if it's OK to give him his regular exercise ( walk ) while he ' s loading?

Yes, walking him will be fine. What you don't want to do is change any thing in his diet right now; no different food, treats, supplements..etc The reason for this is because anything new brought into his system could cause some upset and if you are in the process of loading him you won't know if its the Lysodren/Mitotane or "new thing" that's causing the upset.

I agree with the others in waiting until January to start the load, and yes, we will be here for you and Oscar, we are some of the best hand holders! ;)

Hugs, Lori

[rexifer]

I have merged your post into Oscar'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!


Now I finally know my enemy's name, it's Cushing's! ( pituitary dependent).
If ignorance is bliss then knowledge is power and I am ready to wage against this horrible disease.
We will begin the loading phase on Monday, January 5th beginning with 1/4 tablet of Lysodren watching for any signs of decreased water consumption (my bet prefers a less is better approach even though it may take a little longer to reach the goal) when that happens we stop the meds and call the vet to arrange to test his cortisol levels.
The vet will call each day to check on progress.Friday I will pick up the Lysodren and the Prednisone and continue to educate myself on what to expect. Meanwhile , Oscar is doing OK, maybe just a little tired from all the vet visits and tests and my drama. Right now he is sleeping wrapped in the flannel jacket I bought him for Christmas.
Merry Christmas to all ( human and canine )

[Harley PoMMom]

How much does Oscar weigh? The thing with Lysodren it 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.

Not giving enough Lysodren than it may take forever to load. The usual loading protocol followed is administering Lysodren at a dosage of 50 mg/kg/day, divided and given BID (twice a day). This info plus more can be found in our Resource forum, here: Lysodren loading Instructions and related tips (http://www.k9cushings.com/forum/showthread.php?t=181)

Also, less water consumption may not be the best symptom to look for in loading, the appetite is better, if you would see a minute change in Oscar's appetite, say just leaving a few crumbs, or any hesitation in feeding at all, this is a sign that the loading phase may have been achieved.

Educating yourself is key in facing this disease, great job for wanting to do that, and yes you are 100% correct, knowledge is power. ;)

[rexifer]

Thanks for the information. Oscar weighs 16.5 lbs. To be fair, the printed instructions she gave me did say that food consumption was the key thing to look for but when I was talking to her she felt that because I had mentioned that excessive water consumption was the most glaring symptom that would be what I would notice most. I intend to watch for both and whichever I notice first I'll go with.
I think that the food consumption will be easier to judge than the water consumption.
She feels that even if it takes a little longer she would rather that happen than to overdose given the possible consequences. She has treated many Cushing's dogs and bases this on her experience she explained.
One nice thing about this vet hospital is that there are about 8 or 9 female vets all from the University of California at Davis veterinary school which I am fortunate to live close to. They have access to each other's knowledge and experience with Cushing's as well as the vet school itself. I am hoping this is the right plan.

[rexifer]

I picked up the Lysodren today from CVS pharmacy ( $6.60 per pill). The dose is 1/4 pill every 12 hours until we notice changes in his eating then stop meds and call the vet. I also picked up the Prednisone tablet.
I will begin on the 5th. Do you think I should take off from work to be with him while he is on meds? What have others done?

[Squirt's Mom]

Hope you and yours had a Blessed Holiday!

Ok, Oscar weighs 16.5 lbs. The loading dose is 50mg per kg per day divided in to two doses. So at 16.5 lbs Oscar weighs 7.5kg (16.5 / 2.2 = 7.5). So his loading dose would be 375mg per day divided AM and PM (7.5 x 50 = 375). And 375 / 2 = 187.5mg twice a day. A quarter of a Lyso pill (500mg) is 125mg. So at a 1/4 pill twice a day he will be getting 250mg per day. A little below optimal but shouldn't be an issue. These pills are hard to divide any other way without using a compounded version so we work with the dose that is the closest. Better to be a bit below than too high a dose for sure. ;)

Personally, I would have taken off work to be with mine during a load BUT I am known to be a bit nutty when it comes to my babies and nothing comes before them except my grandsons - no a job or boss. :p:o:D Thankfully, being on disability I didn't have to face that dilemma but many here have managed working and loading their pup. It would be good if you could come home at lunch or have someone to check on him throughout the day with detailed instructions on what to look for that would mean you need to come home. I would forewarn my boss that if something did happen during the load, I *would* be leaving to take my baby to the vet asap as it could be life-threatening. ;)

Keep in touch and let us know how things are going. Did you find the water log chart in Everything Else so you can monitor how much water he is drinking?

Hugs,
Leslie and the gang

[judymaggie]

Hi--my Abbie is on Lysodren. Just wanted to offer a couple of thoughts--if you are a member of Sam's or Costco, you might want to call them to check on Lysodren cost. I am sure it varies from region to region but I paid $5.60 a pill at Sam's here in Florida. Also, Target will match anyone's price and, if you join their pharmacy rewards program (free), you get a 5% off card after filling five prescriptions.
Other suggestion--you might want to start measuring daily water intake the week before you start the Lysodren. This will provide a baseline to use for comparison once you start loading.
I watched Abbie like a hawk during loading--fortunately, I am retired. If I was still working, I would have taken time off but I know that is not feasible for everyone. Leslie's suggestion of having someone come in to check on Oscar is a good one and may allow you to focus on work!

[rexifer]

I didn't look at the water chart yet but I will now with Christmas over. I am somewhat flexible in my work hours as is my husband so I've decided that one of us will be here during loading. I know that I would not be able to work if I knew Oscar was alone anyway.
We are having a rough time until we begin loading because he sleeps with us and we are having to get up ( we tag team) about every 2 hours to let him out to pee and then drink. It brings back memories of having a newborn in the house. As a result we are both sleep deprived and I'm getting headaches and triggering migraines. We've got another week of this. Anyone else ever had this issue?
Thanks for all the love!

[Dixie'sMom]

Quite a few folks here are/were sleep deprived because of the frequency of urination. That's a common problem for Cush parents. Hopefully, relief is in sight for you and the hubby and once Oscar is on his optimal dose of meds, you can all have a restful nights sleep every night :) That may also be one of the signs you watch for to see if he is loaded. Less water and longer duration between potty breaks. I'm glad you can work things out to where one of you will always be with him during loading. Good luck to you and I'll be watching to see how Oscar is doing.

[judymaggie]

Hi--I had a hard enough time with getting up once during the night, let alone every two hours! Also, I didn't have to get up at dawn for work. I am usually up by 7 and Abbie is not in a rush to get out of bed.

I hate to be the bearer of bad news but loading may, or may not, reduce the number of pee trips ... :( I did see a reduction in water intake within two days of loading but didn't really see less peeing. Abbie is now in her 6th week of maintenance and she wants out after every long nap and then I wake her up at 10:30 at night for her last pee. With this routine she has only woken up two nights to go out and has not had any accidents in the house. If I am going to be away from the house for several hours, I have someone come in and take her out. Abbie's ACTH numbers were too high at the one month mark and she now gets her maintenance dose three times a week. I am hoping that, when we get her on the correct dose for a long period of time, I will see a greater reduction in symptoms.

[rexifer]

Thanks,
It's good to know there is a light at the end of the tunnel. I will post when I start loading. I will gladly exchange sleep for his health any day. Thanks.

[rexifer]

Hi everyone,

I'm finally ready to start Oscar on his loadind stage with his Lysodren. We start Monday with 125mg every 12 hours. I quartered the pills today.
The vet wanted to wait until the holidays were over to begin the process so she would be available. She will call everyday to check on progress which is reassuring.
Part of the instructions say to start giving him only 2/3 of his usual food allowance beginning 1 to 2 days before loading and continue the reduced food during loading so I've made food packets for him containing 1/3 for morning and 1/3 for evening feeding. I thought it would be easier if I had it all pre measured and ready to go especially if my husband feeds him.
I think I've read the instructions so often I know them by heart.
Please send good thoughts our way on Monday as Oscar and I begin our journey.

[Squirt's Mom]

You're off to a great start, Mom! Way to go! :cool::cool::cool: We will be right here by your side the whole way. But as pre-prepared :p as you are I imagine everything is going to go smoothly and in a few weeks you are gonna feel like a real pro at this stuff. Oscar is lucky to have you on his team!

Hugs,
Leslie and the gang

[flynnandian]

i am curious what the reason is why he can only have 2/3 of his normal food allowance during the loading phase.
i have never heared of it before.
i wish you and oscar good luck with the lysodren loading!

[Harley PoMMom]

i am curious what the reason is why he can only have 2/3 of his normal food allowance during the loading phase.


It is believed that by doing this that the dog will most definitely have a ravenous appetite, which is true for most cush dogs, so any hesitation in feeding will be noticed right away.

This excerpt is from Chapter 118, Hyperadrenocorticism, from the Textbook of Veterinary Internal Medicine, S. J. Ettinger and E. C. Feldman, editors, 1995, page 1566: http://web.archive.org/web/200608150...eldman-all.pdf Edit/Delete Message


This decrease in food allotment should enhance the dog's excessive appetite and make it easier for the owner to monitor the pet.

[flynnandian]

ok, thank you for the explanation.

[rexifer]

I started loading this morning with Oscar's 1st pill at 7:O0 am. All was well until about 3:30pm. He had a huge drink of water, went outside to pee and then threw up a little liquid. I called the vet who said to monitor him closely and keep a log but since he has only had one dose it is hard to tell if it's related to the medicine or not. He seems fine in every other way. Normal bowel movement and energy. I am taking tomorrow off so I can be with him.
Anyone have any thoughts on this as I am already worried sick.

[Squirt's Mom]

Since this was the first pill I wouldn't think it would be the med but just to be safe I would not give the dose tonite and would wait to see how he is doing in the morning before starting up again. It may be he has a bug and will need time to get over that before starting the load.

[rexifer]

Thanks for your support. I'm in tears over here every time I look at him wishing I could explain things to him and hoping there are no more problems. If there is going to be a reaction to the medicine when is it most !likely to happen?

[rexifer]

Hi everyone,

I am on my 2nd day of loading and have a couple of questions those with more experience than I might be able to answer.

1. If there is going to be a reaction to the Lysodren when would it be most likely to occur?

2. He is to take the meds every 12 hrs. Would a half hour either way be problematic?

[Harley PoMMom]

I have merged your post intoOscar’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!

A reaction can happen at any time, are asking about an Addison's like reaction or something like a tummy ache?

Ideally Lysodren should be given 12 hours apart, but sometimes this just may not be feasible so I don't a problem giving the Lysodren an hour +/-.

[Squirt's Mom]

By reaction do you mean the change from the load or a crisis when the cortisol goes too low?

If you are talking changes that would mean he is loaded, that can happen anytime from day 2 to day 10 or longer. Most pups load in fewer than 10 days, some longer. You must watch Oscar closely for changes in water intake and appetite to gauge when he is loaded.

If you are talking a crisis, that can happen at any time, from the very first dose to a dose years from now. Again, the key is observing him and knowing when something is not quite right with him. But we don't anticipate a crisis. ;)

[rexifer]

Our 6th day of "loading" with Lysodren will begin tomorrow. He's had no ill effects from the drug, seems to tolerate it well. We still don't see any sign of the appetite decreasing, he's as ravenous as ever but one day soon we'll have breakthrough I hope.
He will have an ACTH test next week and we'll see where we're at with this.
Thank you, everyone, for you support through this rough time, it has saved my life to know I have a "family" I can turn to.
I will update after his test.

[Squirt's Mom]

Sounds good! Any changes in drinking? Keep a very close eye - the load could happen at any minute now and you do not want to continue giving the drug once you see that first indication he is loaded.

[rexifer]

We haven't had any change in drinking yet but we are watching very carefully. I tell him jokingly as he is inhaling his food that one day he will actually be able to take a breath between bites,chew his food and be able to taste it!

Question: some things I read say to wear gloves when handling Lysodren because it is cytotoxic. I always wash my hands thoroughly but do I really need towear gloves?

[judymaggie]

Hi -- just to be on the safe side, I wear gloves and a mask when breaking up the Lysodren tablets. This avoids any possible inhaling or absorption of the dust. I just break them all up at one time and then put them back in the bottle. I use tweezers to pull a dose out. I give Abbie her dose in the middle of a ball of canned food so can easily drop pill in the middle and cover it with food.

Does all this really matter? Not sure but it is easy to take these steps and rule out any contamination possibilities.

[rexifer]

Thanks,

Not a bad idea and I think it makes sense. I never thought about breathing it in.
I will be sure and pose that question to the vet.
I don't think the label says anything about protection either, maybe I will also ask the pharmacist,they probably know more about it anyway.
I will be wearing protection just in case though.

[rexifer]

I' m on day 7 of "loading" with no changes noted yet except today when he went to the bathroom his stool was softer than normal for him. It was formed but soft. He has only had one bowel movement today, not multiple ones yet. I' m wondering if this could be a normal side effect of the Lysodren or is this the beginning of a warning sign of too much medication and should I call the vet?
Any thoughts would be appreciated.

[Squirt's Mom]

I would stop and call the vet myself. Are you seeing any other signs of being loaded or over-dosed?

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about stool changes into Oscar’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!

[rexifer]

Thanks you,

That's exactly what I did. We have not seen any other signs, he is drinking as much as before and continues to eat like there's no tomorrow. His energy level is good and he seems !like he feels good. The only change is in the stools. He only went once today and once yesterday it was formed, but soft. I called the vet and she said that since he is not showing any other signs of illness , continue the meds and watch him very carefully and if he has vomiting, diarrhea , lethargy etc. to take him to emergency.
I scheduled an ACTH test for Monday and my gut instinct tells me to stop the meds until we get the results. Seems to me that soft stools are a precursor to diarrhea and I'm not going there.
Thoughts?

[My sweet Ginger]

On day 2, 3 or 4, maybe not but on day 7? I'd take the change in stool as one of the subtle changes of him being loaded just to be on the safe side as the drug works for 48hrs.

[rexifer]

That's what I thought. I'm hoping, will know Monday whether my instincts were correct.

[Squirt's Mom]

I'm with Song. If it were just the drug causing this I would expect it to have happened sooner in the load, not on day 7. We have to keep in mind that some pups never lose all the signs. Some never stop peeing a lot, some continue eating like pigs - BUT the cortisol is well within range on the ACTHs and other signs do improve. ;)

[rexifer]

Update:
I did not give him his pill last last. He had a bowel movement this am and it it much firmer that the day before so I think I made the right decision. I have also noticed a chance in his water drinking habits. For example, evertime he went outside he would stop to drink before he came in, today he does not always stop to drink but comes right in. I think these are positive signs. ACTH test tomorrow.

[Squirt's Mom]

I think so too! Let us know how things go tomorrow.

[rexifer]

Great news!

Got the results of the ACTH test he took yesterday and his levels are NORMAL!
I am so glad I stopped the meds when I did, sometimes all the medical advice in the world doesn't compare to your instincts about your "babies". Thanks for all the advice and support.I know this is not the end but only the beginning of the journey. He will be on 1/4 pill once a week for maintenance.
Question- the vet did not advise any follow up schedule only to say that if any symptoms come back we will have to do another test and maybe change the maintenance dose. Everything I read said that there is usually a follow up test at 1 month and then 3-4 months etc. Should I be doing follow up tests?

Here are his results:

Pre ACTH Cortisol-5.7 ug/DL. Normal 2-6

Post ACTH Cortisol- 6.9 ug/ DL Normal 6-8

[Squirt's Mom]

Yes, you will want one no later than the 30 day mark. Also, maintenance is typically given 2-4 times a week to lessen the chances of the adrenal glands regenerating, the signs coming back, and the pup needing to reload.

[rexifer]

After the 30 day test how often after that?

[labblab]

I don't believe I've had the chance to post to you before and I am sorry to be starting off on a sour note, but if your intention was to perform a normal Lysodren load, these ACTH results are too high.


Here are his results:

Pre ACTH Cortisol-5.7 ug/DL. Normal 2-6

Post ACTH Cortisol- 6.9 ug/ DL Normal 6-8

When loading a dog with Lysodren, the goal is to reach a therapeutic range that is lower than the diagnostic results that are expected for a normal dog who does not have Cushing's. The desired result for a dog treated with Lysodren is a pre and post result that are both between 1-5 ug/dl. So Oscar's cortisol is not yet as low as you would want it to be before starting maintenance, especially since Oscar is only going to receive a single maintenance dose each week which may permit his cortisol to rebound even more quickly.

Perhaps I am missing something here and you were not trying to achieve a conventional load? If you were, I'm afraid these results are not exactly where you would want them to be before proceeding on to maintenance. :o

Marianne

Edited to add: I am having one more "uh oh" moment by seeing that during the loading you were giving him two quarter pills a day, but now you are knocking back to only one quarter pill a week? Often, the weekly maintenance total matches the daily total that was given during loading unless the dog has fully loaded fairly quickly. So not only is he starting out with high ACTH values, but he will only be getting half the possible weekly maintenance dose? I am really afraid that you are going to lose any benefit from this partial loading very quickly!

[rexifer]

Thanks for your input. I understand what you are saying but according to the lab his levels are within the normal range they give. So are their normal ranges incorrect?

[labblab]

The confusing thing about the ACTH is that it serves a dual purpose. It is both a diagnostic test for Cushing's before treatment is ever begun, and it is also used as a monitoring test for treatment progress in dogs being given either Lysodren or Vetoryl (trilostane). The expected norms are different in each of those three circumstances, and fortunately many labs are now printing all three sets of norms underneath the results. However, some labs do not. And in that case, the "default" is the range that is used when the ACTH is being used as an initial diagnostic test to differentiate between dogs with Cushing's vs. dogs that do not have the disease at all. That appears to be the range you were given for Oscar's result (although the post range is a bit more constricted compared to the normal diagnostic ranges I am used to seeing).

If it were me, I would want to check back with the vet in order to see why she/he is satisfied with results that are higher than 5 ug/dL, and also to double-check the maintenance dose.

Marianne

[rexifer]

I will do just that. Where did you find the 5 ug/DL number?

[labblab]

I don't know whethet you have already been given this link, but these are the classic, textbook loading instructions published by Dr. Edward Feldman of U.C. Davis:

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

Here is the relevant quote:


The recommended target range for good control of the cortisol production is a result of 1-5 ug/dl for both the pre and post ACTH stimulation test numbers.

I'll also try to see if I can track down another member's lab results which lists all three of the relevant normal ranges, just so you can see them all in that format.

[labblab]

Actually, here's a resource that should be really helpful to you. It is a reference flowchart published by IDEXX labs. The first page shows the norms for the ACTH when it is used as a diagnostic test. The second page shows the 1-5 ug/dl range desired when monitoring Lysodren treatment.

Looking at this chart, I'll bet you have a typo in your posted "normal" post-ACTH range. Instead of 6-8 ug/dl, I'll bet it is actuslly listed as 6-18 ug/dl.

And just so you'll know, the ACTH is also used as a diagnostic test for Addison's Disease, so that is another way in which the norms are interpreted. Anyway, here's the chart:

https://www.idexx.com/resource-library/smallanimal/snap-cortisol-testing-guide-en.pdf

[My sweet Ginger]

I'm wondering if you didn't copy down the ranges for non Cush pups and the post number of 8 may be actually 18? Would please you check the numbers again?
As Marianne has stated the therapeutic ACTH numbers for pups treated with Lysodren should be 1-5 for both pre & post.
With slightly higher than desired numbers, rather than reload Oscar with a mini load how about upping his weekly maintenance dosage instead just until 30day mark ACTH test.
Have there been any behavioral changes in him in the last few days other than loose stools?

From IDEXX;

ACTH reference range

Canine
2-6 Pre ACTH (resting) cortisol
6-18 Post ACTH cortisol
18-22 equivocal post ACTH cortisol
>22 Post ACTH cortisol consistent with hyperadrenocorticism
<2 Post ACTH cortisol consistent with hypoadrenocorticism
1-5 Desired pre and post ACTH cortisol on Lysodren therapy

[rexifer]

Well, just when I thought things were going well...

We had to rush Oscar to emergency this morning. He woke up at 6am, lively as ever, ate well and seemed fine. He was sleeping on the sofa next to me and I heard him making a funny noise so I peeked under his blanket and he was panting and drooling. I picked him up and although his eyes were open he was limp. I know you all know the panic I felt, I thought maybe he was crashing so I forced a prednisone pill in him and we rushed to the vet.
They ran all kinds of tests and bottom line is that she thinks something is going on in his digestive track, maybe a blood clot that is causing him pain. They will do an ultra sound at 11am today ( Pacific Time). If it is a clot then surgery will be needed. If not then we decide where to go from here.
We got to see him before we left, he is on pain meds and anti nausea meds and out of it but when he heard my husbands voice he lifted his hear and his eyes sparkled a little. It was heart wrenching to see him this way and of course I've cried enough tears to fill a river. Please keep him in your thoughts. I will post again when I know more.
I

[Squirt's Mom]

Oh me.... please let us know how your sweet boy is doing as you can. Prayers and healing energies flying his way!

[judymaggie]

Poor Oscar--sending healing thoughts and prayers your way!

[ScottieBoo]

Well, just when I thought things were going well...

We had to rush Oscar to emergency this morning. He woke up at 6am, lively as ever, ate well and seemed fine. He was sleeping on the sofa next to me and I heard him making a funny noise so I peeked under his blanket and he was panting and drooling. I picked him up and although his eyes were open he was limp. I know you all know the panic I felt, I thought maybe he was crashing so I forced a prednisone pill in him and we rushed to the vet.
They ran all kinds of tests and bottom line is that she thinks something is going on in his digestive track, maybe a blood clot that is causing him pain. They will do an ultra sound at 11am today ( Pacific Time). If it is a clot then surgery will be needed. If not then we decide where to go from here.
We got to see him before we left, he is on pain meds and anti nausea meds and out of it but when he heard my husbands voice he lifted his hear and his eyes sparkled a little. It was heart wrenching to see him this way and of course I've cried enough tears to fill a river. Please keep him in your thoughts. I will post again when I know more.
I

My prayer are with you and Oscar. I trust the Vet will do everything in their power to make him better. Very Glad to hear they gave him something for pain.

[My sweet Ginger]

Praying he will come out of it in no time whatever it is.

[rexifer]

Well, it has been a day to remember that's for sure.
We heard from the vet. He has pancreatitis. It was ausing his pain and nausea.
It is acute and not chronic so they are treating his symptoms and will keep him tonight, try a little food tomorrow and re-evaluate and he may be able to come home tomorrow with pain meds and a low fat diet.
This has nothing to do with the Cushing's or Lysodren.
Anyone have any experience with this and know about low fat dog food and low fat treats?
That is you all for the thoughts and prayers and being there for me.

[Cris]

My 13 year old Maltipoo and my 14 year old Bichon are both on Hill's Science i/d (low fat - GI restore) Casey had an emergency spleenectomy, where her spleen had ruptured and she was bleeding internally…… followed shortly with pancreatitis. Thank goodness, I took her in to see the vet as soon as I did. Maggie, my 14 year old Bichon is also on the diet. She recently was diagnosed with Cushing's and began Lysodren this morning. Both dogs really like the i/d and it comes in can and kibbles.

[molly muffin]

Cushing dogs are definitely prone to pancreatis and we see quite a bit of it on the forum because of that.

So, whatever you eventually move to, to start off, what works is boiled chicken and very mushy rice, (add extra water when cooking to make it bland) no chicken stock or anything, as a lot of those have sodium and onion/garlic salt added. You are looking for bland mush and then you feed several small meals during the day, not big ones as too much is hard for the gastro tract.
As he was having pain and nauseous, he'll prob have some meds to go with that.

I imagine the loading will be stopped for now until Oscar is all better. you couldn't tell if he is loaded or not when in the midst of a pancreatic attack and you never give the cushing meds to a sick dog.

So glad that he is doing better and they are working to get him sorted out.

[Squirt's Mom]

So glad you took him in and they are keeping him tonite. Let us know how he is tomorrow.

[labblab]

Take a look at these two Dogaware links re: pancreatitis and healthy lowfat foods. They were both super helpful to me when my girl had her first pancreatitis attack.

http://dogaware.com/articles/wdjpancreatitis.html

http://dogaware.com/articles/wdjlowfatdiets.html

Marianne

[LauraA]

Poor Oscar :( My old rescue used to suffer badly from pancreatitis, we think this is part of the reason she was dumped. What worked best for us was mushy rice and boiled chicken. We would give her a spoonful around every 2 hours slowly increasing the amount and the time between feeds. It is common in Cushings pups, luckily my Cushings girl has only had it once herself (touch wood!) which actually led to her diagnosis. Hope Oscar is home soon and starts to perk up quickly. Hate not having them at home with us.

[Harley PoMMom]

Pancreatitis can be a bugger, my Harley had the chronic type of pancreatitis. Some of the important things to do are: keeping them hydrated, feeding 3-4 small meals through-out the day, and the diet has to be low fat, keeping them at their ideal weight is also recommended. And yep, that chicken breast meat that is 99% fat free and skinless is good along with very cooked rice, cook it until it is of a mushy texture.

Let us know how things are going, ok ;)

Hugs, Lori

[rexifer]

Just got home from visiting him. He was alert and responded to me. He is getting fluids and pain meds intravenously. They said they took him outside for a little walk but he was shaking so badly he was having trouble walking .He shakes when he is nervous especially at the vets in a strange place. They said he sleeps a lot. I got to hold him and cuddle with him,brought his favorite blanket. After about a half hour he was getting tired and I layed him back in the kennel on his side. He seemed worn out and laid there quietly with his eyes open. I kissed him good bye and then cried all the way home.
I will post tomorrow and let you know how he's doing.

[Dixie'sMom]

Awwww... poor Oscar. I hate to hear this. I'm glad he looked better today. I will be praying for a speedy recovery for that little fellow.

[rexifer]

Sadly our little boy passed away early this morning. He had taken a turn for the worse last night. The vet called at 2 am to say that his sodium levels were off the chart and they can't get them lowered, that he was tremoring and could start seizuring so be prepared for the worse. At 6 am we got another call saying he had 2 seizures since she last called, bad most likely sustained brain damage and was unresponsive so we had to make the call to end his suffering.
It was absolutely the hardest decision we've ever made as those of you who have been there know.
He is with the angels now.
We are a grieving household now and it will take time to heal I know.We will hold our memories close.
Thank you to all for being there when I needed you, I know your arms are around us.

[judymaggie]

I am so sorry that you had to let Oscar go but am glad that you were able to have some time with him last night. My deepest sympathies to you and your family.

[My sweet Ginger]

Oh, I'm terribly sorry for your loss of Oscar. Words can't express how sorry I feel for you and your family as it was such a sudden turn of event. Do take comfort in knowing that he is now pain free. RIP sweet Oscar. Hugs, Song.

[ScottieBoo]

This is so very sad to hear. I have been down that road having to make that decision. It is indeed the most hardest decision to make. Yet Somehow deep down inside we know it is the right one.

Please know you are not alone and many others have or are struggling with such pain. Oscar is now out of pain and you were a WONDERFUL PARENT TO HIM!!!!

So find a Moment to Smile and be proud of ALL you did for him until the end.

[Squirt's Mom]

Oh I am just so sorry for your loss and pain. :( Please know we are here anytime you need to talk - we do understand.

Our deepest sympathies,
Leslie, Trinket, Brick, Sophie, Fox, Redd and all our Angels.



Time to Go

The time has come I think you know
the Lord is calling so I must go
I love you so much; I wish it wasn't so
I wish I could stay; I don't want to go

You're the best family a dog ever had
so kind and gentle, never mean or mad
I'll never forget the day that we met
I was so lucky to become your pet

You opened your door and showed me your heart
I'll never forget you; we'll never part
You loved me and cared for me over the years
you taught me everything and took away my fears

The Lord is calling now I must go
but before I go I want you to know
I know it hurts to lose a friend
but I'll always be with you even to the end.

Written by John Quealy

[Renee]

I am so sorry Oscar has passed. Rest in peace Oscar.

[molly muffin]

Oh my gosh. I am so very sorry to hear this. :(. I know your heart is broken.
My sincerest condolences to you and your family.

[rexifer]

Thank you everyone for your kind words. Yes, our hearts are broken. We are trying to remember the good things and not go over and over the events of the last two days.
The ER Dr. called this morning to give me an idea of what they think happened and any he turned worse so suddenly.
They think he had a large pituitary tumor which affected the production of a hormone that regulates sodium levels. Without the ability to regulate his sodium it went sky high and leeched water out of his cells all over his body including his brain which caused the seizures and coma. There was nothing that could have been done. I know I did the right thing for him.

[addy]

I'm sorry for your loss and to read about Oscar. Having the ER vet clarify what happened can hopefully help you find peace.

This is such a hard time, we remain with you if you need to talk, okay?

[rexifer]

Thank you so much, I may need to talk to someone , right now I think I am in shock and can't hardly say his name with out breaking down. My husband dearly loved him and is not taking this well and neither is our son.
Everywhere I look around the house are reminders,his toys, his blankets etc. Today I curled up with one of his blankets that smelled like him and just held it tightly against my heart. Our other dog is going around the house looking for him.
I did talk to my girlfriend today. She lost her Greyhound to an autoimmune disease at the same facility Oscar was in. The course of his disease was similar to Oscar's and she had to decide to let him pass also. Talking to her helped although we were both in tears for awhile.
She told me that today when she went out to get the paper her rose bush had one perfect white rose that had just opened and she thought it was strange as it is winter. She cut it a put it in a vase. She said she is taking it as a sign and calling it the Oscar rose.

[LauraA]

I am so so sorry to hear about Oscar. It is truly heartbreaking when we have to let them go. Cry all you want for him as he is truly worth all those tears.

[molly muffin]

I am sure you are in shock. Everything just went bad so fast it seems. :( I was shocked when I read your update as that was not at all what I was expecting or hoping to read.
I can't imagine how horribly this is for the family.

big hugs

[Budsters Mom]

I am so sorry to hear about the loss of sweet Oscar.:o

Fly free sweet boy, fly free!

[doxiesrock912]

You made the ultimate act of love for Oscar. My sincere condolences. Hugs

[babyblackbear]

I am so sorry for your loss.

[Spencersmom]

So very sorry to hear about Oscar!! Please know that you are not alone!

[rexifer]

It was a tough night. He always slept with us, sometimes under the covers. I could almost feel him there. I had a dream that he was somewhere running free and well again and having the time of his life.
My husband woke up a couple of times sobbing his heart out and of course it set me off again.
It is so hard, so hard.

[Squirt's Mom]

I believe your dream last night was a True vision, sent by Oscar to sooth your Soul. I also believe the white rose was just what your friend felt it was - a sign from her baby. These two things alone offer proof that our babies never really leave us, that they are always by our sides even tho their form has changed. We can no longer feel the warmth of their bodies or the texture of their hair but we can still feel them and see them and hear them. We are tied for all time and nothing, not even death, can sever those ties.

Hugs,
Leslie and the gang

[Dixie'sMom]

Oh No! I am so sorry to see that Oscar was not able to overcome his illness. My heart breaks for you and your family. I know you will miss him desperately. You are a great Mom and gave him the greatest gift of all - Release and Peace. He repayed your love by showing you that he is free and happy at the Bridge. I know you will see your boy again one day. He will be waiting for you.

I'm sending prayers of comfort your way. Please do not hesitate to reach out for a shoulder to cry on or a hand to hold. We are here for you.

[Trish]

So sorry to read the news about Oscar, RIP little man and big hugs to you and your family xxxx

[apollo6]

I am so sorry for the loss of your sweet Oscar. These fur balls leave such a foot print on our lives we are never the same. Don 't listen to what people say. Oscar was a big part of your family. You and your family feel your feelings,do what every you need to do to comfort yourselves. We are here to comfort you during this time.
Hugs Sonja and Angel Apollo