help for BT with Cushings?!

[rosiemama]

hello all you wonderful dog owners~
im grateful to have found this site and eager to learn more about your experiences with this disease. your insights and wisdom are invited.:)

my girl Rosie is a boston terrier who is currently 9 yrs old.
she has been healthy until about 6 months to one year ago...
increased appetite, thirst and urination; general fatigue~not having her usual energy or playfulness in addition to difficulty with long walks; panting and shaking frequently...a bit of a poochy tummy starting etc.
skin lesions began with large round bumps that turned into open sores and then scabbed over. the skin around these bumps became calcified and continued to spread until she had several large patches on her back. took her in to my great vet and we began testing...several months and many dollars later ending with a cushings diagnosis.

meantime we had tried different courses of anti-biotics and skin treatments for fungal and bacterial infections. none of course were successful. so she was quite sick and depleted by the time we realized it was cushings...long story shorter, started lisinopril and when she reached a nearly toxic state, a course of steroids which i gradually weaned her off of. then a waiting time of 5 days and another short course of lisinopril ending as soon as her appetite returned. no steroids this time around. it's been almost two weeks and she is stable. for now the vet and i agree that we wait until appetite and thirst have greatly increased and treat with another 1/4 lisinopril or more if needed. it is a delicate balance from what i have learned.
she is back to short walks and much more perky rosie over all.
her skin lesions are SLOWLy beginning to heal with weekly baths using DerMagic soap bar and conditioner. i have previously used only mane and tail products and am gradually adding them back in but only after the DerMagic soap.
so what else would you like to know and what advice might you have.

we were so heartbroken at first and she was so ill that it was quite a scare...husband and three young adult daughters all adore her.
this disease is only "treatable" and from what i have learned so far requires constant monitoring and treatment, which can allow for a semi-normal life?!?!

thanks mucho

rosie's mama

[Squirt's Mom]

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[Squirt's Mom]

Hi and welcome!

Is your vet trying to treat the Cushing's with Lisinopril? It is an ACE inhibitor and is used for congestive heart failure and hypertension but it does NOT treat Cushing's. So does your baby have heart problems?

What tests were done to diagnose the Cushing's? Would you mind getting the actual results of those tests and posting them here? That will help us a great deal to help you and your baby.

Looking forward to learning more about Rosie!
Hugs,
Leslie and the gang

[labblab]

Welcome from me, too! But like Leslie, I am totally puzzled by the Lisinopril and also by the steroids. Supplemental steroids are the last thing you would be giving a Cushing's dog since they only amplify the root problem -- especially in terms of related skin lesions. If Rosie is suffering from Calcinosis Cutis (and it sounds as though that may be the case), excessive steroid levels in the body are the actual cause of that condition.

It will help us a great deal if you can tell us why Rosie was being treated with the Lisinopril since it is a drug that is unrelated to Cushing's and would not improve the condition in any way...

Marianne

[labblab]

I am suddenly wondering if you may be referring to Anapryl instead of Lisinopril? Anapryl is a drug that is sometimes used as a trial medication for Cushing's. Unfortunately, though, only a small percentage of dogs show improvement on that medication. There are two other Cushing's drugs that are generally much more effective and much more widely used these days.

[rosiemama]

Oooopppsss wrong drug name. Sorry and you all are so
Sweet. Drug mixup-humans or animals. Hmmmm!?!
Ok Lysodren is the correct drug name. And the
Reason the vet and I chose it was because her
Cushings is Adrenal based. Her liver enzymes were so
Off that we started it right away.
More about testing later.

[molly muffin]

Hello and welcome from me too.

Okay lysodren makes sense, but it sounds like she got too much and basically overdosed. Lysodren is Very tricky and has a very set sort of protocols that have to be followed, this is for the dogs safety.

This is the set of protocols that we give to all over members when they ues lysodren:

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

This does sound like CC (calicinosis cutis) which is when calcium deposits come up through the skin. I hate to say it but it can get worse before it gets better, but it is possible. Trichor spray which is an antibiotic spray can help to prevent yeast/bacterial infections in the sores. You want to cut away the hair around them and keep them dried out.

Now with lysodren, you are basically eroding the outter cortex of the adrenal gland. What you want is a very steady dosage of lysodren and no bouncing around. You're looking for a post ACTH result of under 5.0ug, but above 1.5, in the 3's or 4's will work usually.

What has me very confused is this dosage of "as needed, etc" normally you load, on a pill a day based on weight, till the load is finished, then you start the maintenance phase which is the dosage of the load, but instead of every day, you divide it up by about 3 days per week. Test and make sure she is holding the load.

What dosage did she load at? What are you giving her now? and what are her current cortisol levels?

I know, lots of questions.

[Squirt's Mom]

Oh dear....I am very concerned about your baby based on the info so far. Lysodren is a very powerful drug that must be respected....and from what I see so far, your vet is showing little respect for it nor understanding of how it works. So please fill us in on the testing to date, INCLUDING the test done to diagnose the Cushing's as soon as you can. FYI - if your vet started your baby on the Lyso based only on elevated liver enzymes, that is so very, very dangerous.

Is your baby still taking the Lyso? If so, how much and how often?
EDITED TO ADD: How much does she weigh?

[rosiemama]

Thanks so much Sharlene and all of you new friends...

The loading phase is finished and now we are trying to see what the maintenance phase will hold. It sounds like we should also be testing her cortisol levels during this phase...how often would you reccomend.

During the loading phase she was taking 1/2 of a 500mg tablet twice daily.
She took that for approx 10 days until she obviously was losing appetite etc,the unfortunately she required a short dose of very mild steroids to regain her general health. Now my vet says to watch her closely and when her appetite and thirst once again are high, and symptoms like panting/low energy develop give 1/4 of a pill. Still using the 500 mg. She took that two weeks ago and has felt well since...now appetite etc is beginning to increase.

What questions should I ask my vet and what would you recommend for testing in the maintenance phase? He has had several cases of Cushings but is not a specialist or an expert. I have done my research and feel this treatment is the best course.
Will look up the testing and dates and get back to you. We started with testing the lesions for fungal and bacterial infections but then after the first blood test went straight to treating with Denamarin and consequently both a biopsy of skin spots, and a special test for Cushings. The name of which is escaping me at this moment...required leaving her there in the am and injecting cortisol.

Specifics soon. We do have a certain diagnosis of Cushings and certainly would NOT have begun the Lysodren without that!

Many thanks and more soon...

[Squirt's Mom]

Ok, those details bring me some relief. :o But before you start the maintenance phase, I would want an ACTH to make sure the cortisol was not still too low. You are seeing some signs start to come back so this is the perfect time to check that cortisol level. You don't want to let it get high again but neither do you want to put her back on Lysodren if the cortisol is still too low. So an ACTH and soon would be my next step.

[Squirt's Mom]

The maintenance phase is NOT "as needed". This is a specific dosing schedule. She would take the same amount of the drug over a week's time that she took during the load. So if she took 500mg a day (1/2 tab 2x a day) then she would take 500mg spread out over a week, like every M, W, F, and Sun she got 125mg. This is EVERY WEEK for the rest of her life. If your vet is saying to give her a dose only when you see signs, we need to talk again. ;)

[rosiemama]

Thanks again for your advice and for the link to the helpful page that explains the loading and maintenance phase of treating Cushings with Lysodren.

I plan to contact my vet tomorrow and request an ACTH test BEFORE we begin what will be the maintenance phase. Will also pass along to him the print out of your document and ask him to read carefully so we can discuss together how to proceed.

My gut sense is that his advice to me thus far was his way of judging when she has reached the "loaded" or "induced" phasel, and also assessing gradually with caution, her sensitivity to Lysodren. So Ill offer this protocol and be eager to hear his response. I do trust his wisdom and deep care for Rosie...and also have a very respectful and mutual dialogue with him over the years.

You all have helped discern and clarify some important points and Ill most certainly be asking many more questions soon : )

R Mama
aka Celaine

[molly muffin]

What did your vet say? Curious minds want to know. :)

[rosiemama]

Howdy.

Just back to work here after some time away.
Dropping off the guidelines for treatment with Lysodren from your site
To my vet today and asking for his response.
Hoping to test cortisol levels before next dose!
Will let you know what he says.
From what he and I had previously agreed upon
It's time for another Maintainance dose. Her appetite has
Greatly increased and panting etx
When I take her in this week will also ask for
Copies of all the tests done thus far and share
With you all. Eager for your feedback and ideas.
Thanks

[molly muffin]

We'll be interested to in seeing how she is doing.

Let us know what the vet said and if you did any follow up testing. I always like to do the ACTH testing to know exactly what is going on prior to making medicating decisions.

[Squirt's Mom]

From what he and I had previously agreed upon it's time for another maintainance dose. Her appetite has greatly increased and panting etx

This is one of the areas we are talking about that is being done completely wrong. There is a SET schedule for the maintenance phase - you give that pill every 2-4 days, period, unless your baby is sick. So let's say your maintenance schedule is Mon, Wed, and Fri - you do not need to ask the vet about whether she needs it or not - you simply give it every M,W,F - and you do NOT wait to see signs coming back to give a maintenance dose.

If the signs are coming back, then she is losing the load and will have to go thru that again.

I cannot say this loudly enough - your baby needs a new vet if she is to have any chance of surviving this disease. NOW. TODAY. Please for her sake find another vet before this one kills her. :(