Sweet Kona has passed - Question on Lysodren loading

[chocoholic]

Hi,
I am new to posting but have been reading many informative posts here. My 8 year old chocolate lab, Kona, was recently diagnosed with Glomerulonephritis and then also pituitary dependent Cushing's. She has been taking Enalapril which has helped with her hypertension. I just completed her Lysodren load but I am afraid that I went one day too long. She will not eat her food. She only eats some cooked chicken breast. When I do manage to get a few bites of kibble in her she throws it up. I took her yesterday for her ACTH test which was as close to the 48 hours as I could get. The vet told me to just let her be until the results come back in 3-4 days. Is this normal eating after the load? I don't want to make her worse by just letting this go. My vet isn't highly experienced with Cushing's so I am not sure if she really knows what is best. Any help that you can give us would be greatly appreciated. :)
Thanks, Wendy

[Squirt's Mom]

Do you have any prednisone? If so give her a dose now. The rescue dose is 0.25mg/kg. To find the weight in kg if you are in the US, divide the lb by 2.2.

If you have an ER vet close by, that is where I would be headed now. ;) Lysodren has a long life in the body - up to 48 hours. So if you did go a day too long, your baby could be in trouble and in need of pred. The electroylytes should be checked if you take her to an ER.

How much does your baby weigh?
What dose of Lyso was she taking?
How often did she take it (how many times a day)?
Did you vet tell you what to look for that would mean the load was done or just tell you to give it X days?

[Harley PoMMom]

Yikes, it does sound like Kona's cortisol may have dropped too low and if this were me I would give her that rescue dose of prednisone that Leslie calculated.

Hugs, Lori

[Squirt's Mom]

How is Kona this morning? Looking forward to hearing from you!
Hugs,
Leslie

[chocoholic]

Hi,
Thank you so much for responding so quickly. Kona started having diarrhea last night as well so I went with the prednisone as you suggested. She has managed to eat some rice and chicken today and seems more interested in food... just not her k/d kibble. I spoke with her vet this morning and she told me to keep her on the prednisone for a few days and also an antidiarrheal. Then start her lysodren maintenance on Monday.

Just a little history of my baby. Kona weighs 90 pounds. Her vet noticed that her protein levels were high in April when she had bloodwork done. She was checked for an infection which came back negative, then her protein creatinine was checked which came back at 1.4. We had an ultrasound done which only showed some inflammation on her kidneys. Since no growths were found the vet decided Kona had Glomerulonephritis. She was also hypertensive at that point so it seemed to fit. We put her on Enalapril and Hill's k/d food. One month later her blood pressure was better but her protein creatinine had gone to 2.1 so she was not getting better.

I decided to do some more research because I felt like something was being missed. When I ran across the info on Cushing's I just knew that was what she had. I asked the vet who seemed unsure because some of her other test results weren't pointing that way. I insisted that they run the initial screening test and sure enough it was positive. We then had the Dexamethasone test run and that came back as pituitary dependent Cushing's. We started the Lysodren load at 200mg once per day. I was watching her very carefully and she seemed to be eating normally until one day, 6 doses in, she didn't seem as interested in her food. She ate more slowly than normal so I stopped at the 6th dose. She just seemed to get worse after that though. She wouldn't eat at all. Then I got her to eat some chicken so I just fed her a little of that. At almost exactly 48 hours her test was run. She is still not feeling well for sure though and that was 2 days ago. Her test came back at 1.8 so the vet said the load was good. I hope she is right and that my baby starts feeling better soon. :(

Thanks again for your help! Any additional input is greatly appreciated as this is no easy road to travel. I just hate seeing her so sick.

Thanks,
Wendy

[My sweet Ginger]

Hi Wendy,

I'd like to know two things to make sure.
You mean 2000mg a day instead of 200mg, right? Then the dosage was correct for her weight but it should've been divided by 2, morning and evening 2 pills (500mg) at each meal time.

Can you tell us both numbers from the ACTH stim test, the pre and post? We are missing one number which I'm guessing the pre number.
If the post number is 1.8 that would make me worry and I'm worried therefore I wouldn't hurry to start her on maintenance so soon.

I hope she gets better with prednisone and a break from Lysodren.
Song

[chocoholic]

Hi Song,
Yes it was 2000 mg per day but all in one dose instead of split up. Guess the vet didn't know as much as she claimed. :mad:

The pre stim number was <1.0 and the post was 1.8. I don't know enough to have a clue what that means so maybe you can help with that. :)

Thank You!
Wendy

[My sweet Ginger]

I'm worried about Kona being under your vet' care re Cushings treatment who says it was a good load looking at the numbers of <1 & 1.8. Together they are too low and there is not much stimulation.
1.8 maybe a good enough pre number but not an ideal number for a post. Kona's electrolytes need to be checked for Addison's if she isn't doing well even on prednisone and you may need to look for a vet with more experience on Cushings.
How is she doing tonight?

[chocoholic]

I may have to look for a vet that is more experienced with Cushing's I guess. She ate her chicken and rice and so far seems to be about the same. She is definitely not herself. Normally she has a ball in her mouth and is happy. She is really just laying around and seems uncomfortable :( I hope the prednisone brings her back. What would good levels be for these tests? Is there any way to fix this?

Thanks,
Wendy

[My sweet Ginger]

I don't remember the exact numbers but I think we'd want to see pre number no lower than 1.5 and post number higher than that but somewhere under 5. Also in cases like this you'd want to run an ACTH before you start maintenance.
I'd call your vet and have her check Kona's electrolytes if she doesn't get better by tomorrow morning.
How much prednisone is she getting?
I hope other more experienced members will chime in.

[labblab]

Hello Wendy, and welcome from me, too. I'm sorry that Kona is feeling poorly, and hoping that she is just suffering from the "blahs" after having her cortisol level lowered dramatically in a short amount of time. There is even a name for this: "corticosteroid withdrawal syndrome" and although not an actual Addisonian episode, it can leave dogs feeling pretty yucky until their systems adjust to this new "norm." Temporarily giving her the supplemental prednisone can help ease the transition if this is the problem.

The desired therapeutic cortisol range for a dog treated with Lysodren is actually lower than that for a dog treated with trilostane.


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. An ACTH stimulation test is done as soon as it is suspected that the dog is loaded, to confirm if a successful loading has been achieved. An ACTH stim test is done again after a month of giving the weekly maintenance dose and another ACTH stim test is performed after three months of maintenance therapy, to be sure that the weekly maintenance dose of Lysodren is correct for the individual dog. An ACTH stim test should then be performed every 4 to 6 months to monitor the cortisol production and to determine if any dose changes may be needed along the way. Any changes in the dog's eating or drinking habits or behavior should be reported to the Vet immediately and an ACTH stim test will likely be needed to check the dog's cortisol levels and to see if the dose needs adjusting.

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

So your vet is correct that the post-ACTH result is within the desired ideal range. Song is correct, though, that it looks as though the pre-ACTH result is lower than we would like, and this may help explain why Kona is feeling yucky right now and why the supplemental prednisone may be helpful.

The thing is, you do not want to wait too long to start maintenance therapy or you will risk allowing Kona's cortisol level to start escalating again. The flip side, though, is that I would think you'd want to see her exhibiting normal behavior (signaling a sufficient rebound in her overall adrenal function) before starting maintenance. So beginning the maintenance phase as early as Monday is likely too soon. I would talk with your vet about holding off unless you see significant improvement over the weekend, including an end to any diarrhea. And certainly if she worsens even more while taking the prednisone, I agree with Song about getting her blood chemistries checked to make sure her electrolytes are in proper balance.

Marianne

[Squirt's Mom]

I am very concerned that her cortisol will continue to drop and that she may not be ready, nor need, to start maintenance on Monday. If her appetite is still off, if she still has loose stools/diarrhea, if she is showing any signs of lethargy do NOT start the maintenance.

[chocoholic]

Hi,
Kona has made an incredible rebound today :) She was up running around with her ball wanting to play this morning and actually ate her kibble for dinner tonight. She has slowed down a little bit this evening but is still much better than she has been all week. I didn't give her the prednisone today because she was so much better and she seems to be drinking a lot of water so I don't want to go too far the other way again. If you think I should have please let me know and I will do so. Otherwise we will see how tomorrow goes. Thank you so much for your support and advice :D It is amazing to have such caring and knowledgeable people to talk to.

Wendy

[Squirt's Mom]

OH that is good news indeed! I hope she had a better night and that this morning she is much more her old self! If things continue in this vein, I would be ready to start maintenance on Monday as the vet suggested. ;)

[Gwenny6]

Are you still giving the anti-diahrrea medication? I would think you should probably not give that so you can properly assess if she is still having diarrhea. But I am far from an expert!!

I'm so glad your pup is doing better. Please continue to post on here and ask questions. These people are amazing!!!! They saved my dogs life when my vet and IMS had no clue what they were doing!

[chocoholic]

Hi,
So it appears Kona is having some issues and I am just not sure if they are normal side effects or not. I started her on the maintenance dose on Monday as the vet had directed because Kona was almost completely normal. Unfortunately the next day she decided not to eat all of her food. This seems to be escalating and she will only eat cooked chicken or pork and baby carrots and treats. She refuses to eat her kibble and as of today won't even eat treats. I bought some canned food and managed to get her to eat a little bit. Beyond that she appears to be extremely uncomfortable. She keeps making noises and moving as if her back end is hurting. She has gone way down hill in the past 2 days.

Is this normal when going on the maintenance dose? Or is this type of issue something to be concerned about? Any advice is appreciated :o

[My sweet Ginger]

No, it's not normal for her to be feeling the way you described.

- Any changes in the dog's eating or drinking habits or behavior should be reported to the Vet immediately and an ACTH stim test will likely be needed to check the dog's cortisol levels and to see if the dose needs adjusting. - from Marianne's post

What's her weekly total Lysodren dose and on what days is she taking Lysodren?
Inappetence and hind leg weakness or wobbliness are all symptoms of overdose.
If it were me I'd stop maintenance and run an ACTH stim test.

[Squirt's Mom]

Yes, stop the Lyso immediately and call the vet asap for another ACTH. This is not a normal reaction.

You say she was "almost completely normal" - what was still not normal? Was there any loose stool or diarrhea? What was still off when the maintenance was started Monday?

How long had she off the prednisone by Monday when the Lyso was started?

And I'll repeat Song's questions as they are important - what dose of Lyso are you giving and how often?

It seems the vet didn't think this was Cushing's in the beginning but you did based on what you read online. You need to know that the LDDS, the test used to diagnose Kona, is notorious for false-positives in the face of a non-adrenal illness - like inflamed kidneys. ;) So based on Kona's reaction to treatment, I am very concerned she doesn't have Cushing's at all. The ultrasound on a cush pup nearly always shows enlarged adrenal glands and an enlarged liver. There are also certain lab results we see fairly consistent in cush pups. So let's start at the beginning.

Please post every ACTH result along with the date performed.

Please get copy of the LDDS and post those results here.

Please get copies of lab work done that shows things like CHOL, BUN, TRIG, T4 and post all the abnormal results here - anything too high or too low. Include the little letter and normal ranges with each so they look something like this -

ALP 2561 ug/dl 150-500 (EXAMPLE)

Please tell us what the ultrasound report says - anything mentioned that is abnormal seen with the internal organs.

Do NOT give any more Lyso and if Kona is still not right this morning, get her to an ER to be checked out (ACTH and electrolytes). Let us know how she is doing.

Hugs,
Leslie and the gang

[My sweet Ginger]

So here's a quick summary of Kona so far.

8 yrs old chocolate lab weighing 90 lbs.
Finished Lysodren load on day 6, Sun. the 6th.
An ACTH was done on Tues. the 8th. pre <1.0 & post 1.8
Started diarrhea on Wed. the 9th.
Started on pred on the 9th and ended on Thurs. the 10th that we know of.
Started maintenance on Mon. the 14th.
Inappetence restarted on the 15th.
She's still not doing well as of yesterday, Sat the 19th.

Did you give any more Lyso since Mon. the 14th?
I'm very sorry you and Kona are going through this and hope she's doing better. Song.

[chocoholic]

Hi,
Kona did well last weekend. Her loose stools were gone and she was fine except maybe not quite as energetic as normal. I had only given her three days of prednisone and two of antidiarrheal, ending on Friday, as she was much better. I watched her closely over the weekend to make sure she was on track and all was well. She was so close to normal that I started the maintenance dose on Monday. I gave her 2000mg spread out over Monday, Wednesday and Friday. She had taken 2000mg daily during the loading so that was what I gave her per the vet. I am taking her in now and will get copies of all of the test results so that I can post them when we get home. Thank you all so much for the help and good thoughts.
Wendy

[molly muffin]

I think due to how low her cortisol went on the load that you when you started the maintenance that she would have been on less than at the load. Those numbers are very close to going the other way to Addisions.

What did the labs show?

[Squirt's Mom]

How is Kona today?

[chocoholic]

Hi,
Sorry I haven't posted.... it has been a bit of a rough week. In addition to trying to help Kona get by, my daughter who is in college in Germany is very sick and none of the doctors seem to be helping her. Too much mom stress :(

So at this point Kona is feeling better. I am not sure that we are doing what is best but we had to do something to bring her back. Some additional info on tests that I got at the vet:
In June Kona had an ultrasound before Cushing's was even thought of. She had hyperechoic nodules on her liver. Her gall bladder was distended. The adrenal gland was not visualized.

The vet then said glomerulonephritis. After she was on meds and didn't respond, I asked for the Cushing's screening in mid-August. Her ratio was 15. Anything >13 is consistent with Cushing's.

She then had the Dex suppression test.
Pre sample was 19.4 ug/dL Normal range is (1.0-5.0)
Post 4 hour was 1.3 ug/dL. Normal range is (0.0-1.4)
Post 8 hour was 3.6 ug/dL. Normal range is (0.0-1.4)

Results say if post 8hr was greater than 1.4 and post 4hr was less than half the baseline (pre sample) then pituitary dependent hyperadrenocorticism positive.

So after she was so bad this weekend we put her back on prednisone. She has improved greatly. The vet said to keep her on it until next week and then we will do the stim test again. Seems like a long time to me. Is it possible she might go too far back and we have to load again? Maybe we overloaded initially and she doesn't need maintenance? If she does, she definitely needs a way lower dose I guess.

Anyway, for now we are in a holding pattern just taking the prednisone and back to eating so I guess that is better.

Thanks all for your help and concern :)
Wendy

[My sweet Ginger]

The fact that she needs pred to feel better is proof that she was overdosed so she needs pred as long as her body needs it.

It could take some time for her adrenal glands to regenerate so please do not hurry to start maintenance too early. You have to read her clinical signs.
Make sure the ACTH test next week gets done AT LEAST 24hrs after the administration of prednisone so the numbers won't be skewed by pred.

I'm not so sure 2000mg/wk is too high for her. It just could have been the maintenance was started too early when her cortisol was still too low hence the side effects.

Did they check her electrolytes? They should be checked.

[chocoholic]

Thanks for the info. Kona is doing well on the prednisone so far so we are going to continue and do the test later this upcoming week. I guess we will have to judge from there about going back to the lysodren. They didn't check her electrolytes. Do you think it is still important to do now? Or can it wait a couple days for the ACTH test day?

Thanks!

[My sweet Ginger]

I'm so glad Kona is doing well on pred. I'd think it can wait for a couple more days as long as she is fine. How much pred is she getting? Just curious.

[molly muffin]

If she is doing well on the pred then her electrolytes are probably okay but it wouldn't hurt to check them with you do the ACTH to make sure.
Glad to hear she is doing well.

[chocoholic]

Hi,
I am so worried about my Kona right now. I feel like we are floundering not knowing what we are supposed to do. The vet said keep her on the prednisone so we did but were tapering the dose. She was doing well so the vet said lets run the test. I took her off of the prednisone 36 hours before so as not to skew the test. Ran that on Wednesday and she crashed hard on Thursday. I put her back on the prednisone and she finally ate today but her back end is still not working well. Should I assume that she was not ready for that test? She shouldn't crash like that just from the test right?

I am looking for a new vet right now because I feel like the current one doesn't know what she is doing. Any thoughts on this would be helpful. Also, right now giving her 10mg prednisone twice per day.

Thanks,
Wendy

[molly muffin]

it sounds like she really does need that prednisone right now and keeping her on it is important.
She did have the test on Wednesday though right? before the crash on thursday?

If so you will know how low she still is

[Harley PoMMom]

I'd probably have her electrolytes checked also, this is done with a blood test usually called a chemistry panel.

Hugs, Lori

[chocoholic]

Okay I will keep her on the prednisone. Hopefully those results come in tomorrow so I have a better idea of where she stands. I made an appointment for her with a new veterinarian for Monday. They are well established and have other pups with Cushing's so I think they will be more knowledgeable about what she needs. I will have them check her electrolytes when I take her.

As always, thanks for your support :)

[Harley PoMMom]

In addition to trying to help Kona get by, my daughter who is in college in Germany is very sick and none of the doctors seem to be helping her. Too much mom stress :(



Hey Wendy, How is your daughter doing?

[My sweet Ginger]

It looks to me her cortisol is still too low, backed up by her needs for pred, wobbliness and inappetitance.
Please don't worry about Cushings for now therefore do not hurry back to maintenance and no ACTH test until she shows clear signs of Cushings. She may even need to stay on pred for a long time depending on how fast her adrenal glands will recover. We couldn't wean my pup off pred. Our IMS had me try to decrease her dose a little by a little VERY slowly and in the end we still had to stay at the lowest therapeutic level for the longest time.

I'd def check Kona's electrolytes when you take her in on Mon.
Does Kona show any of the Cushings sign these days?
It seems like my pup's PU/PD never really went away but I knew she wasn't Cushings. Could be something else was causing that.

I hope Kona will come out of this like a trooper and be her old self again very soon. Hugs.

[Squirt's Mom]

Oh no she is no where near ready to be off the pred, bless her heart. I would certainly want the electrolytes checked; the vet should have done that automatically. ;) It is possible she is permanently Addison's and will require pred and electrolyte support from now on. But she may well recoup IN TIME and need the Lyso again. Right now it's hard to tell. But do get those electrolytes checked asap and let us know.

Keeping you both in my thoughts and prayers.
Hugs,
Leslie and the gang

[labblab]

Hi Wendy, just a quick note to say that in addition to all the other good info you've been given, I'm thinking that 20 mg. of prednisone daily may be more than Kona needs and may end up causing a rebound of Cushing's symptoms. Given her weight of 90 pounds, if my calculations are correct, a daily total of no more than 10 mg. ought to be sufficient to replace any natural shortfall, and she may not even need that much if she stays on the pred longterm. You mentioned you had been lowering the dose prior to the ACTH -- so had you been giving her even more than the 20 mg. beforehand, or is it just that you have reverted back up to 20 mg. now since she had been acting so poorly?

If she is doing better now on the 20 mg., I'm not thinking you need to change anything before Monday. But I'm guessing the new vet will want to get that pred dose weaned back down to a lower level.

Hope things remain calm over the weekend!

Marianne

[My sweet Ginger]

Please take time doing it as you have to give her body time to adjust to the lower dose and get there gradually, watching her reaction very closely all the while.

[chocoholic]

Hi,
So Kona is still having issues with her hind end. She just isn't stable and is still fairly lethargic. The new vet checked her electrolytes and they were actually within normal range, but her white blood cell count is high. I did just get back her acth from last Wednesday and the pre test was 5.5 ug/dl norm is 1.0-5.0 and post was 5.4 ug/dl norm is 8.0-17.0. Waiting to hear how to proceed but have lowered the prednisone dose a little to get her down to 10 mg. Seems like no one knows what to do.... if she is Cushings or Addison. Hopefully we will have some answers tomorrow.

Btw, my daughter is okay. She has a bad case of mono and was in the hospital for a week, but is now home resting and trying to get her strength up to go to class. Thanks for asking :)

[Harley PoMMom]

Glad to hear that your daughter is feeling better, that mono can be a bugger.

Also glad to hear that Kona's electrolyte results are normal! Now, about those reference ranges you posted (norm is 1.0-5.0 and norm is 8.0-17.0) they are for a dog that is not being treated for Cushing's. With Lysodren the therapeutic ranges are 1-5 ug/dl this is for the pre and post results. So, Kona post is a wee high, but obviously it seems that she doesn't feel her best at that post number, and taking in regard that all dogs are different and react differently, I would be inclined to have her ACTH stim numbers at a bit higher level, say around 7ish. So, that's just my 2 cents worth ;)

Hugs, Lori

[chocoholic]

Hi Lori,
Thanks for the info. So being that I still don't understand all of this, does that mean that she would be considered Cushings still or more toward Addisons? And what would we need to do to get her numbers up to the 7ish level?

I am still waiting for a call from the vet for her advice as well.

Wendy

[labblab]

Please remind us how long it's been since Kona had any Lysodren -- I'm thinking it's been maybe a month now? Also, I need to look back and see what her previous ACTH results were, but I don't think they were a whole lot lower than this. If so, this means the outer tissue of her adrenal glands is not regenerating very rapidly. In that event, I'd think you would not be restarting any Lysodren dosing at this time and perhaps she will continue to need a minimal amount of predisone as a supplement (5 mg.?) until/unless her ACTH monitoring shows a significant rebound, especially during times when she is stressed. But I need to double check all these assumptions I'm making about her treatment historywhen I have a little more time...

Marianne

Edited to add: Well, after checking, I'm kinda half right and half wrong. I'm right about the timeframe -- Kona loaded a little over a month ago. But I'm wrong about the previous ACTH results as they were much lower: <1 and 1.8. So Kona's cortisol is beginning to creep up again, but the question is, why is she not feeling any better? Also, I'm wondering why she is not showing any increase in the post-stimulation number over the pre number now, unless perhaps the relatively high dose of pred that she's been getting is blunting her natural cortisol production. It is a puzzle, and I'll be anxious to hear what the vet recommends. I am still guessing, though, that the pred will need to be tapered down even more to a really minimal level.

[My sweet Ginger]

With Kona's normal electrolytes, Kona's and my pup's cases have became very similar. With her pre 5.5 and post 5.4, not only there's no stimulation but it actually decreased meaning her adrenal glands are not generating at all. No wonder she's not feeling well.
She will need prednisone until her adrenals start to regenerate cortisol. If not she will be permanent Addison's (yes, even if her electrolytes are in normal ranges ) and will be on prednisone for life. Either way right now she needs prednisone to SURVIVE.
The only way you can do is try to slowly lower pred to reach her lowest possible dose but don't rush to get there, please.

For now do not even think about having any more ACTH tests done UNTIL she shows signs of cushings.

Know that her cortisol is still too low as long as she exhibits these adverse effects. It will only be a waste of your money and more so a huge unnecessary stress for Kona.
I have to think Kona's most recent ACTH numbers were skewed by pred she was taking as it was the case with my pup which were pre 2.9 and post 2.9. They were not the numbers from her natural cortisol as my pup was taking daily dose of pred even though we skipped it on the day of her ACTH.
Put her on appetite stimulant if her appetite is off, they do help and please come back and let us know of her progress and treatments.

BTW, I'm relaying this info that came from my IMS. Our GP vet who is so nice and had a great relationship with up until then thought my pup's load was perfect. I remember asking her crying 'Then why is she doing so poorly?' The thing is she still wanted me to start her on maintenance. So yea, sadly a lot of great GP vet's knowledge on Cushings is quite limited I come to find out.
I'm interested in knowing your new vet's approach in treating Kona.

[labblab]

I think the dilemma here is that we don't know whether Kona's recent ACTH results were "blunted" (no/little response to the ACTH stimulation) because the outer layer of her adrenal glands have not yet rejuvenated from the Lysodren, or instead whether the daily doses of prednisone (large at times) have put her adrenal glands to sleep, as it were. Absolutely I am not a vet, so everything I write here is just conjecture from a layperson. But as I have written previously, I am fearful that Kona's prednisone dose frequently has been larger than necessary for physiologic replacement of lost cortisol through an Addisonian episode. So the danger with that, especially when the pred is given daily, is that the adrenals stop producing cortisol on their own because there is already so much supplemental steroid circulating in the system. This is actually how dogs can end up with "Iatrogenic" Cushing's, or suffering from Cushing's symptoms even when their own natural cortisol production has been shut down. In that situation, not unlike Kona's, a dog's natural cortisol response to ACTH stimulation is low-normal or blunted.

If Kona's recent ACTH had remained really low as it was in the beginning (<2), I'd be more inclined to think that the adrenals were still physically unable to produce cortisol. But with a blunted result up in the area of 5 ug/dl, I think that may be more likely the "fault" of the daily pred rather than of a lasting effect from the Lysodren, and continuing the daily supplementation indefinitely may not be necessary nor helpful.

Of course, the continuing wild card to all this is that Kona continues to feel unwell, and so it becomes really essential to figure out whether she really needs the daily prednisone or whether the daily prednisone is actually now causing a problem. Plus, even if the prednisone does not need to be continued, Kona still has to be tapered off of it in order to allow her adrenal glands to kick back into producing on their own. This can be such a complicated issue that I am really hoping your vet can get some expert guidance in this regard.

Marianne

[labblab]

I wanted to come back this morning and add this link to a blog entry written by noted veterinary endocrinologist, Dr. Mark Peterson. As you will see, he discusses what he believes to be optimal prednisone dosing for a dog suffering from Addison's as a permanent condition. He explains that in that situation, he does recommend dosing every day but at a level that does not exceed a formula of .1 - .2 mg/kg., and that he would rarely dose any dog at a level that exceeds 5 mg. (which he says is the average dose even for a human). I know that Kona is a big girl at 90 pounds, but if we do the conversion to kg., the dosing range he suggests is only 4-8 mg.

One important point that he notes is that for dogs who are permanently Addisonian, you don't worry that daily dosing will suppress natural adrenal function because it has already ceased. But I do believe the take-away is that for a dog who is experiencing only a temporary issue with low cortisol, you do need to be mindful of the risk that lengthy daily dosing will end up suppressing functional rebound of the adrenals' natural production. And this is why I have been concerned about your vet prescribing daily doses as high as 20 mg. for Kona. The reason why she crashed after the 36 hours without pred may be because her adrenals have not yet rejuvenated from the erosion caused by the Lysodren, but it also could be because her adrenals have stopped producing cortisol on their own because of the lengthy course of prednisone. It may take a specialist to help figure this out. Anyway, here's the link:

http://www.endocrinevet.info/2011/02/q-whats-ideal-prednisone-dose-for-dogs.html

Marianne

[My sweet Ginger]

At this point no one really know whether Kona's adrenals will stay Addison's state permanently or not but either way she will need pred for now and definitely it needs to be tapered down or off in a timely manner.

We ran an ACTH test on Ginger after about 5-6 months of daily pred treatment (.25 mg/kg by then) just to see if her adrenals were stimulating. She skipped her morning dose of pred and the results were pre 3.8 and post 18.1. Mind you that we knew going in that the results will be still skewed by her daily dose of pred, our IMS just wanted to see the stimulating factor and they were indeed stimulating. Although Ginger didn't stay Addison's permanently going by the results of her ACTH she somehow still needed to stay on pred to help her function better for a few more months.

So yes, whether Kona's case is being caused by too much erosion of her adrenal glands by Lysodren or a hefty dose of prednisone therapy one thing is clear and that is she needs daily supplement of pred for now but DEF. can't stay at her current dose of 20mg (0.49mg/kg) indefinitely.
Hopefully her adrenals will start regenerating cortisol in time with the tapering off of pred which may or may not take some time but I will pray for that.

Wendy, you mentioned you've lowered the pred. Is she doing poorer since the lowering of pred do you think? What dose of pred is Kona on at the moment and what was your vet's exact instruction on that?

[chocoholic]

Well things are definitely not getting better. Kona is on 10mg per day of prednisone. Could be that I didn't taper her appropriately from 20 to 10. She was only on 20 for a few days so I just don't know about that. Unfortunately our vet has been out for a couple of days so I am going to take her in today. Her back end is still not right and now it seems she is unable to do her business.... either kind. Then she comes in and lays down and dribbles. She had a few accidents a couple of days ago which she hadn't done in awhile but I am worried about her inability to go. She is currently on Clavamox, Enalapril and Prednisone. Any info on this would be helpful.

Thanks,
Wendy

[My sweet Ginger]

Wendy, if Kona only got 10mg this morning and is doing poorly give her another 5mg. If she gets better after the 5mg then you know the dip was too much too soon. What we did was we stayed on at least one week or more on each decrease of pred with Ginger and make sure her body handles the decrease without getting worse. We took time lowering the pred and tried to overlook at the PU/PD that comes with pred temporarily. What you are describing of her behavior now is still a symptom of possible low cortisol to me.

[My sweet Ginger]

Is the Clavamox for her UTIs? My pup did a lot of dribbling when she was going through chronic UTIs - persistent Ecoli. She'd make many short stops to pee in one outing but nothing really came out. She was first treated with Clavamox multiple times then simplicef for a couple of times and then 30day course of Baytril which I think finally put an end to her long lasting UTIs. Did you do urine culture?

[chocoholic]

We took Kona yesterday to see why she was having so many problems. The vet did an xray and found a large pelvic mass which was pressing on her organs and blocking her urethra. Not sure why this wasn't caught in the ultrasound from several months ago or why it progressed so quickly at the end, but it was just too much for her. We took her to the emergency vet and they drained her bladder. Unfortunately her abdomen had fluid in it and it made her heart unstable. As much as I wanted to take her home and spend just one more day with her, she was not able. I will miss my little angel Kona. She was always with me and was my best friend. The stars that shine the brightest always burn out so quickly.... she was surely that.

Thank you all so much for your support and advice. It was so helpful knowing you all were here when I couldn't even count on my vet to know what was right.

Wendy

[Squirt's Mom]

Our thoughts and prayers are with you and yours as is our deepest sympathies.
Leslie, Trinket, Brick, Sophie, Fox, Redd, and all our Angels



See You Soon
by Luka Bloom

I hope I love you enough to let you go
On the road only you can see
I hope I love you enough to let you go
And loosen the hold that you have on me

I want to bless you on your way
Say always to yourself be true
I hope you know there is no sweeter place in the world
Than the places I have been with you

See you soon, see you soon

The weakness in me fills my heart with fear
Telling me to control and try to keep you here
The spirit in me that's what is good and true
Telling me to be strong, and trust the letting go of you

See you soon, see you soon

The road waits patiently before you
Away you go now
Don't even look behind
Fill yourself with riches from the times we knew
I'll keep your goodness here
In my heart and in my mind

See you soon, see you soon

I hope I love you enough to let you go...

[judymaggie]

My heart goes out to you during this difficult time -- please take some comfort in knowing that Kona is now pain-free and able to run with all of our angel pups at the rainbow bridge!

[labblab]

Oh Wendy, my heart is in my throat as I am reading your note. I am so, so shocked and sorry that things happened so fast and that you were not able to share at least a few hours at home with Kona. You absolutely made the decision that was right for her, but at such a cost for yourself. You tried to do everything you could to heal her, and I hope that even in your own pain you will be able to take comfort in knowing that you spared her any more pain and that you gifted her with a lifetime filled with love. These final hours are only the blink of an eye in a lifetime of love.

Please know that we remain here for you, Wendy, and we will be honored to read anything more that you may care to write in the days to come. I send you tons of hugs across the miles on this first day after.

Always in loving memory of your beautiful Kona,
Marianne

[labblab]

Just wanted to add that my own dear Lab cushpup was diagnosed when he was eight and passed when he was nine (enlarging macrotumor). With these big dogs, even under the best circumstances we know that their lives will always be much shorter than we would wish. But to lose them so very early -- it is so very hard. Again, my heart goes out to you...

[Robert]

So sorry for your loss. You did the hardest thing but the only thing you could do for Kona. Prayers to both of you.

[Budsters Mom]

Fly free sweet Kona, fly free!

[lauren5]

Wendy,
I followed your posts about your beloved Kona and am quite sorry to learn of Kona's passing. Your dog was fortunate to have you as her Mom, as you certainly tried extremely hard to take good care of her. I am very sorry for your loss and hope your sweet memories give you some comfort as you grieve,
Lauren

[molly muffin]

Oh Wendy :( I am so sorry. Just a total loss of words.

My sincerest condolences to you and your family. :(

[My sweet Ginger]

Having to lose one's baby under any circumstance is such an aching heart but to lose the way you lost dear Kona, I don't know how anyone can ever know how to deal with after such an aftermath. You only brought her in to make things better for her and having to say your last goodbye to her right there... Oh Wendy, I really have no words that will comfort you but to say I'm so very sorry.
Poor lovely souls we keep losing here one by one. It's just so much so for me that I can hardly come here and offer my condolences to anyone anymore because each time it forces me to look at what's ahead of us in near future.

I will pray for you that one day the many happy memories of Kona will replace the sad and heartbreaking ones that are so fresh right now.
RIP sweet Kona and fly free. Hugs, Song.

[spdd]

So sorry to read about Kona.... you are not alone. I've had wonderful encouragement from unbelievable people on this forum. My sincerest condolences.

[chocoholic]

Thank you all for your kind and caring words. I never knew how painful this would be. I still feel like I will never get through it and cry every day for my sweet angel. She was my constant companion so I miss her desperately. She just went so fast that it is difficult to deal with and I feel so guilty for not knowing she was so sick and in so much pain. I would certainly have done anything possible to help her. I guess we can never really know what is to come.

As always, thanks for your support and encouragement.

Wendy

[labblab]

Oh Wendy, I so wish I could reach out and give you a real hug. I know that when my boy died, I was totally unprepared for the depth of my grief. He was my first dog, and I simply had no idea beforehand as to how much I would miss him, every second of every day. Our dogs are such true companions; it is like losing half of ourselves when they are gone. I am glad you have come back to us, and I hope you will continue to do so in the days to come. I hope that talking may help at least a tiny bit. Because we join you in honoring Kona, and we join you in honoring your memories of your lives together.

Sending my warm thoughts to you, and always in loving memory of your precious girl,
Marianne

[Squirt's Mom]

I knew for a bit over a year my Squirt was leaving and I tried to prepare myself for the inevitable. When that time came I found I was not ready at all and I still hurt today, more than a year later. I still question what if I did _____ or didn't do ______....would she have lived a bit longer? No, we are never ready no matter when, no matter how, no matter the time we have to adjust - we are never ready to lose one we love so very much.

You are a good mom and your sweet Kona knows that better than anyone. She is watching over you with all the love you gave her, which she will keep in her heart til you meet again.