Just Tested - Coco has passed

[CocoPuff]

Hi everyone! My 9 year old Chocolate Lab just had her LDDS done today and the screens are showing Cushing's. She just had her Thyroid tested and has been checked for diabetes prior to today. She is showing all the classic signs for Cushing's and I am just happy to have an answer for all the symptoms. My vet is calling her pathologists tomorrow and talking to him in order to work up the best treatment plan and luckily she has experience with this. I won't know until tomorrow which route we are going to take but she is leaning towards the Lysodren. I don't have any of the test numbers that I've you guys ask for but when I get them I can put them up here. I mainly just wanted to say 'hi' after trolling around reading the other posts. Its always better to have a sounding board for this kind of stuff!:)

[molly muffin]

Hello and welcome to the forum!

Yes you will definitely want to have copies of all your test results and start your own home file. Believe me it can keep you sane sometimes when trying to keep track of what happened and when.

This is a link to our lysodren help sheet: http://www.k9cushings.com/forum/showthread.php?t=181

If your vet does go with lysodren then you'll want to print that out and have it handy. it's a big help.

If they go with trilostane, most important thing to start off with is 1mg/1lb dosage (no more).

It does help to have a place to come to talk and bounce ideas around. It's helped me tons over the years.

Let us know what the vet says.

Welcome again!

[Squirt's Mom]

Hi and welcome to you and Coco! :)

Lysodren is my drug of choice, too. ;) It all sounds scary at first but we will be here to help you all the way. The link Sharlene posted on Lyso will be helpful if you do use Lyso - many have printed it out to have handy. Do get copies of all the testing done and post the results here - the actual test results, not the invoices. ;)

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

[mytil]

Hi and welcome from me too!

Absolutely correct....this is the best sounding board place I know for Cushpups and parents ;).

Here are some links that talk more about Cushing's --- great reading for any owner to better understand what your dog is going through --- http://www.k9cushings.com/forum/showthread.php?t=180

Feel free to post any results here of the tests performed as well as the symptoms that prompted you and your vet to test for Cushing's.

Terry

[CocoPuff]

These are her LDDS #'s from yesterday.

09-21-15 Cortisol, 8 hr Post Low Dexm 6.200 ug/dL
09-21-15 Cortisol, 4 hr Post Low Dexm 1.100 ug/dL
09-21-15 Cortisol, Baseline 6.400 ug/dL

Last Monday they did Urine Protein and that was at 300.00. They also did a quick hypothyroidism test last Monday that came out in the gray area so they did the blood test and sent it off, which of course came back negative. They also did test for diabetes.

After talking to one of the other vets on Friday (I was in with my Golden who just had ear surgery) she suggested the LDDS based on the uncontrollable weight (I've tried the Metabolic food to no help but now we know why), the excessive water intake which is causing her to have accidents in the house and she doesn't even realize it. We also talked about Coco's body shape and the first question from the vet was "Does she have a pot belly?" I said yes, we even make comments about her beer gut. I had no idea about this disease and am so glad just to know what is going on and can't wait to get her started on treatment!

As an aside...I take my pups to the local Banfield (which has wonderful vets here) and since she is signed up on a plan I can pull her labs of the internet so if there is anything else you guys are interested in as far as labs, let me know, they aren't hard to get.

[CocoPuff]

Hi all...just talked to the vet about our treatment plan and we are planning on doing Coco's load in a couple weeks. We are waiting because my vet will be out of town and she wants to be nearby while we are doing the load. Ling story short, where is the best place to purchase the Lysodren? I am needing 500mg tablets. The cheapest I can find is $6.35 per tablet.

Thanks!
Kelly & Coco

[Harley PoMMom]

Hi Kelly,

I've merged your new post into your original thread about Coco. This way, Coco's entire health and treatment history are all in one place.

I see we don't have some important information about Coco, such as her weight, and the dose of Lysodren the vet has prescribed?

You can get her medication compounded (Mitotane), diamondback pharmacy is one I see used on here: http://www.diamondbackdrugs.com/mitotane-to-treat-cushings-disease-in-dogs/

Oh, I'm going to re post that Lysodren/Mitotane link, it has some really good info: http://www.k9cushings.com/forum/showthread.php?t=181

Hugs, Lori

[judymaggie]

Hi, Kelly! When my Abbie was on Lysodren (we switched to Vetoryl as the Lysodren wasn't consistently lowering her cortisol), I purchased it from Target pharmacy. The lowest price I found was at Sam's ($5.50 a pill) and Target matched their price.

[CocoPuff]

Coco is a chocolate lab and weighs 95lbs. She should be around 65 but we haven't been able to control her weight in some time and she had no other symptoms so I was always told to watch her diet. We will be doing her load at 2x500mg tablets 2x per day. If that goes the way it should we are going to maintain with that same dose weekly. I have a four day weekend coming up and the vet agrees this will be the best time so I can stay home with her in case she tanks. My vet has treated many Cushing ' s dogs in the past. I was able to find the tablets for $5.35 each at www.petmartpharmacy.com. I think that answers all the questions...thank you guys so much. After reading about what all is involved I'm just hoping to get through the load, it sounds like once that is over you're through the worst of it.

[Squirt's Mom]

Thanks for the info! Ok, the loading dose for Lyso is 50mg/kg/day. So at 95lbs, Coco weighs 43.18181...kg (95 / 2.2 = 43.181818...). That would make the daily dose 2159.0909... for Coco which would be divided into AM and PM doses, rounded down to 2000mg/day. So 1000mg AM and 1000mg PM would be correct. YAY! I love it when the vet starts out on the right foot! :cool::cool::cool:

You are wise to start the load when you will so the vet is available. Did the vet give you any prednisone and tell you when and how much to give if needed? If not, call today and get some. This is NOT an option with Lysodren unless your vet will be available 24/7 the rest of Coco's life - vacations, weekends, every single day, any hour of any day, if the vet will be available at all times then you can forego the pred. If you vet cannot guarantee that, demand the pred. Odds are you won't need it but you must have it on hand just in case. Prednisone will keep our babies going should there be a crash, meaning the cortisol goes too low which is life-threatening. We can help you with the rescue dose of pred if needed as well but it's always good when the vet participates. ;)

I'm glad you found a good price on it! Once maintenance starts that cost will go down, too, because you will be using fewer pills per month - given 2-4 time a week in maintenance VS per day in the load, or induction.

You will do just fine with the load. You have a whole host of people here to help you anytime you have concerns. Never hesitate to ask questions or chat about something.

Hugs,
Leslie and the gang

[CocoPuff]

My vet and I have already discussed the prednisone as well :) She will be prescribing it but since we won't be starting for a couple weeks I won't have it in hand until closer to the start date. After reading some of the other posts in here I feel very lucky that my GP is so well versed and experienced with Cushing's dogs. I have her cell and she will be in clinic the entire weekend during the load (she is a Banfield vet and they are open seven days a week). She is the chief of staff at the local Banfield and she helped save my pug that went through his share of scares his first year. Having other dogs and having to watch water intake, how did you guys do that? Did you separate during the load? Food isn't really an issue since they are all really good about only eating out of their bowl, except Coco who cleans up after everyone.

As a side note...I've noticed that some people are having a hard time finding an experienced vet nearby without going to a specialist. Is there a for where we can share info about local vets that are experienced with Cushing's?

[Harley PoMMom]

Very Important: With Lysodren you feed the dog first than pill with some type of fat, say like peanut butter or cream cheese. Most dogs with Cushing's have a ravenous appetite and if there is a slight pause or hesitation in eating the Lysodren should not be given, this hesitation/pause could mean the dog is loaded and an ACTH stimulation test is needed.

As far as a sub-forum for recommendations for vets, no we do not have one, I'll bring this up to the other staffers and we'll see. ;)

Hugs, Lori

[Squirt's Mom]

As for measuring water intake with multiple dogs - you assume the other dogs are drinking a normal amount of water (approx. 1 oz per lb of body weight) and that the cush baby is the only one drinking more than the normal intake amount. So if you have 3 10lb dogs and one is a cush pup, you assume that 20 oz of the water you put down will be consumed by the non-cush babies and anything more than 20 oz was consumed by your cush baby. So if you put 70oz of water in the bowl thru the day you assume your other babies drank 20 oz of that 70 and assume that your cush baby drank the other 50 oz.

Here is a spreadsheet one of our member put together for us to help track water intake - http://www.k9cushings.com/forum/showthread.php?t=3583

[CocoPuff]

Thank you so much! The spreadsheet should be very helpful. My vet suggested looking into the Kmart Pharmacy and if you join their prescription club, depending on the amount you buy, the price for Lysodren ranges from $5.26 to $5.40. I've spent the last few days doing some heavy duty shopping around. Everyone on here is so helpful and makes me feel like I'm not in this fight alone.

Once we go into maintenance, how often to the regress as far as symptoms? I have concerns because we are having to move to Hawaii for a few years due to my husband's job and we are not going to be able to take her with us. We do already have in place someone that will take her and my Golden (they are bonded and cannot be separated and we have concerns on the amount of stress the trip would place on them due to age). We have also already discussed the financial aspects of care and I will be continuing to pay for vet/prescription/food as I don't want to burden him financially. I just want to know what to tell my friend to look for and when he needs to be concerned.

[Squirt's Mom]

The first thing you do is give your friend access to your account here and make sure he knows where Coco's thread is so he can talk with us while you are gone. We are here to help Coco no matter who is taking care of her. So give him your access here to start ( if your password here is one you use elsewhere, change it to something unique). Also print out the link on Lysodren loading and tips so he has that handy along with your vet's contact info and the ER info.

As for losing the load and the signs coming back, that doesn't happen often with Lyso. If the load was done correctly and the maintenance started on time, and the med is given correctly, most pups on Lyso remain on that dose for some time with no need for adjustments like there is with Vetoryl, which is frequently changed. It is possible to lose the load and the signs come back, tho. IF this happens it is handled one of two ways - either a full load is repeated or a mini-load is done using a lower dose for a shorter load time. That will depend on the vet's assessment, the strength of the signs, and the ACTH results as to which one is needed.

[Squirt's Mom]

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

[CocoPuff]

Luckily we aren't leaving for 10 months and we are doing the load in about a few weeks. She should be well into her maintenance by the time we leave. I will certainly make sure he has her home vet's info but he lives in Florida (I am currently in Tennessee). My parents live nearby so they should be able to help as well. I am planning to get him on here as well. I already felt horrible about having to leave them and this just ups the ante. I know that he will take great care of them though so that is helpful.

[Squirt's Mom]

Oh gosh, changing vets is the scariest part of this to me! You seem to have a good vet in TN that understands this disease and the drug being used. You have no idea how rare that is in the canine Cushing's world! So instead of making sure he has access here first, my FIRST step would be finding the vet he will use and making SURE they are as good as the one you have in TN. Oh dear....now I'm worried when I really wasn't before.

[CocoPuff]

Her current vet is at the local Banfield (the clinic located in PetSmart) so as long as he keeps Coco at a Banfield in Florida the vet will continue to have access to all of her records. She should also be able to find a vet that she is comfortable referring Coco to in Florida at another Banfield location. I would like to keep her there so I can continue her on their preventive care plan which also includes discounts on anything not covered under the plan. The good thing about knowing this far out is it will give me time to find a new vet down there and get Coco into her maintenance prior to her moving. With Orlando being such a large city I am sure that we will be able to find a vet that can meet her needs. I am definitely going to make sure that there is an open line between him and Coco's current vet so he will be able to contact her to ask about the care down there as well. The toughest part is her being 9 and us being gone for 3 years, I'm worried if she will make through us being gone. At least I will be able to see her when I come back for visits. I do think this is a better option then putting her through the stress of moving to Hawaii and having to go through the flight to get there.

[CocoPuff]

So been off here for a couple weeks but we are starting Coco's load on Saturday. Lysodren has been delivered (thank you for the Diamondback recommendation, I was able to purchase 40 capsules for $140) and I am picking up the prednisone and speaking with the vet tonight. Her ACTH is already scheduled for Wednesday. Thank you guys so much for all the info on here and I will be sure to post if I have any questions. Her vet has told me that she will be readily available for me this weekend and even gave me her cell phone number in case Coco tanks over the weekend.

[judymaggie]

Hi! Will be thinking good thoughts for Coco's loading. When I was going through the loading with my Abbie, I kept the protocol sheet nearby at all times so I could keep being reminded what to look for. Abbie's drinking slowed down after four days but waited until there was a change in her eating which happened at seven days -- her habit was to scarf down her food and, half-way through, she stopped eating, walked away and eventually came back to her bowl. She had the ACTH on the eighth day. Even though Coco's ACTH is scheduled for Wednesday, if you don't see any changes by that day, you can wait. As I recall, it is recommended that it be done on day eight even if no changes. Are you planning on giving Coco pepcid before her meals? I gave it to Abbie just as a precaution and she never had any stomach upset from the Lysodren.

[Squirt's Mom]

Could you remind us of the dose she will be taking, how often, and her weight?

We will be with you all the way!

[CocoPuff]

She is 95 lbs and taking 1000 mg (500mg x 2) twice a day. I picked up my prednisone last night and the vet and I had a long discussion about what to expect. She said this how she typically loads and has had only one crash. She told the one that crashed she didn't prescribe the loading dose but came in to the situation after the crash and was able to get the dog stabilized. Because of how high her cortisol levels were during her LDDS, she wants Coco to come in on day 5 for her first ACTH to see where we are in the load. At that time we will determine if we need to continue or if we have been successful. Of course, she said if I see any of the signs that her levels have normalized to call her and she will tell me whether or not to continue with dosing her. She has already told me that if anything happens, even at 2 am, to call her on her cell and let her know immediately. I've really lucked out with the vet. She is friends with a very good friend of mine and goes to the farm to treat her horses and due to a pug that had some major issues his first year the entire office knows me. After reading some of the stories on here I am so happy I have her.

[Squirt's Mom]

Wonderful! The dose is spot on and the directions from the vet are great! I am so glad she let you know there is the possibility the load will happen before that 5 day mark and told you what to look for! Excellent! Here are the loading tips again so you don't have to go looking. Lots of folk print this out and have it handy while loading.

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

You are off to a great start! We will be with you all the way!
Hugs,
Leslie and the gang

[CocoPuff]

So we are through the weekend and so far her load is going great, we are now on day 5. She is at the vet today to have her first ACTH, the vet wanted to check her levels and see if we need to continue. If so, the vet said I can take her back tomorrow while I'm at work so they can keep an eye on her and my boss is letting me bring her in on Friday when there aren't many people here. So far her energy levels are the same and she has slowed down slightly on how fast she eats, but not the amount and still has quite the appetite when it is time to eat. Her water intake has been really hard to judge but the vet and I discussed it prior to starting. I have been giving Pepcid prior to her eating but she still has had some horrible gas, which is typical for her. I think I've had a successful load so far! Next we're going to work on her incontinence, the vet said she may have a distended bladder from the excessive water intake that we will have to medicate for. She is still "leaking" but the vet said we will probably wait til a couple weeks after the load to make the determination.

[Squirt's Mom]

The slowing down in eating may well be he sign that she is loaded. Did the vet tell you to stop giving the Lsyo until the ACTH results are in? If not, I would do that in your shoes because of that sign - slowing down in eating.

It can take some time for the kidneys to recoup from the damage caused by the cortisol -and some never do slow down on urine production so the peeing never slows even after the cortisol is back in range. If your vet suggests Proin, please please please research that drug very very well before giving your baby one single pill. My Squirt took that and I didn't research first - she had a stroke and never fully recovered. I would have much preferred to clean up pee than to see her suffer for the 3 months following that stroke. She had nearly every adverse effect listed. :( Others have used Proin with no trouble at all but we had lots.

[CocoPuff]

She is at the vet getting her ACTH now so we will know this afternoon whether to continue the load, reduce the dosage or continue with what we've been doing. The vet has offered Proin and like you said its a chance as some do really well and some do really bad. Just like the Mitotane, some do really well and some do really bad. I'm going to allow her to even out with her Cortisol levels for a week or two to see how she's doing with the incontinence. I can't find diapers big enough for her (she's 95 lbs and should be 65) but have tried using men's underwear (it already has a hole for her tail) with a depends pad in it with some luck. Vet says we're going to take this one step at a time.

[CocoPuff]

Our Lysodren load is done! ACTH came back with her Cortisol baseline a little low but the second one came back well within normal. The vet is figuring out her maintenance dose and we should be starting next week. Vet said she should rebound on her baseline pretty quick and since she still has high energy and is eating well so she isn't concerned but for me to still keep an eye on her. So happy we made it through this initial load well!

[Harley PoMMom]

Could you get those ACTH stim results and post them here...thanks! When a dog has a successful Lysodren load their maintenance dose is their loading dose BUT it is spread out during the week instead of it being given every day, so since Coco loaded on 1000 mg, her maintenance dose would still be 1000 mg (as long as her ACTH numbers are within the therapeutic ranges ) but it would be divided up into smaller doses during the week....e.g.Coco could have her 1000 mg maintenance dose split in two 500 mg pills and one pill to be given on Monday and one pill to be given on Thursday for a total of 1000 mg for that week.

Hope I'm not confusing you :o

Hugs, Lori

[My sweet Ginger]

Lori, I think this makes Coco's dose is 2000mg per day. :)

She is 95 lbs and taking 1000 mg (500mg x 2) twice a day.

[CocoPuff]

She was 2000 mg during her load but she responded so well that her vet wants to maintain at 1000 mg per week until her next ACTH, starting in five days (Mondays and Fridays). She said we would see how she does on that then go from there. I believe her baseline was .7 and the second # was 1.4. The vet did note her baseline was low and said she was glad we did 5 days. I will post the actual results when I can look at them.

[Harley PoMMom]

...so since Coco loaded on 1000 mg, her maintenance dose would still be 1000 mg (as long as her ACTH numbers are within the therapeutic ranges ) but it would be divided up into smaller doses during the week....e.g.Coco could have her 1000 mg maintenance dose split in two 500 mg pills and one pill to be given on Monday and one pill to be given on Thursday for a total of 1000 mg for that week.

Hope I'm not confusing you :o

Hugs, Lori

It's what I bolded that is confusing ain't? What I mean is that the 1000 mg dose can be divided into 2 doses which would be 500 mg one day and 500 mg another day...for a total of 1000 mg :o

[CocoPuff]

That's what the plan is right now. 500 mg on Monday and 500 on Fridays until her next ACTH. She wants to see if that's the proper dose. It's all confusing but the vet is doing great talking me through it.

[My sweet Ginger]

All right then but those numbers are too low to me for comfort to start maintenance next week if they are indeed actual numbers. :o Let's hope they rebound enough by then.

[CocoPuff]

She was fine leaving the vets. She stayed there all day and I picked her up after work. Got home and she wouldn't eat, then threw up the water and snacks she had. Called the vet, I have her cell, and was told to give her pred and try to see if she'll eat small amounts of chicken and rice. She said more pred in the morning and we'll see about starting next week depending on how she comes through this. Vet said it could be low cortisol or stress from being at the office all day. Hopefully she starts picking up in the morning. She was doing great this morning and still a ball of energy this evening when I picked her up. What else do I need to look for tonight?

[My sweet Ginger]

I hope it's from her being at the vet all day but lethargy, sleepiness, back end weakness, wobbliness or swaying, diarrhea, vomiting are all signs of low cortisol.

[CocoPuff]

Her back end is fine and she's gobbling down chicken and rice. I'm hoping that it's stress but I also know these are all signs of low cortisol. Keeping an eye on her and vet said give her more pred in the morning and if she doesn't seem better I can take her in while I'm at work. The lethargy is hard to judge at this time of night because she's usually pretty ready for bed at this time of night. Fingers crossed she's doing better in the morning.

[Harley PoMMom]

I know how worried you must be, is Coco's demeanor the same? Yep, as Song posted, if you see any of those other side effects, especially diarrhea or more vomiting, I would recommend getting her into see the vet ASAP.

Hugs, Lori

[My sweet Ginger]

Yes, let's all hope she will do better tomorrow and it's good that she's eating good, probably pred doing it's job.

[CocoPuff]

She's drinking and eating after the pred. I've been in contact with the vet and she said depending on how she is in the morning will determine if she needs to come in. She's typically pretty laid back and fairly lazy this time of night. She's much more active and outgoing in the morning or when I get home. I figured tonight I'd get up and check on her every so often. Like I said though she was great this morning and leaving the vet around 6:30 tonight. Vet said she looked great leaving and that's why she was not so concerned about the low baseline today. Guess they can tank fairly quickly like this?

[My sweet Ginger]

Did Coco get her Lysodren this morning before ACTH?

[CocoPuff]

Yes, vet said to give it to her. Even called to double check that was correct. She seems to be sleeping comfortably right now. She was tested about 3 hrs after she had it this morning.

[My sweet Ginger]

She seems to be responding to pred tonight which makes me think her reaction from this evening is more likely from her cortisol going too low.
I'm concerned for the fact that Lysodren usually works another 48hours after administration therefore it seems to make more sense to me doing an ACTH after 48 hours but I'm seeing more and more that protocol not being followed. So in Coco's case the vet has to take the 48hr fact into consideration. Keep watching her very closely.

[CocoPuff]

Coco had an OK night last night. She woke up feeling better, another round of pred and she ate like a champ. As the day goes on she looks like she is feeling tons better. I spoke with the vet today and we are going to continue pred and wean her down over the next couple of weeks. We are also going back in tomorrow for another baseline, not a full test. She wants to do another baseline in a two weeks prior to starting her on maintenance. The vet seems to think that her low baseline yesterday from the loading dose coupled with the stress of being at the clinic and the car ride caused her to bottom out. Like I said, she was fine when we left the vet yesterday and it was right after we got home that she started acting down. Hopefully we are back on track and I just hope the limbo doesn't put too much strain on her system.

[CocoPuff]

We went in last night and just did a baseline cortisol test and she came back at .5 with normal being 1-5. The vet gave her an IV of dex (?) which she said is something they give Addison dogs. We are currently doing a pred regimen in hopes of getting her levels back up. We are going back Monday to get another baseline with another ACTH in two weeks. At that time we will determine whether to go to maintenance or continue pred. Vet thinks that she was over stimulated on Wednesday night and has told me to make sure she stays calm and not to stress her in any way right now. She has been panting constantly the past few days but that has stopped and her incontinence issues seem to be on the mend. I did ask the vet about the lyso working on them for 48 hrs and she said there are about 5 different methods for the load and she is using the one that has been the most successful for her in the past but of course one method does not fit all sp she is more than willing to listen to what I have to bring. Right now we seem to be through the worst and Coco does seem to be on the mend.

[molly muffin]

Just don't rush anything, let that cortisol come back up to a good level before starting maintenance.

We always seem to see a drop for 48 hours after the last dose of lysodren. I know there may not be a lot of literature on it, but we see a lot of dogs come through here and I think that has been the trend and one of the reasons we recommend the ACTH 48 hours after the last dose.

Hoping she continues to perk up, let us know. Just slow and steady back up to normal levels. :)

[CocoPuff]

Went in today for strictly a baseline reading. She is at 7.2 which I was told is normal for a Cush pup. We are continuing the pred and going back for the ACTH in two weeks based on the vets method. After the next ACTH we will ale a determination on the next step. Hopefully we can go to maintenance. I guess we'll see. In the meantime vet said not to do anything that would cause stress and to keep a calm environment at home for her.

[labblab]

Can you tell us how much Coco weighs, how much prednisone she is getting, and whether she had been given prednisone within 24 hours of the baseline cortisol? If so, unfortunately the prednisone itself would have elevated the cortisol level in a way that would make it impossible to assess Coco's natural cortisol rebound. If Coco did in fact go for more than 24 hours without pred before the test, then a baseline cortisol of 7.2 is way higher than a level that would be consistent with a continuing Addisonian condition. As you know, the treatment goal for a dog taking Lysodren is to have both a pre-ACTH and a post-ACTH result between 1-5. So if Coco's natural cortisol production has already rebounded to a baseline level of 7.2, I'm fearful that she will lose the benefit of the load during the next two weeks. But that level of natural rebound seems very unlikely after just a couple of days, so I'm feeling confused about Coco's situation right now.

I am also very puzzled by the statement that 7.2 is "normal" for a Cushpup, and am concerned that a full ACTH may need to be done sooner rather than later (without interference from supplemental pred). I'll be anxious to learn more specifics about Coco's pred regimen prior to this baseline cortisol testing.

Marianne

[CocoPuff]

Coco is 95 lbs and Friday, after being on Pred since Wednesday (when she crashed) she had a baseline reading of <.5. We started the pred regiman and continued over the weekend with 20 mg twice a day and retook the reading on Monday (yesterday) so it was probably affected by the Pred. At this point we have gone to 20 mg once a day and are going to wean her off the pred. We will be doing another full ACTH Stim in two weeks and deciding where to go based on that. I am somewhat concerned about her with all the different meds and bouncing back and forth with her cortisol levels. I should be able to pull the lab results off now.

[CocoPuff]

Initial LDDS results.

Cortisol, 8 hr Post Low Dexm 6.200 ug/dL Above Normal 0.100 - 1.400 ug/dL
Cortisol, 4 hr Post Low Dexm 1.100 ug/dL Above Normal 0.100 - 0.900 ug/dL
Cortisol, Baseline 6.400 ug/dL Above Normal 1.000 - 6.000 ug/dL

ACTH results after 9 loading doses (2000 mg x twice a day, Saturday - Wednesday morning)

Cortisol, Post ACTH, Cushings 1.700 ug/dL Below Normal 6.000 - 17.000 ug/dL

Cortisol, Baseline 0.500 ug/dL Below Normal 1.000 - 6.000 ug/dL

She crashed Wednesday night after being brought home from the vet's office. I contacted the vet and she was given 20mg of Pred that night, 20 mg Thursday morning, 10 mg Thursday evening and 10 mg Friday morning. Friday evening around 6:00 pm we went in for a Cortisol baseline. Due to low cortisol levels we also checked her electrolytes, which were all normal and she was given an IV of Dexamethasone.

Cortisol, Baseline 0.500 ug/dL Below Normal 1.000 - 6.000 ug/dL

We continued pred over the weekend, 20 mg, twice a day until Monday morning (yesterday) and went back in for a cortisol baseline.

Cortisol, Baseline 7.300 ug/dL Above Normal 1.000 - 6.000 ug/dL

Right now we are weaning her off pred, 20 mg once a day for four days, then 10 mg once a day for four days, then every other day, then every two days leading to her next ACTH.

Hope all this helps and gives you a better picture of what is going on.

[labblab]

Thanks so much for this additional information. Since Coco was taking a daily total of 40 mg. of pred over the weekend immediately prior to the Monday baseline, I do have to believe that the cortisol reading was reflecting the supplemental pred in addition to Coco's natural cortisol production. Unfortunately, I don't think you can separate the two out so as to know whether or not Coco's natural production itself was rebounding at that time.

I am glad to know that you will be tapering the prednisone. Coco has been taking some pretty high doses and I think it will be good to get the pred decreased sooner rather than later. I am not a vet, but from my experience here, it seems as though many GP vets tend to prescribe higher doses of pred during episodes of low cortisol than do specialists who work regularly with Cushdogs or Addison dogs. When a dog is acutely unwell, a higher dose may be called for temporarily. But in terms of ongoing supplementation, we have seen experts recommend a daily dose of pred that generally doesn't exceed much more than .2 mg/kg (which in Coco's case would not be more than 10 mg.: 95 pounds = 43 kg. x .2 = 8.6 mg. daily total). Here's an article that discusses pred dosing for dogs who are permanently Addisonian, but you will still catch the drift re: physiological replacement needs for dogs experiencing low cortisol. And even though Dr. Peterson talks about dosing every day for dogs that are permanently Addisonian, doing alternate-day dosing/tapers for dogs with temporary issues (as is hopefully the case with Coco) is indeed often recommended so as not to suppress natural adrenal function.

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

So the point of all this being...assuming that Coco continues to feel well, I am glad the pred is being tapered, and you will want to make sure she doesn't receive any supplemental pred for 24-36 hours prior to the next ACTH test. That way you will be certain that the ACTH will be testing her natural adrenal function and not the effect of the supplemental steroid.

Marianne

[CocoPuff]

Coco went in for her ACTH after tanking after her load. She's been on pred since she tanked and we have tapered her down to 10mg every other day. Her last dose of pred was Saturday evening so we were well over 24 hours when the test was done. Her ACTH came back normal and right where it needs to be! My vet is consulting with specialists prior to going to maintenance on the Lyso to see if we need to go with the initial dose she was going to do or back off (1000 mg a week or down to 500 mg a week). We already have her scheduled for her next ACTH 30 days out and can adjust again then if necessary. Due to the high stress the vet visit and car ride puts on her, my vet suggested Coco have her pred last night and one more dose on Wednesday. Fingers crossed that we have her Cortisol stabilized for now and hopefully we can keep it that way. Her baseline yesterday was 1.7 and post was 3.6(?) but I will have to double check that second number. I know my vet said she wanted to see between 3 and 4 on the post and we were there yesterday. She is doing great by the way and she has definitely rebounded from that crash!

[molly muffin]

I don't think you'd start her on the maitenance dose that she tanked on while loading. I think that you start them lower, since the risk would be that she would tank again.

One of the others can correct me though if wrong. I'm not as familiar with the lysodren protocol for after a crisis that required prednisone to recover from.
I know with trilostane, you wait for the cortisol to continue to raise and symptoms to return, but not sure if you do that with the lyso. :(

What did they decide to do as far as the lyso and dosage?

[CocoPuff]

Her loading dose was 2000 mg per day (two 1000 mg doses). I haven't heard back yet but the vet was leaning towards the 500 mg per week. Her symptoms have not returned yet and I think she was leaning towards starting next week, which will be two week from the last ACTH.

[labblab]

Hi again! I'm guessing that the "correct" maintenance dose for Coco is a bit of a roll of the dice. Since she went too low on her cortisol at the time of loading, I think you do indeed want to reduce the maintenance dose, but by how much? That's the big question. Given Coco's history, it does seem as though it is much safer to be conservative rather than aggressive with the dosing, although dropping clear back to only 1/4 of the loading dose may be too drastic a cut-back to keep her cortisol under proper control. Time will tell, and Coco's behavior coupled with subsequent monitoring ACTH will be the yardstick by which to measure future dosing tweaks. No matter what maintenance dose you go with, I agree that I'd want to perform another ACTH within a month in order to check her progress so that the cortisol does not get out of hand again.

Under normal circumstances, with Lysodren treatment you do not want to wait until symptoms rebound before starting maintenance. If cortisol has elevated highly enough to again cause symptoms, it is likely that the load has been lost and you'd have start all over again at square one. So yes, since Coco is once again behaving normally and this recent ACTH was right within target range, I'd think you'd be ready to launch into maintenance in order to keep the cortisol from increasing too much once again.

Definitely keep us updated as things progress, OK?
Marianne

[CocoPuff]

Talked to the vet last night and we are beginning maintenance tomorrow at 500 mg per week. She is already scheduled to go in for her ACTH in 30 days. She has perked up quite a bit and acting like her old self again (pre-cush) so hopefully her levels are right where they need to be. I still have pred on hand. A bit nervous about starting the maintenance but so hoping that we can maintain her where she is...she's doing tons better and even looking like she may be slimming up some :)

[Squirt's Mom]

That dose needs to be divided into 2-4 doses over that weeks time and not given all at once. Giving her 125mg 4x a week would be my choice if she were mine. Also, I would want an ACTH at the 2 week mark just to be on the safe side...UNLESS I saw signs she had gone too low again. Then if all was ok at the 2 week mark, wait for 30 days then check again.

[labblab]

Yes, actually I do agree with Leslie about retesting after two weeks. I know the testing is stressful and expensive, but if the 500 mg. is either too high or too low, it would be much better to find that out sooner rather than later. I'm so glad Coco's feeling better now, though!

Marianne

[CocoPuff]

Hi All! Coco was doing really well on her maintenance dose. We went in for her ACTH and her levels came back right where the vet wanted to see them, this was back in December. Shortly after, my family and I went on vacation for the holidays and had a house sitter as we felt this was the best for her to reduce stress levels. Well, came home after being gone and she crashed. Took her to the vet, her Cortisol baseline was .6 and she needed fluids and a DEX shot. Unfortunately I had no choice but to leaver her again (had to get the stepkids back to Mom before the break was over) and the pet/house sitter picked her up that night, followed the pred regimen and she was great when he picked her up. We came home on Sunday and all seemed well until I went to work yesterday and when I got home she didn't look like herself and appeared to be crashing again. She has been on pred (20mg per day) for a week now and has not had her Lyso (500mg per week and she's a 95 lb lab) since the 26th. I'm starting to wonder if the treatment is causing too many ups and downs and if it would be better to not treat. The vet has mentioned moving to Trilostane and I don't know if I should try that. She seems to be easily stressed and this seems to be causing the issue. Any advice would be welcome. We've been treating since October.

[molly muffin]

Oh no.

When they go too low on lysodren, there is a good chance that she is now Addisons. Keep her on prednison, let the vet know she is crashing again and see if they want to up the dosage of pred, she might need more electrolyte fluids too.
What normally is done, is you keep her on prednisone for a bit and then under the vets direction, start to slowly taper off and see if her adrenal glands will produce on their own again. Sometimes they do, sometimes they don't.
If not, then she will be Addison and on treatment for that.
In Europe, eons ago, they use to actually induce Addison in cushing dogs as they felt that was easier to treat than Cushings.
But for the moment it is too early to think about switching her to trilosane. It might never be needed.
Lets see how she does.

[CocoPuff]

Her body gave out last night. We were continuing her pred and I had been in contact with vet. Unfortunately, she appears to have had a heart attack based on what happened. She was gone by the time we arrived at the vet. Thank you guys so much for the help on here.

[labblab]

Oh Kelly, I cannot tell you how sorry I am. Please know that Coco will always be honored and remembered here, amidst all our other treasured souls.

http://www.k9cushings.com/forum/showthread.php?p=183303#post183303

She was such a brave girl, and you tried everything within your power to heal her. I am truly so very sorry. Please know that you will always remain welcome to return to us to talk or to share stories about your lives together. Your entire family here shares your sorrow on this sad day.

Sending many hugs across the miles,
Marianne

[judymaggie]

Kelly -- my sincere condolences on the passing of your dear Coco. You took such good care of her and did everything possible for her.

[molly muffin]

Oh no Kelly. :(. I am truly so sad to hear this news. My condolences on your loss. :(.

[mytil]

Oh no, I am so very sorry!!!! My heart is with you and your family. She knows you did everything you could for her.

((((hugs))))
Terry

[CocoPuff]

Thank you all for the kind words. She is greatly missed.