dry skin

[lozadaNY76]

hi my name is Shannon and my dog is Jordan he is a nine-year-old golden retriever or. Jordan has been told he does not have Cushing's however all of his symptoms point towards it. I am at a loss and not sure what to do but to get him retested again. He suffers from very very dry skin now and I don't know how to treat it. I have tried that vet prescribed shampoo and that has not worked anybody have any ideas.

[Harley PoMMom]

Hi Shannon,

Welcome to you and Jordan! We're a nosy bunch here and we would really appreciate it if you could tell us some more about your boy's treatment history, in this way we can provide you with better feedback, ok?

If you could please get copies of the testing that was done on your boy and post the results here that would be great. With respect to the blood chemistry and CBC, you need only post the highs and lows and please include the reporting units and normal reference ranges. Have any diagnostic tests for Cushing's been performed, and if so, could you post those results too? Does Jordan have any underlying illness that he is taking medication for, and if so, what is it and what is the medication? Could you tell us what symptoms Jordan is displaying? Has hypothyroidism and diabetes been ruled out? Does Jordan have diluted urine?

Cushing's is probably the most difficult canine disease to diagnose. Physical symptoms associated with Cushing's are shared by many other diseases, blood and urine abnormalities are shared with other other diseases and the diagnostic tests to measure circulating cortisol are flawed and can yield false positive results in the face of non adrenal illnesses or even stress. All of these things make it very challenging to correctly diagnose Cushing's which makes it one of the most misdiagnosed canine diseases. There isn't one test that can accurately identify it so multiple tests are needed to validate a diagnosis for Cushing's. Cushing's moves at a snail's pace so one does have time to get a confirmed diagnosis for their pet. The sole purpose of treatment is to remedy problematic symptoms as the medications used for Cushing's do not to cure it.

Please know we are here to help in any way we can, and if you have any questions do not hesitate to ask them. ;)

Hugs, Lori

[molly muffin]

I want to say hello and welcome. I love golden retrievers, just beautiful lovely dogs. (yes I had one for a long time)

First you would want to rule out things like thyroid, diabetes, gallbladder, pancreatic issues, usually if one of these things, it will show up in a cbc blood test. Has that been done?
Also rule out a UTI. If the urine is very dilute (is his concentrated or dilute) then a culture is often needed to determine if infection present.

If these options are all negative, then you'd move on to cushings testing, with say an LDDS test.
Also if feasible an ultrasound could be beneficial to see if there is anything going on with the internal organs.

[Wuchi]

While they are trying to find out what is causing the dry skin there are a couple of things to try to sooth the dogs skin some:
-- coconut oil, only use "Unrefined"(Safeway, drug stores, Trader Joes, etc carry it): usually used on dry paws and belly. Just place some in palms and rub together to warm before applying. You can also give the dog a small amount in food. Helps with itchy, dry skin.
-- fish oil (pet stores): give a small amount in food -- amount/# is listed on the bottle. For smoother coat and to help with dry skin.

Both of these contain fat so watch the amount you give especially if a pet is prone to pancreatitis.

[Wuchi]

Has your dog been checked for allergies? Definitely do the blood test first as mentioned in above posts. If the blood test is ok, if you haven't already, there might be food and/or environmental/chemical allergies involved. Check their food on Dogsdvisor.com (look at comments section for your food and see if others are having similar symptoms -- a lot of dogs are alergic to corn and chicken), consider taking the Dodds allergy test, try to figure out if anything in their environment changed since dry skin started (new laundry detergent, floor spray, etc)...

Does your dog have thinning skin and/or hair loss -- a lot of Cushings dogs do.

[lozadaNY76]

Hi my name is Shannon and my 9 year old golden retriever in in the process of possibly getting diagnosed with Atypical. July of last yearI noticed a pot belly when giving him a bath. My vet tested for Cushings but labs came back fine with the exception of a UTI. We were back in September for an increase in urination (he had an accident) and the pot belly again. They said the cause of the pot belly was that he was eating thing outside and his belly was full of rocks, waste, dirt and so on he also has another infection. Sadly that did not stop the increases peeing, pot belly, hunger like I never seen and now massive dry skin flakes and I could start to feel his back bone and his eyes got huge and he aged over night. My vet did another Set of Cushings tests and they came back normal again. I was sent to an internal meds specialist. He did the same tests along with imaging tests. Found a blood clot in a vein going on the liver. Put him on plavix to see if that would help. Came back with same issues plus loss of muscle and significant weight loss. next week he has tests to be done and sent to the University of Tenn.

I can't find much information on this illness and am looking for a place to be able to discuss his results when we get them. Thank you for having this forum!

[Harley PoMMom]

Hi Shannon,

I've taken the liberty and moved your post that was in another member's thread and placed here in Jordan's original thread, in that way all information regarding Jordan is in one place.

Could you get copies of all tests that were done on Jordan and post those results here? I see that he is being tested for Atypical Cushing's, is this the University of Tennessee's adrenal panel that is being sent there? What kind of infection does Jordan have? Were diabetes and a thyroid issue been ruled out?

I am providing a link to our Helpful Resource forum that includes articles regarding Cushing's and written by some of the most renown veterinarians that specialize in endocrinology, we also have a thread there with information about Atypical Cushing's for which I will add that link too.

Helpful Resource thread: http://www.k9cushings.com/forum/forumdisplay.php?f=10

Atypical Cushing's: http://www.k9cushings.com/forum/showthread.php?t=198

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

Hugs, Lori

[molly muffin]

It is possible that Jordan has atypical. This would be determined by the test that is being done and sent to U of Tenn. With atypical, you have normal cortisol levels and you have other sex hormones elevated. I'm told that they want to see at least 2 of the other sex hormones elevated to classify it as atypical.

The treatment for atypical cushings is very benign and you can begin to add in to his regular daily diet. Lignans and melatonin. It normally takes about 4 months to see if it will work.

[kspach]

Shannon,
Just wanted you to know that it took 2 weeks for the test results to come back from the University of Tennessee, in case you are wondering. Nobody told me that it would take so long. Will be interested in what your results will be. Keeping you and Jordan in my thoughts.
Kathy

[lozadaNY76]

Hi everyone. I did not realize Imposted in Jan as well as June. Sorry for the redundancy. I am also not sure how to reply to each one of you so I am just posting answers. I will post all test results tomorrow.

Lori, thank you for setting this up for me. Kathy, yes I know the wait time for TN. I expect the results from the tests buy the begin of July.

Jordan has had allergies in the past but they are not prevalent now. I home cook for my dogs because of his allergies. He has thyroid and takes medication for that. He takes Levothyroxine. Diabetes was ruled out as well as a number of other things based on his CBC. He had ultrasounds, urinariay analysis, and yes his urine is diluted and he gets UTIs. His last was in February of this year. He has had a chemistry panels done. He had LDDST test in December and his cortisol levels were fine. The test being done by TN is the adrenal panel combined Dex/supp/acth.

I started Jordan on lignans and melatonin at the beginning of March. I had to take him off for 10 days for the test being done at TN but he is back on them now. I give him 5 mgs of Melatonin (K9 Choice) 2xs a day and 2capsules of Flaxseed Lignans a day ( he is 78 lbs). He also takes Pet tabs vitamin daily, fish oil and dasaquin. I add a probiotic to his food since I home cook.

It is easier to ask what symptoms Jordan does not have. He suffers from muscle wasting, pot belly, constant thirst and hunger (to a point that he was eating everything outside until we realized it after he had to have an enema). He is not active as much his hair is thin and not growing back, has dark patches on his skin and he is constantly shedding dry skin (dry with large amounts of seborrhea).

[Harley PoMMom]

He had LDDST test in December and his cortisol levels were fine.

Just for clarification for my feeble mind :eek::) This was an ACTH stimulation test that was performed in December and not a LDDST, right? The ACTH stimulation test is used for monitoring the treatment for Cushing's...and I know I'm a pain in the butt, sorry, but could you please post those results for us. :o

Hugs, Lori

[lozadaNY76]

Just for clarification for my feeble mind :eek::) This was an ACTH stimulation test that was performed in December and not a LDDST, right? The ACTH stimulation test is used for monitoring the treatment for Cushing's...and I know I'm a pain in the butt, sorry, but could you please post those results for us. :o Hugs, Lori

I will post what I have. The December results reference LDDST.

[labblab]

That will be great if you can get the actual test results. And in looking back through your thread, it looks as though the December test was a diagnostic test as opposed to a monitoring test (Cushing's medication had not yet been started). So a LDDST would have made sense at that time. The actual numbers will still be helpful, though. ;)

Marianne

[lozadaNY76]

Do I need to type everything in or can I scan the documents in?

[labblab]

All we need are typed results that are abnormally high or low on general lab tests, along with the normal range. For the LDDST or any other Cushing's-specific diagnostic tests, please type out all the test numbers.

[lozadaNY76]

I got the results from the university of TN. I will post them today. Vet says that he has Cushing's not Atypical. He is not sure why his tests were coming up negative before. Is that something any of you have experienced?

[molly muffin]

He has cushings in that the cortisol was high on the UofT test?

Do you know if it was the ACTH test that the other vets where doing, or was it the LDDS test?
The reason I ask is because Tenn would be doing an ACTH plus sex hormone test on the blood. If the other vets were consistently doing an LDDS test, the gold standard for diagnosis, then I can say, yes we have seen that, in my own dog.

My dog never tested positive on an LDDS but did consistently on ACTH, showing high cortisol.

Type out, just what is high or low on any tests results withe test, the result, the range

[lozadaNY76]

My vet did LDDS. The university did the ACTH.

[molly muffin]

The LDDS is what my dog always tested negative on too. It's rare for that to happen consistently but as we both know it can happen. We had some thoughts that there was something else going on causing the high cortisol.

The thing is that the high cortisol will eventually cause problems with other organs, and that is why we eventually started treatment eventually.

[kanga]

Hello don't know if this was mention here! Mine before has the same problem like yours before I find out with the help of my friends and also I ask my vet for some helpful solution of that skin problem and my friends and vet told me about this "VIRGIN COCONUT OIL" (http://www.dogingtonpost.com/benefits-of-coconut-oil-for-dogs/) that was great and now it's resolve because of this, hope it will helped you with your problem.

[lozadaNY76]

Yes we use coconut oil

[lozadaNY76]

TEST RESULT (baseline). NORMAL RANGE** BASELINE RESULT NORMAL RANGE** POST-ACTH
Dex Supp
4hr 8hr post ACTH
Cortisol 4.6 <1.0-5.6 6.4 2.1 37.4*. 7.1-15.1
Androstenedione 0.12 0.05-0.36 0.16 0.11 1.46 .24-2.90
Estradiol 45.5 23.1-65.1 47.0 50.4 44.4 23.3-69.4
Progesterone <.20 <.20 .23 <.20 3.76* .22-1.45
17 OH Progesterone .28* .08-.22 .99 .38 9.83* .25-2.63
Testosterone <15.0 <15.0-24.0 <15.0 <15.0 <15.0 <15.0-42.0

*Above or below average

Comments: baseline 17-OHP is elevated along with elevated post-ACTH cortisol and progestin concentrations indicating adrenal hyper function. Deviation from Referernce intervals is marginal (baseline 17-OHP) to significant (post-ACTH elevations)

[lozadaNY76]

The vet wants to start Jordan on Lysodren, 500mgs one and a half pills 2 times a day for 9 days then do another test on him.

[judymaggie]

Hi! I looked back through your thread and cannot find how much Jordan weighs. The Lysodren loading protocol recommends 50 mg./kg/day -- I just wanted to check your vet's dose of 1500 mg./day.

Here is a link to Lysodren loading and maintenance guidance from our Resource forum:

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

Go to the second post. Please note that Dr. Feldman, who is an expert in the field, advises that, if a dog has not yet loaded by day 8, an ACTH should be run. Your vet is saying "9 days" which obviously is not too far off. However, please know that many dogs load before day 8 or 9 and it is critical that the Lysodren be stopped as soon as loading has occurred. Therefore, if you are seeing signs of loading (see link -- second post which lists the things to look for) regardless of what day it is, you should not administer the Lysodren that day and call your vet to schedule an ACTH for the next day.

It is critical that the Lysodren be given after a meal. This way, if you see a change in Jordan's eating habit (he walks away or pauses or whatever might be different than usual), you do not give the Lysodren. If you have not been measuring Jordan's water intake, I would suggest you do that for a couple of days prior to starting the Lysodren and then continue during loading so you have some comparison.

Since Lysodren can cause stomach upset, I would suggest that you give Jordan some Pepcid AC (original) 20 minutes prior to the morning meal. You can check with your vet on the appropriate dose for Jordan's weight. Also, be sure that your vet gives you prednisone to have on hand -- it should be dosed as an emergency dose which is different than that used for other purposes. I can't recall the formula off-hand.

My Abbie loaded after 6 days -- her water intake slowed down significantly after 3 days but she was fine otherwise. I waited until I saw a change in eating habits -- she normally inhaled her food. That morning she ate a few bites and then looked around, walked away and eventually went back to her bowl. I did not give her any Lysodren that morning and had the ACTH the next day. I printed out Dr. Feldman's protocol and kept it out on the counter so I could check it frequently -- this made me less nervous during loading.

I did start the Lysodren mid-week so that the chances of her loading during my vet's hours were greater. My vet also gave me his cell phone number and said I could call him whenever I had concerns -- I know not all vets would do that but it was comforting.

We will be here with you during loading -- if you have any questions at all, please check in with us.

[lozadaNY76]

as of June 13 Jordan was 78.71 lbs (35.7 kg)

I will review the post you suggested. Thank you.

[kanga]

How's your pup now?

[lozadaNY76]

he's ok. still has all the symptoms. but doing ok,

[lozadaNY76]

What does loaded mean?

[judymaggie]

Morning! "Loaded" refers to a dog who has completed the period of time that it is being given the high dose of Lysodren and has decreased hunger, significantly decreased water intake, lethargy, diarrhea, etc. An ACTH is then done. Lysodren is stopped until the results of the test are in. Then the vet determines what the weekly dose of Lysodren will be based on the test results and how quickly the dog loaded. Typically, the weekly maintenance dose is the same as the daily dose was during loading. For Jordan, this would mean giving him 1500 mg spread out during the week, usually in two or three doses (for example, 500 mg. three times a week).

Your vet's recommendation of 1500 mg a day during loading fits with the recommended dose of 50 mg/kg/day. The exact dose according to the formula would be 1750 mg but the pills are really hard to accurately break into quarters.

[lulusmom]

Judy has provided you with excellent information on Lysodren but I wanted to share a bit more info with you about what loaded means.
The goal of treatment is to reduce cortisol production gradually until just the right level is reached. The right level is when the pre and post acth stimulation test results are between 1 and 5 ug/dl. It is at this point that the dog is considered loaded. Lysodren is a very serious drug that has a cumulative effect, and when administered in large daily (loading) doses will kill enough adrenal tissue to effectively stem the flow of cortisol. Every dog is different in terms of how quickly their cortisol production decreases in response to lysodren which is why we pet owners have the huge responsibility of monitoring our dogs for the signs mentioned by Judy and also contained in the lysodren loading instructions. If you miss a sign of loading and continue to dose, cortisol can drop too low and your dog can get pretty sick. I know from experience that this can happen even if we do an excellent job of monitoring. My second cushdog's pre and post acth stimulation results were .8 ug/dl which are scary low but fortunately he never got sick. I did, however, give him a rescue dose or two of prednisone for good measure. You do have prednisone on hand, right? If not, do not start loading until your vet give you a prescription.

With respect to the best time to start loading, I personally recommend that you go with Dr. Edward Feldman's instructions. He wrote the book on Lysodren and prescribed it to his many patients at UC Davis for decades. The vast majority of dogs will achieve loading between days 5 and 8. Based on the law of averages, he recommends that you start loading on Saturday which is the best day for making sure your vet's office will be open should serious adverse reactions occur. He also tells the vets listening to his lectures to make sure they call their clients daily, starting on day two to get updates. Lysodren is a serious drug and he doesn't trust a client to be diligent in their monitoring of their dog and to remember everything to watch for. He therefore calls his clients and quizzes them on what they have observed and how the dog is feeling to make sure they haven't missed anything.

I hope your vet has provided you with proper counseling and will be keeping in very close contact with you during this time. Regardless, we're here to answer any questions you may have and support you in any way we can. Once you start loading, please check in with us every day to give us an update.

Glynda

[lozadaNY76]

my vet said nothing about prednisone? what is the dosage I should ask for? Also he wants to start loading on a Wedneday. Is that safe?

I work during the day, how do I monitor him then?

[lulusmom]

Oh my, I am very concerned that your vet did not know that providing pet owners with prednisone prior to loading with instructions to use in the event of emergency is not an option, it is mandatory. Jordan's weight is 78 pounds which converts to 35 kg. The rescue dose of prednisone is .2 mg/kg. Jordan's dose would be 7 mg. Exactly what instructions did your vet provide for loading Jordon?

I always started loading my dogs on a Saturday. I always made sure I watched my dogs like a hawk when they ate their breakfast and dinners so that I could detect absolutely even the most subtle change in eating habits. I always took vacation when I loaded my dogs. If you cannot take time off, you need to make absolutely sure that you can at least monitor Jordan while he is eating in the am and pm so you can detect any changes. If there is any question at all, it's always better to stop dosing and have an acth stimulation test to make sure.

Now that we've provided you with a whole lot of information on Lysodren, can I ask why your vet chose Lysodren (mitotane) over Vetoryl (trilostane)? Lysodren is rarely prescribed because of the much greater frequency of side effects, which is why your vet should have talked to you about how important it is for you to be there while loading. I am thrilled that you are asking extremely important questions that we can answer for you but I am very concerned with your vet's ignorance of proper protocol, which was established for SAFE and effective treatment. At this point, I'm tempted to ask you to either consider switching treatment to Vetoryl or changing vets. I have also treated my dogs with trilostane which is the compounded version of name brand Vetoryl. If you cannot commit to staying home with Jordan or have someone else with him while you are at work, I would highly recommend that you talk to your vet about switching to Vetoryl. If your vet chose Lysodren over Vetoryl for cost reason, you can always go with compounded trilostane from a reputable compounding pharmacy, which is hugely cheaper than name brand Vetoryl. Many of us use Diamondback Drugs in Arizona.

[lozadaNY76]

I think he choose that form of treatment due to cost and maintenance and that it is the common treatment for the disease.
I will most likely not be home to watch the loading. I have been unemployed for 7 months and I may be hired this week for a new job to start. I as you can see I can't ask for a week off. Is Lysodren not a good option? I have read that Trilostane (vetroyl) can have dangers too. I read it here on one of the forums.

[lulusmom]

I have treated my dogs with both treatments and both were equally effective. I would be open to treating with either drug if I were to have a future dog diagnosed with cushing's; however, I am very familiar with both and have had several years of hands on experience and over a decade of obsessive research on the disease and its treatments. I can appreciate that your vet is compassionate and is trying to help you by cutting expenses but I can tell you from experience that when my own dog paid the price for my vet's ignorance, I had zero compassion for that vet and if I could, I would have punched his lights out.

It is our goal to provide you with as much information as possible so that whatever decision you make for Jordan is an educated one. If you move forward with Lysodren, I highly recommend that you don't start the loading process until you have made a very concerted attempt to educate yourself because the onus is on you to protect Jordan. The good news is that you have us to help you do that. Cushing's moves at a snail's pace so take another week to educate yourself before you start loading and whatever you do, do not start loading without prednisone. I am pretty busy today but I'm going to try to find and post some information I ran across in a veterinary teaching textbook that spells out what a vet needs to tell their clients before sending them home with Lysodren. If I can find it for you, I highly recommend that you share it with your vet. You will not be the first member to provide free continuing education for their vet. :D

To answer your question about trilostane, yes it can have very serious side effects as well but it's mode of action is completely different and because it's half life is so short, the majority of side effects resolve without the need for prednisone by simply withholding the drug. If a dog gets sick on Lysodren, especially during the loading phase, you can stop dosing and the dog still may get sick because of its cumulative effect. Regardless of the drug chosen, it is imperative you do your best to learn about the drug and how treatment is monitored for safety and efficacy.

Glynda

P.S. We'll be keeping fingers and paws crossed that you get the job.

[DoxieMama]

Hi there, I don't have anything to offer beyond what Glynda has provided. But I wanted to post as we've experienced our share of unemployment over the years.... GOOD LUCK with the job offer!!

[lulusmom]

I've finally had time to track down the client information I mentioned previously and have posted it below. This was written by Dr. Edward Feldman for vet students who will eventually be veterinary internal medicine specialists and will be counseling their own clients in the future. Dr. Feldman is a very well published, expert endocrinologist who has co-authored veterinary internal medicine textbooks for many years.

Dr. Feldman instructs his clients to reduce their dog's food intake but the vets and specialists who cared for my cushdogs didn't provide me with those instructions. My cushdogs had incredible appetites. They foraged for food constantly, begged and drove me nuts so I didn't feel food restriction was necessary. Someone could have shot off a cannon next to their head while it was in their food bowl and they wouldn't have looked up before their bowls were licked clean, looking like they just came out of the dishwasher. :D Dont' be confused by the name o,p'-DDD. That is the chemical name for Mitotane which is the active ingredient in Lysodren.



Third Edition - Feldman and Nelson Canine and Feline Endocrinology and Reproduction
Chapter 334 – Canine Hyperadrenocorticism (Cushing’s Syndrome)

CLIENT INFORMATION

o,p’-DDD Treatment of Pituitary Cushing’s

Hyperadrenocorticism (Cushing’s syndrome) refers to a clinical condition that results from having excess cortisone in the system. A minority of dogs with this disease have a tumor in one of the two glands that produce cortisone (the adrenal glands). Your dog, like more than 80% of dogs with the naturally acquired form of this disease, has a small tumor at the base of the brain in an area called the pituitary gland. The pituitary gland controls adrenal function. A tumor in the pituitary can cause excess cortisone throughout the body and results in symptoms recognized by owners (“pituitary-dependent” Cushing’s). The most common symptoms of Cushing’s syndrome in dogs include excess urination and water consumption, a voracious appetite, hair loss, muscle weakness, a “pot-bellied” appearance, panting, thin skin and lethargy. Virtually all dogs with Cushing’s syndrome have at least one or two of these signs, but it would be uncommon for a dog to have all these symptoms. By evaluating a variety of test results, your veterinary has diagnosed your dog as having pituitary-dependent Cushing’s. Now, treatment with o,p’-DDD has been recommended.

During World War II, scientists did research on the insecticide DDT in an attempt to create an extremely toxic agent. One of the forms of DDT created was o,p’-DDD (Lysodren; Mitotane), a chemical which can destroy the cortisone producing cells of adrenal glands in dogs. The drug has been used successfully in thousands of dogs with Cushing’s but you must remember that it is “poison” and that it must be respected and used appropriately. The protocol we use in treating dogs with this drug is straight-forward. A day or 2 before starting treatment, begin feeding your dog 1/3 of its normal food allotment twice daily (each 24 hours it should receive a total that equals 2/3 of the normal amount). This should make your dog even more hungry, but this is just for a brief time (we do not recommend use of this drug in dogs with a poor appetite). After 1 or 2 days of reduced feeding, begin giving the o,p’-DDD at a dose of 25mg/kg of body weight twice daily (a dog weighing 22 pounds would receive ½ tablet twice daily; the tablets contain 500mg). The drug should be given immediately after the dog eats. So feed your dog, note how long it takes to finish the meal, and then give the medication (the drug is absorbed best from a stomach containing food).

The key to treating these dogs is watching them eat and knowing when to stop giving the o,p’-DDD. As long as their appetite is ravenous, give the medication. As soon as you see any reduction in appetite, STOP giving the drug. Reduction in appetite may be noted as taking longer to finish the meal, the dog may eat ½ of the food and wander wary for a drink and then finish, the dog may simply look up at you (the owner( once or twice before finishing. In other words, we do not want your dog to stop eating entirely, we wish to see a “reduction“ in appetite as a signal to stop the medication. Other signals to stop giving the medication include reduced water intake, vomiting, diarrhea, and listlessness. But, appetite reduction usually precedes these more worrisome symptoms. Most dogs respond to this drug in 5 to 9 days, a few in as little as 1 to 3 days and some may take longer than 14 days.

No dog should receive more than 8 days of o,p’-DDD without being tested on the effect of the drug. The test is done by your veterinarian and will take 1 to 2 hours. We typically start the treatment on a Sunday, plan the recheck test 8 days later (Monday) and more than 85% of owners have stopped medication on the Thursday, Friday, Saturday or Sunday before the test performed on Monday. Once the o,p’-DDD has been demonstrated to have had effect, your dog no longer will require food restriction. Your dog will continue to receive o,p’-DDD the rest of its life. The initial maintenance dose is usually approximately 50mg/kg per week (a 22 pound dog would receive 1/2 tablet 4 times a week). That dose will likely be increased or decreased based on testing performed 1 month after maintenance treatment has been started and on testing performed every 2 to 4 months, thereafter. The average dog (11.5 years old when the syndrome is diagnosed) treated in this manner lives about 30 months (some live a few weeks and some for 6 – 10 years). The dogs with the longest survival have owners who are committed to helping their pet, diligent veterinarians, and luck. Close observation and frequent veterinary rechecks can only help in the long-term management of these dogs.

[lozadaNY76]

thank you so much for all of this information. I did get the new job also!

[Joan2517]

Yay! Congratulations!

[DoxieMama]

I did get the new job also!

WOO HOO!! Congratulations!! :D

[judymaggie]

Super congrats on the new job! :D Be sure to let you know when you start the Lysodren so we help you get through the loading stage.

[molly muffin]

Congratulations! Awesome news about the job. :)

You don't have to be there during a load, you just have to be vigilant and do things in steps. Like give him food before the lysodren. If he hesitates at all, even a bit or slows down in a not normal kind of way, then that can be a sign that the load is done and you don't give any more lysodren. Then you have the ACTH 2 days later.

I know we all want to be right there the entire time that a load is going on or a new drug is started but it is seldom feasible and especially with starting a new job.

[lozadaNY76]

We start loading this weekend. I spoke to the vet and his response to my question to the Prednisone is that this is how he prescribing the drug Lysodren and that prescribing prednisone is an old method and they prefer to have the dog go to vet if he exerts signs of distress.

I am so confused

[DoxieMama]

I don't think anyone is saying NOT to go to the vet. They're only saying have prednisone on hand so you can give it to him immediately and then head straight to the vet! (Is your vet open 24 hours? How long does it take you to go from home to the vet's office?)

[labblab]

Hello and a belated welcome from me, too. It seems possible that there may be a bit of confusion as to what we mean when we encourage having prednisone on hand. We are only talking about having prednisone to give as an emergency "antidote" should a Lysodren overdose be suspected. What your vet may be referencing is a largely outdated practice of giving small doses of prednisone daily, alongside the Lysodren, with the intention of blunting side effects. That practice is no longer commonly endorsed for the very reason that the daily prednisone can mask the signs that the loading phase has been completed.

In terms of having a supply of prednisone on hand in case of emergency overdose, however, that is a different situation. As Shana has just asked, do you have a vet that is readily available to you 24/7? If so, that would be the only situation where the prednisone is probably not necessary. It is true that, ideally, you would want to rush your dog in for evaluation as soon as you suspect trouble. And if you can do that -- take your dog in immediately -- then actually you would not want to give any prednisone because it will interfere with the monitoring ACTH testing for at least 24 hours thereafter.

However, for many folks, the emergencies seem to occur most likely during the night or on the weekend when the vet is not readily available. In that situation, you need to have prednisone on hand to give during the interim, until your dog can be professionally evaluated. So unless you have access to a vet at all times, it is really important to have some emergency prednisone on hand.

Marianne

[lozadaNY76]

The emergency vet is 6 min away and open 24/7

[Squirt's Mom]

Oh! Then you are very lucky and I personally feel much better about the denial of Pred for your baby. Be sure you know the signs of an over dose and have a plan in place for getting to the ER vet quickly should see anything suspicious.

Let us know how things are going!
Hugs,
Leslie

[lozadaNY76]

it there something posted on the forum listing the signs

[labblab]

In answer to your question, I'm going to repeat Judy's excellent advice given earlier in your thread. Please click on the link she has given you for a discussion of indications as to when you should stop giving Lysodren or when overdosing had occurred.


Hi! I looked back through your thread and cannot find how much Jordan weighs. The Lysodren loading protocol recommends 50 mg./kg/day -- I just wanted to check your vet's dose of 1500 mg./day.

Here is a link to Lysodren loading and maintenance guidance from our Resource forum:

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

Go to the second post. Please note that Dr. Feldman, who is an expert in the field, advises that, if a dog has not yet loaded by day 8, an ACTH should be run. Your vet is saying "9 days" which obviously is not too far off. However, please know that many dogs load before day 8 or 9 and it is critical that the Lysodren be stopped as soon as loading has occurred. Therefore, if you are seeing signs of loading (see link -- second post which lists the things to look for) regardless of what day it is, you should not administer the Lysodren that day and call your vet to schedule an ACTH for the next day.

It is critical that the Lysodren be given after a meal. This way, if you see a change in Jordan's eating habit (he walks away or pauses or whatever might be different than usual), you do not give the Lysodren. If you have not been measuring Jordan's water intake, I would suggest you do that for a couple of days prior to starting the Lysodren and then continue during loading so you have some comparison.

Since Lysodren can cause stomach upset, I would suggest that you give Jordan some Pepcid AC (original) 20 minutes prior to the morning meal. You can check with your vet on the appropriate dose for Jordan's weight. Also, be sure that your vet gives you prednisone to have on hand -- it should be dosed as an emergency dose which is different than that used for other purposes. I can't recall the formula off-hand.

My Abbie loaded after 6 days -- her water intake slowed down significantly after 3 days but she was fine otherwise. I waited until I saw a change in eating habits -- she normally inhaled her food. That morning she ate a few bites and then looked around, walked away and eventually went back to her bowl. I did not give her any Lysodren that morning and had the ACTH the next day. I printed out Dr. Feldman's protocol and kept it out on the counter so I could check it frequently -- this made me less nervous during loading.

I did start the Lysodren mid-week so that the chances of her loading during my vet's hours were greater. My vet also gave me his cell phone number and said I could call him whenever I had concerns -- I know not all vets would do that but it was comforting.

We will be here with you during loading -- if you have any questions at all, please check in with us.

Marianne

[lozadaNY76]

Thank you all again. I completely forgot she posted that information already. So scatter brained lately. We start the medication Tuesday.

[molly muffin]

Let us know hoe it goes and if you have any concerns luckily the ER vet is right there and we will be here with you.

[lozadaNY76]

Thank you all so much!

[Whiskey's Mom]

Yes good luck from a fellow golden parent And her furry kid! :)

[lozadaNY76]

Jordan has completed day 2 of his Lysodren loading. Have not seen any issues or changes yet. Keeping my fingers crossed for an uneventful loading!

[Harley PoMMom]

Keeping my fingers crossed for an uneventful loading!

Me too! ;) I will be checking for those updates!! :) And if you have any questions please ask them. One more thing, just in case this wasn't mentioned, any slight hesitation or pause in eating can be one sign that Jordan is loaded.

Hugs, Lori

[lozadaNY76]

How long does an ACTH storm test take?

[DoxieMama]

One or two hours, depending on what they use. http://www.endocrinevet.info/2011/03/whats-best-protocol-for-acth.html

[lozadaNY76]

We have started day 6. Jordan is still eating but I did notice he did not finish his treat of a frozen carrot. Should I be concerned?

[judymaggie]

Hi! Not a concern -- just keep being vigilant. Be sure to watch Jordan when he eats in the morning. If he deviates from his typical eating pattern (hesitates, walks away, only eats a portion of regular amount, etc.), then don't give him the Lysodren and call your vet to let him know that Jordan has loaded and it is time to schedule the ACTH.

Keep up the good work -- you are doing great!

[lozadaNY76]

Thank you. He is currently scheduled for his ACTH Wednesday but keeping a watchful eye. Jordan seems tired now. Still spunky at meal times but overall resting a lot.

[lozadaNY76]

Jordan has had some weird red spots show up on his stomach. related?

[Harley PoMMom]

Could be, skin rash is listed as a side effect from Lysodren. Does it seem to bother Jordan?

[lozadaNY76]

nope. Vet said that she does not think it is a side effect. He is going to get checked Wednesday.

[lozadaNY76]

I know I keep asking a million questions but tonight I made a bowl of Cheerios and Jordan did not come into the kitchen to get a couple. He always does. He just looked at me while laying on the floor. Should I stop the Lysodren? His ACTH is tomorrow and he has one dose left.

[Harley PoMMom]

Always, always feel free to ask all questions you want ;)

Since his behavior has changed with food that he regularly eats, I would forego giving him anymore Lysodren. I also would mention this to the vet so that they will take this into consideration when evaluating his ACTH stimulation test results.

Hugs, Lori

[labblab]

I definitely would not give any more Lysodren, either. If the ACTH shows that he needs more, you can easily continue. But you cannot "undo" a dose once you've given it. Good luck with the results today!

Marianne

[Squirt's Mom]

Yep, definitely stop the Lyso. This could be that subtle sign we look for and like Marianne said - we can't take back that pill once given and it will work for approximately 48 hours. ;) Let us know what the ACTH says when you get the results!

[lozadaNY76]

thank you for the help

[lozadaNY76]

ACTH stim results low are >.02 pre and post. New test scheduled for 2 weeks. So far no major indication that he is in crisis. Eating the same just tired.

[DoxieMama]

Wow!! Good thing you stopped the Lysodren when you did! No more meds for now then, right?

[lozadaNY76]

yes no more

[Harley PoMMom]

With his cortisol level that low he should be getting a supplemental glucocorticoid such as prednisone. Were his electrolytes checked too?

[judymaggie]

Hi -- just checking -- did you mean that the pre and post were below .02 (<.02) or above .02 (>.02)?

[lozadaNY76]

the results were less than 0.2. sorry for the putting the decimal in the wrong place. So it is low.

[labblab]

Yes, then with results that low, I just want to reconfirm you have access to nearby 24/7 emergency care. I think that fact, coupled with currently normal behavior other than acting tired, would be the only rationale for not supplementing with prednisone at home. If he remains tired, though, I'd think he should still have some pred to help him feel better.

Like Lori, I do hope his potassium and sodium levels were also checked (or soon will be) with an ACTH result that low.

Marianne

[lozadaNY76]

I have requested the result details

[lozadaNY76]

How long will Lysodren stay in Jordan's system? Can it his levels get lower even if he stopped taking the medicine 36 hours ago? will go into crisis? Should I be worried?

[labblab]

For many years, we had been told that Lysodren can continue to drive cortisol even lower for up to 48 hours after the last dose. More recently, we have had trouble actually documenting that belief with solid research information. So in honesty, I don't know whether that is really the case or not. But even if Jordan's cortisol doesn't fall any lower, it is already plenty low enough to result in serious side effects. So if you have not been given any prednisone, you will need to be very vigilant as far as monitoring his behavior. At this point, there is no way to know for certain when, or even whether, his adrenal tissue that has been eroded by the Lysodren will rejuvenate sufficiently to return to a normal range.

Plus, there are two separate concerns when adrenal function has been oversuppressed. The first is the production of cortisol, for which prednisone is given when supplementation is necessary. The other is the production of aldosterone, the adrenal hormone that regulates the balance of sodium and potassium in the body. If these electrolytes become too unbalanced, the result can be life-threatening. So if aldosterone production has dropped too low, then an additional type of steroidal supplementation is necessary. This is why we are so concerned that blood chemistries were checked in addition to the ACTH.

The bottom line is that if Jordan worsens, you need to return him to the vet immediately for emergency evaluation.

Marianne

[labblab]

I just wanted to come back to add that I am not wishing to scare you unnecessarily. For most dogs, the adrenal tissue does indeed rejuvenate over time, and sometimes very quickly. But for some dogs, the oversuppression can be a long-term issue, and it is important for you to know that it is a possibility so you'll know you need to act quickly if Jordan worsens.

Marianne

[Squirt's Mom]

How is Jordan this morning?

[lozadaNY76]

He is good. On a high note WE ARE GETTING PREDNISONE!

[judymaggie]

Hi! Glad to read that Jordan is good this morning and that you are getting prednisone, even if just to have on hand. Curious to know what your vet has told you about when/if to restart the Lysodren. There is a delicate balance between waiting too long and "losing" the loading and giving it too soon when cortisol results are so low. I think you mentioned getting another ACTH in two weeks. I am assuming that is to see if cortisol levels have come up and that, in the interim, you will not be giving Jordan any Lysodren.

Because my vet had no experience with trilostane, my Abbie started out on Lysodren -- her cortisol levels dropped below .1 during loading and, when we started Lysodren again, they went up above acceptable levels. We tried a second mini-load and the same pattern occurred. We kept manipulating the dose with small increases and finally gave up and, after a month's break, started on trilostane (with me calling the shots based on information from this group and the resources we have here). We had a much easier time finding the right dose and her cortisol levels have been within a good range for several months. I am telling you this just to let you know that there are other options if the Lysodren continues to present problems.

[lozadaNY76]

He did not say much, however I know that they mentioned Trilostane as the next option.

Jordan is doing some what better but today I noticed he is having a hard time with his back legs. Like the are giving out on him. happens when he gets up from the lying position or tries to jump. is this the muscle wasting it bc his stomach is so pendulated is spelt wading his legs apart? Had this happened to anyone before?

[labblab]

It could be from muscle wasting, but it could also be weakness from a cortisol level that is so low. I would ask the vet to let you go ahead and give a small daily dose of prednisone for a couple of days in order to see whether that helps him. It really should not hurt him and it might help him recover from the adrenal oversuppression. The dose of prednisone he would need is really quite small: a supplemental daily dose would likely be no more than 0.25 mg. per kg. But it might make him feel a lot better.

Marianne

[Squirt's Mom]

Personally, there is no way I would consider switching to Trilostane (Vetoryl) just yet. He simply went a bit long on the load and dropped too low - his loading dose was correct. With the pred, if needed, he should bounce back and the cortisol rise to an acceptable level *proven* via the ACTH. At that point Jordan will start the maintenance phase. So tuck the idea of switching in the back pocket for now. ;)

I should explain that I am the oddball here, as in most things :D - and I prefer Lysodren. Why? - it has been around longer while we are still learning things about how to use Vetoryl and things change with that drug while they remain pretty dang constant with Lyso; Lyso is usually less expensive to use because fewer dose changes are needed meaning fewer ACTHs needed; with fewer ACTHs needed the pup has to be poked and prodded less often. And in spite of popular hype, neither drug is safer when used correctly - both have the exact same risk factors. The only thing that plays into this thought is the length of time the drugs remain active in the body - a dose of Trilo is leaving the system in 2-12 hours while a dose of Lyso sticks around for 24-48 hours.

[lozadaNY76]

i gave him the prednisone.

[Squirt's Mom]

How is his appetite? any nausea or vomiting? Is he drinking normally? Any diarrhea or loose stool?

The pred should perk him right up within an hour or less if the back leg weakness is due to the cortisol level. Let us know how he is doing...and remember we LOVE details. :D

You're doing a great job of watching him!