Introduction: Butters 6 yo mixed breed male

[pmfpa]

Hello Everyone,

It's nice to find support for this disease. My dog was just diagnosed on 2/4/16 at Ohio State veterinary clinic. This after another vet told me he had kidney failure which just didn't fit with his symptoms in my mind. We are now in the induction phase of Lysodren. It is a bit unsettling to feed your dog stuff that you shouldn't touch, but I get it. Mostly just hoping I'll recognize the tipping point.

One concern I have is that this is usually an old dog disease. My dog's a rescue so his age is a guess but he's probably 6 years old, perhaps 7 at the most. I guess I'm seeing a long line of problems coming his way including an increase in tumor size. Good to have a veterinary school nearby. And online support from people who have gone through this.

I've had lots of dogs in my life, but this guy is special. No disrespect to my other faithful pups, but this guy is special. He's accepted a new baby in the family and my grown daughter often looks at him and wonders who would have ever given you up.

Anyone out there with a middle aged dog who has cushing's?

Pam

[Harley PoMMom]

Hi Pam,

I have manually approved your membership so now all your posts will be seen right away. Also, please just disregard the validation email that was sent to you from k9cushings.

Welcome to you and Butters! The majority of dogs that have Cushing's disease are generally our senior pups, however on the forum we do see this disease in younger dogs.

We are a nosy bunch here so could you tell us more about dear Butters, in this way we will be able to provide you with our best possible feedback, ok? And the way we find this additional information is through a lot of questions, so here goes some of mine. :)

Could you get copies of all tests that were done on Butters and post any abnormalities that are listed? With respect to the blood chemistry and complete blood count (CBC), you need only post the highs and lows and please include the normal reference ranges. What test/s for Cushing's were performed and could you post those results too? Does Butters have any underlying illness that he is taking medication for? And if so, what is it and what is the medication for? What symptoms did Butters display that led you or the vet to test him for Cushing's in the first place? Does Butters have pituitary or the adrenal form of Cushing's? How much dose Butters weigh? What is the dose of Lysodren that Butters is taking?

When starting the induction phase of Lysodren the Lysodren should be administered at a dosage of 50 mg/kg/day, divided and given BID (twice a day). Is he getting his Lysodren twice a day with some fat, and is the Lysodren being given after he eats his meal? The time it takes a dog to load is an individual thing, some dogs load faster than other, however if a dog doesn't show signs of being loaded in 8 days than the Lysodren should be stopped and an ACTH stimulation test should be performed to make sure that the dog's cortisol isn't too low, we have had dogs show no symptoms of being loaded and when their ACTH stim test was performed the results did show that the induction was achieved.

Well I believe I have asked enough questions for now and am looking forward to hearing more about your sweet boy. I am sorry for the reasons that brought you here but glad you found us. I'm providing a link from our Reference forum with information regarding Lysodren: http://www.k9cushings.com/forum/showthread.php?t=181

Hugs, Lori

[pmfpa]

Hi Lori,

I'll do my best on labs. Ohio State kept the prior vets records and I never thought to ask for them.
Butters is a mixed breed probably beagle and Australian cattle dog. He's approximately 6 or 7. His weight is 51.9 lbs or 23.6kg; blood pressure 170-200 mmHg; Mild elevations ALP and ALPCAP 490; cholesterol 381;total protein 5.8 electrolytes WNL; urine spgr 1.002; Adrenal glands on CT 6 and 8 mm
LDDS 1.4 at 4 hours and 1.5 at 8 hours. ACTH stim was 33.

The first vet did not do the ACTH and said he had kidney failure based on the specific gravity and relatively normal LDDS. I didn't believe this based on his symptoms that I had related.

I had him first evaluated for drinking way more than usual, and an increase in appetite.

Treatment for the induction phase is Lysodren 500mg 1.25 tablets BID. I was grinding this up and putting it in some moist dog food which is wellness turkey and is grain free. This is mixed with his other dry food which is potato duck.

All advice is welcome,

Pam

[judymaggie]

Hi, Pam & Butters! My beagle, Abbie, was treated with Lysodren initially. We switched to Vetoryl after being unable to get her cortisol under control with the Lysodren.

A few things to mention -- first, I would recommend you stop grinding up the Lysodren in Butters' food. One of the signals that he is loaded would be a hesitancy to eat or even walking away from his food bowl and then going back. If his beagle personality comes out when eating, the signal might be as subtle as lifting his head from the bowl if he usually gulps down his food. If any change in eating is noted, you would not want to give Butters any more Lysodren. It would be a better choice to give the Lysodren after a meal is completed, rolled up inside something fatty (which helps the Lysodren to be absorbed). Lots of folks use peanut butter or cream cheese. Since my Abbie is one of the few dogs that dislikes peanut butter, I roll her meds into a small piece of sliced cheese and stick it into her mouth. In order to avoid any possible gastric issues with the Lysodren, I gave Abbie pepcid before each meal.

Did the vet give you any prednisone to give Butters just in case he shows signs of an overdose (diarrhea, vomiting, lethargy)? This is often referred to as an emergency dose. There is a formula for this which I can look up and get back to you.

Butters' blood pressure is high. Did the vet start him on any blood pressure meds? What is the schedule to recheck his blood pressure?

Are you measuring Butters' water intake? Here is a table you can use to do that (click on the bolded "HERE"):

http://www.k9cushings.com/forum/showpost.php?p=59503&postcount=1

[pmfpa]

Hi Judy,

Thanks for the advice on how to give the meds. I did read somewhere that fat was needed for absorption. I'll try peanut butter. I may pick up some pepcid also to give him prior to a meal.

I have 4 mg dexamethasone tablets. They said it would not interfere with the reading on the ACTH test.

I do believe they are going to treat the B/P when we get him on a maintenance dose. I had enalapril from the vet that said he had kidney failure and I told the OSU vet that, but she wanted to hold off for now. His next appointment is for 12/12 if he experiences no decreased appetite on the lysodren. I suspect we will be there sooner than that.

Pam

[judymaggie]

Pam -- just looked up the emergency prednisone dose and it is .25 mg. per kg. With Butters weighing 23.6 kg, his dose would be 5.9 mg. The 4 mg. tablets would be fine but know that you could give him 1 1/2 tablets if he really crashes but we will think positively!!

The link that Lori gave you has a print-out of Dr. Feldman's Lysodren protocol. I kept that near to me through-out Abbie's loading. The reason I mentioned measuring Butters' water intake is that a decrease in drinking is just as significant as a decrease in eating.

If you decide to get the pepcid, be sure to get pepcid AC (not pepcid complete). I get the 10 mg. generic, famotidine, at a big box store. I wait about 15-20 minutes before feeding her. You should check with Butters' vet as to what dose would be good for him. Abbie weighs 25 lbs. and gets 5 mg. (half a tablet) twice a day. This is the low end of the recommended range (.25-.50 mg./lb.).

[pmfpa]

Thanks for the prednisone dose. I suppose dexamethasone is the same doseage. I've given Butters pepcid in the past. I gave him 1/2 of a 10mg tablet prior to dinner. Guess he could take 10mg. I've been writing down how many bowls of water. 2000ml so far today. I don't know where he puts it all.

[labblab]

Hi Pam, no, prednisone and dexamethasone doses are definitely not equivalent. I just used a quick online "conversion calculator," and it said that 1 mg. of prednisone equals only 0.15 mg. of dexamethasone. If that is correct, there is really a big dosing difference.

http://www.globalrph.com/steroid.cgi

Did the vets not give you dosing instructions along with the dexamethasone? If not, you need to check with them ASAP to clarify.

Marianne

[pmfpa]

Hi Marianne,

I checked my Dexamethasone bottle again. It is 4 mg and directions on the bottle are to give 1 tablet orally only if needed. He is 23.6kg

Pam,
Butters 6 yo mixed breed (possibly some beagle). Dx Cushing's Disease 2/4/16. Started on induction of Lysodren 500mg 1 and 1/4 tablet q 12 hrs initially. ACTH stim test 33; hypertension 170-200mmHg; mild hypercholesterolemia 381; Urine SpG 1.002. Diet: Natural Balance potato and duck

[pmfpa]

Hello,

Butters has had 5 doses of Lysodren. He's been very lethargic today and water consumption has dropped. He was anxious for morning meal and I went ahead and gave him his dose following this. Just on the couch since. I emailed the vet and gave him a dose of dexamethasone 4mg. per her instructions. I'm to take him to ER if lethargy progresses or he doesn't want to eat. Otherwise I drop him off at OSU in the morning.

Nice to have the vet very accessible.

Pam

Butters 6 yo mixed breed (possibly some beagle). Dx Cushing's Disease 2/4/16. Started on induction of Lysodren 500mg 1 and 1/4 tablet q 12 hrs initially. ACTH stim test 33; hypertension 170-200mmHg; mild hypercholesterolemia 381; Urine SpG 1.002. Diet: Natural Balance potato and duck

[Harley PoMMom]

Hi Lori,
The first vet did not do the ACTH and said he had kidney failure based on the specific gravity and relatively normal LDDS. I didn't believe this based on his symptoms that I had related.

I can't believe the vet would diagnose kidney disease based on a low urine specific gravity (USG). :eek: My last pom, Sampson, had kidney disease he was a rescue and I was not informed of his kidney problem. He was diagnosed by my vet, his creatinine and BUN were pretty elevated, which are markers for renal disease.




Treatment for the induction phase is Lysodren 500mg 1.25 tablets BID. I was grinding this up and putting it in some moist dog food which is wellness turkey and is grain free. This is mixed with his other dry food which is potato duck.

All advice is welcome,

Pam

So to clarify Butters' loading dose; is it 1 1/4 Lysodren pill = 625 mg given twice a day for a total of 1250 mg?

How is Butters feeling right now? any inappetence, diarrhea, or vomiting?

Hugs, Lori

[pmfpa]

Hello

I took Butters to OSU this morning thinking I had totally jumped the gun. To mu surprise he is addisonian.

The endocrinologist at OSU prefers to make dogs permanently addisonian with daily steroids and mineral supplements. They will also do maintenance on Lysodren, keeping him cushionoid.

I'm clueless as to what is better for him and for me. I don't want to go crazy watching him. I do want what's best

Any experience with these options. Sorry I have no labs. I just spoke with the doctor on the phone. I'll pick him up later today

Pam

[pmfpa]

Sorry I missed some posts. Still learning the website. I won't be going back to the vet that diagnosed kidney failure. I was practically arguing with him to consider the ravenous appetite.


Butters was on one and a quarter tablets of 500mg Lysodren

Pam

[Harley PoMMom]

A few of our members were surprised that their dog was loaded when they didn't show the symptoms, good job for being so observant!!

Please get a copy of those ACTH stimulation results and post them here, thanks!!

Some vets in Europe prefer to totally destroy the adrenal glands when treating Cushing's, then treat the Addison's, feeling that it is the easier problem to treat. To me, and this is just my opinion, there a few reasons I believe this should not be done: if a dog with controlled Cushing's (with Lysodren) misses their maintenance dose it will not cause harm BUT in a dog with permanent Addison's, which requires daily medication to live, a missed dose can be life threatening; according to Dr Feldman, who is a renown Cushing's expert, about 33% of dogs treated like so have a relapse in Cushing's symptoms during the first year; and to me, putting it simply, it just doesn't make sense to me to completely destroy the adrenal gland when there is really no reason to.

Hugs, Lori

[molly muffin]

Do you mean that they planned to purposely make him Addisons without telling you before hand? Or that it just happened during the load?

I personally would not want to go to Addison on purpose as I think cushings is easier to handle than Addison, but that is just my personal opinion.
Are you going to meet with the specialist to go over options of both routes?

[labblab]

As Lori says, even though we are aware that permanent adrenal suppression is (or at least was at one time) more commonly practiced in Europe, I don't believe I am aware of even one U.S. member who has reported this action being purposely taken on their dog here in the U.S. in recent years. If the pluses regularly outweighed the negatives, I would think that it would be an option that we would see much more often.

We do have members whose dogs have become permanently Addisonian as a result of inadvertent overdosing, and from what I can tell, you are largely trading one set of issues for another. Since you are asking for opinions, if Butters was my dog, I would want to reserve the option of permanent destruction. By definition, it is an irreversible decision. I would first want to pursue the maintenance Lysodren course that is by far the more widely accepted approach in this country. If for some reason you decide otherwise further down the road, permanent ablation remains an option.

Of course, right now we are assuming that Butters' adrenal function will indeed rebound from the Lysodren. Since we don't yet know specifics, it is difficult to judge the extent of his current oversuppression. But it is possible that his adrenals will never rebound sufficiently from even this loading dose. If so, then you will join some of our other members who have found themselves in this situation, and I'm sure they will do their best to guide you.

Marianne

[lulusmom]

Hi and belated welcome to you and Butters.

I was quite surprised to see that the vet at OSU has you giving Butters dexamethasone concurrently with Lysodren, as it is highly unusual for a board certified internist in the U.S. to do this. Based on the information you have provided, I believe your vet is following general protocol for adequate control of cortisol, which is not the same as that followed for total ablation of the adrenal glands. Total destruction of adrenal glands requires large doses over a period of weeks whereas general protocol calls for a loading dose over a period of days needed to achieve a level of adrenal tissue destruction to reduce serum cortisol concentrations on pre and post acth stimulation to 1 to 5 ug/dl. Maintenance doses are not necessary when adrenal glands are completely destroyed so as a maintenance dose is contemplated for Butters, this is further evidence that your vet is not intentionally causing Butters to become permanently addisonian.

A reduction in water intake is definitely a sign that a dog is loaded and no further Lysodren should be given until after an acth stimulation test was done. As I recall, you continued to dose Butters so I am not surprised that his cortisol is too low. I would be very interested in knowing the results of the acth stimulation test when you have them. I would also like to know how many days had Butters been loaded when you noticed the reduction in water intake? Did your vet tell you that it is mandatory to watch Butters eat in order to detect even the slightest change in eating habits, such as raising his head out of the bowl or looking up at you instead of inhaling his food and licking the bowl clean? Even the most subtle of changes can indicate that a dog is loaded. I know from experience that not all dogs have read the book and are good at not tipping their hand, or should I say paw. :D My second cushdog never showed any signs of loading and his cortisol was also too low on the first stim test. We waited two weeks before starting maintenance and the little bugger's adrenal glands had regenerated too much so we had to do a mini load and then start maintenance.

Glynda

[labblab]

Glynda, Pam will correct us on this, but I believe the Dex was only given for rescue purposes and the instruction was to go ahead and give it for the first time today after Butters became so lethargic. I don't believe it was being given alongside the Lysodren on a daily basis.

My impression is that the vet is now giving an either/or scenario since Butters' cortisol production appears to now be over suppressed: either proceed with total ablation, or allow for rebound and then commence maintenance dosing. But Pam will straighten us out on this! ;)

Marianne

[pmfpa]

Hello Everyone,

I was trying to ask opinions while babysitting my 2 year old grandson. Nothing coherent comes out while he's trying to get my attention.

Butters had 5 doses of the 500mg lysodren, 1.25 tablets. The last dose he received was after breakfast when he ate ravenously as usual and drank a bowl of water. The rest of the morning, he was just lying around and it seemed more than usual. By 12:30 in the afternoon, I emailed the vet due to lethargy. That's when I gave him 4mg of Dexamethasone which was only a rescue option. By 3:00PM he was lively and proceeded to drink 2000ml of water the rest of the day.

I really thought I had jumped the gun, but his ACTH today was Pre<1 and following 150mcg of Cortrosyn IV, his level was <1. Prior to treatment he was 33.

I don't see how I could have caught him any sooner. He's normally a really laid back dog who never was a voracious eater. He takes food gently and takes his time chewing.

The vet now wants to repeat the ACTH test on Monday and decide on a maintenance dose. She also offered the option of higher doses of Lysodren for a month to cause necrosis of the glands and then manage him as an addisonian dog. The endocrinologist at OSU feels it's easier to manage an addisonian dog. (not sure for whom). I was also told I could go with maintenance for now and change to the other option if I so desired. Obviously there is no chance of choosing the latter and changing my mind.

I wanted some other opinions. I found 2 and a half days of lysodren stressful. I can't imagine dosing him enough to destroy the glands.

I would like to see evidence that dogs treated one way or the other had improved overall outcomes. I don't know if these studies exist.

For what it's worth, his Sodium was 145.2 nl (143-150) and Potassium was 4.15 (nl 3.5-4.8)

This all gets quite expensive and I'm loving my pet insurance but I'm sure my premium will skyrocket when my anniversary occurs next month. Anyone have experience with PetPlan?

One last question, will I ever get to enjoy my dog again and not be watching him like a hawk for any little sign of change?

I hope this is clearer and forgive the brief post earlier.

Pam

[Harley PoMMom]

Butters' recent ACTH stim results show that his adrenal glands are not producing enough cortisol, he probably will need cortisol supplementation. Did the vet say to keep giving the Dexamethasone?

Also, you don't want to give him any Lysodren until his adrenal glands have time to rejuvenate, and the time that takes is unknown. Once you get Butters stabilized on his maintenance dose it will become less stressful, but over time his dose will probably need tweaking.

[pmfpa]

Hi Lori,

I'm only to give the dexamethasone if he appears to lose appetite or becomes lethargic or any of the other symptoms. He seems to be just fine at this time. Eating drinking. He's even lively.

No Lysodren until after his next ACTH test on Monday. Then they will calculate his dose. I will not do the high dose Lysodren to make him addisonian until I see evidence that this will prolong his life.

Thanks,

Pam


Butters 6 yo mixed breed (possibly some beagle). Dx Cushing's Disease 2/4/16. Started on induction of Lysodren 500mg 1 and 1/4 tablet q 12 hrs initially. ACTH stim test 33; Post loading of Lysodren, ACTH <1; hypertension 170-200mmHg; mild hypercholesterolemia 381; Urine SpG 1.002. Diet Natural Balance Sweet potato and duck

[molly muffin]

That's great to hear that he is lively. Always a good sign. :)
Let us know what the ACTH results are. I'm hoping for a nice middle of the road result showing everything is fine and that Butters can move on to maintenance.

[pmfpa]

Hello Everyone,

I'm in the week following Lysodren induction, where Butters became addisonian after 5 doses of 625mg of Lysodren. That final dose was 2/6 and the ACTH was on 2/8 with less than 1 results.

His appetite has never been off. His drinking has decreased. He started just wanting to be outside on the 11th, despite it being 15 degrees. He was also laying around (not real strange for him). I gave him dexamethasone 4mg and around 3-4 hours later, he went outside and peed so long, he could no longer pee with is leg up and continued to pee on all fours. In retrospect, I think he know something was wrong and staying outside just because he couldn't figure out the problem. I think he had urinary retention.

He was more normal the following day on the 12th and now on the 13th, I think he's becoming more lethargic and staying outside longer even though it's 8 degrees. I think I will give him another dexamethasone 4mg today.

Is it possible that his adrenals would be this compromised after just five doses of Lysodren? I gather the effects of the dexamethasone last around two days.

Next ACTH is 2/15. I know I'll know more then.

Pam

Butters 6 yo mixed breed (possibly some beagle). Dx Cushing's Disease 2/4/16. Started on induction of Lysodren 500mg 1 and 1/4 tablet q 12 hrs initially. ACTH stim test 33; Post loading of Lysodren, ACTH <1; hypertension 170-200mmHg; mild hypercholesterolemia 381; Urine SpG 1.002. Diet Natural Balance Sweet potato and duck

[Harley PoMMom]

Hello Everyone,

Is it possible that his adrenals would be this compromised after just five doses of Lysodren? I gather the effects of the dexamethasone last around two days.

Next ACTH is 2/15. I know I'll know more then.

Pam



Yes, that can happen and it may take a while for his adrenal glands to rejuvenate and start producing enough cortisol for his system to function properly, that next ACTH stim test will give us more insight.

Hugs, Lori

[labblab]

Hi again, Pam. I'm really sorry that Butters is still not himself. Yes, it is actually possible that only five days of Lysodren may still be oversuppressing his adrenal function. So continuing to give supplemental dexamethasone may be helpful and actually necessary.

Unfortunately, I am a lot more familiar with prednisone than I am with dexamethasone. But as we know, the good thing is that the dex won't interfere with the ACTH testing on Monday, so you can continue to give it to Butters if he needs it. The part I am uncertain about is the size of the dose and also the duration of action. From the conversion table I saw, it seemed as though 4 mg. of dex is a rather big "rescue" dose of steroid, but if that's what OSU told you to give him, then they are the ones who would know. So yes, I would go ahead and dose him, and we'll all be really anxious to find out how his results turn out on Monday!

Marianne

[pmfpa]

Hello Everyone,

We had the second ACTH stim after Butters' initial loading dose of 5 doses of 635mg of Lysodren. One day later he was <1 and today, a week later he is still <1. Electrolytes were normal although I don't have those numbers yet.

The vet still mentions the plan of making him addisonian on purpose. She feels he would be easy to get to that point with his sensitivity to Lysodren. She mentioned an enlargement in the pituitary adenoma with this treatment. I always thought this was a potential side effect of treatment, but she made it sound like it was more likely with him being in a state of iatrogenic addison's permanently. They still seem to be pushing this, but I'm not ready to go there and they are fine with that also.

She wants him to have 4mg of dexamethasone daily until we go back next Monday for another ACTH stim test.

I did give him dexamethasone once this week when he was acting weird and it helped him. He voided for a very long time after the dex. He probably does need some with being <1 for over a week.

Pam

Butters 6 yo mixed breed (possibly some beagle). Dx Cushing's Disease 2/4/16. Started on induction of Lysodren 500mg 1 and 1/4 tablet q 12 hrs initially. ACTH stim test 33; Post loading of Lysodren, ACTH <1; One week later, ACTH <1; hypertension 170-200mmHg; mild hypercholesterolemia 381; Urine SpG 1.002. Diet Natural Balance Sweet potato and duck

[pmfpa]

Hello,
I apologize if this is the wrong place for new messages. I'm looking for people that have had experience with macroadenomas and radiation.
I last posted when my dog Butters was diagnosed with Cushings. I was always frustrated by the lack of effect the Lysodren or Trilostane had on his polydipsia. I kept seeking out other opinions and Ohio State school of Veterinary medicine finally did an MRI. They were convinced that it wasn't going to show anything, but Butters had a macro adenoma with an area of hemorrhage around the tumor. OSU did not recommend radiation at this time since Butters was not showing neurological signs except lethargy. This didn't make sense to me and I sought a radiation consult. He is finishing up week two of a three week series. He's still lethargic, but on occasion I see more brightness in his eyes. He gets sedated daily except for the weekend so who knows what to blame the lethargy on. The internal medicine vet at the center where he is receiving radiation wanted to increase his trilostane from 20mg a day to 60mg a day. Butters is 50 lbs. He has been very sensitive to Lysodren reaching <1 on ACTH stim after two and a half days of induction. I didn't want to raise his dose in the middle of radiation and not know what treatment he was reacting to if he had problems. One thing at a time makes more sense to me. I've also seen something about dogs with macro tumors doing better on low doses. I'm not sure if this has actually been studied or is anecdotal. The most amazing help has come from the desmopressin drops. His water intake has gone waaaay down on this. I had asked a vet about trying this months ago and was told it was so rare in dogs.

This has been a long and frustrating journey. I feel like I've had to fight for every test and advocate for him from over aggressive treatment. The radiation oncologist has been great.

I could use some advice and support if anyone has experience with this. I've never been told how big the tumor is. Perhaps the hemorrhage around it made this difficult. The radiation doc says she's treated larger tumors.

Pam

[DoxieMama]

Hi Pam,

I'd say this is the best place for your post, as we like to keep a dog's history all together. I'm sorry I don't have any knowledge or experience to answer your questions, but hopefully one of the others will. Did you raise your concerns to the IMS after this recommendation? What was their response?

Shana

[labblab]

Welcome back, Pam, and I am wishing sweet Butters the best of luck with the radiation treatment. I do feel very concerned, though, about the IMS' recommendation to triple Butters' trilostane dose and during the midst of the radiation. What is the reason and rationale for doing that?????

I could be wrong, but I think some of our dogs who have received radiation for macros have had their trilo reduced or even stopped entirely during the active treatment. As the tumor continues to shrink, natural cortisol production will probably be a moving target. Once the radiation is completed, cortisol production is reassessed and appropriate dosing recalculated if it is needed at all. Some dogs have enjoyed a treatment break or reduction during the initial time period when the tumor is reduced in size. I don't believe I've ever heard of trilo being increased - and so markedly! - during the course of radiation. I would think that it would be extremely difficult to monitor for behavioral signs of overdose while Butters' is also experiencing possible side effects from the radiation/sedation.

So once again, why is the IMS telling you that an increase of this magnitude is either warranted or safe?

Marianne

[pmfpa]

Hi Marianne,

I voiced my concern and he had no problem with me waiting until after the radiation to adjust his dose of Trilostane. MedVet in Columbus is a very busy place. I had to see the IM doc to get refills on his desmopressin drops. These help enormously.

During the visit, the very busy IM vet (who took three phone calls during our 10 minutes) felt that the dose of 20mg was very low for a dog of Butters size. I agree, but in the past he was so sensitive to mitodane, that the second vet I saw wanted to keep the dose very low and monitor with ACTH testing. When I expressed concerns over continuing polydipsia, she recommended going back to OSU and that is when he had an MRI. He's had stim results of 10 and 16 while on 20 mg of Trilostane. I honestly think his major problem is the diabetes insipidus.

I get the feeling that there aren't that many vets familiar with treating the macroadenomas. I just have to speak up and voice my opinions and not worry about offending the vets. I was a nurse-midwife and delivered human babies for 32 years. I also did gyn care and screened women for pituitary adenomas. I try not to voice opinions and alienate the vets. Human medicine is very different, but introducing too many variables into the mix just isn't a good idea. I got the feeling he was too busy to really thinks about the consequences.

I'm not going to increase his meds until I see a stim test after radiation.

I am accumulating a stock of drugs that I don't need at this point. I have 20+ pills of Lysodren I don't anticipate using. I could have paid for a stim test with the price of those.

Pam

[molly muffin]

I wouldn't make any changes in medication either while under going radiation.
How many treatments of radiation will there be?

I know it is so frustrating isn't it to buy all that medication and supplements and then not end up being able to use them. I have the same thing at my house. And food, food that i buy that my dog won't eat after a week on it and sometimes a couple days is all I can get out of can food, yet have to buy a whole case if I get it through the vet prescription. Very frustrating.

[pmfpa]

Butters is done with radiation! Sixteen total treatments done in 15 days. One day was a double treatment. He's still on the Vetoryl 10 mg twice a day and desmopressin drops two a day. I have skipped the drop on occasion and his water intake remains appropriate. He's becoming much brighter than pre-radiation. He's not playing or anything drastic, but he's brighter, following me around like he used to and going outside and anxious to walk. In two weeks he will see the radiation doc, the internal medicine doc, and the neurologist. Yikes.

I don't know if this will prolong his life but it seems to be working. I can't for the life of me understand why the docs at Ohio State didn't recommend radiation at this time.

Pam

[judymaggie]

Hi, Pam! What a great update on Butters!! :D So glad that treatments are done and that Butters is acting like his old self.

[molly muffin]

What a great update! Sounds like radiation was the best road for him and for a macro tumor if it is feasible to have it done, is the way to go. :) Hoping for continued improvement.