Angus, 8y/o Olde English Bulldogge - Lysodren

[Angus2223]

My soon to be 8 year old, Olde English Bulldogge, Angus, was diagnosed w/ Cushings last July 2015. What a road this has been, to say the least! I take her to an animal hospital in Buffalo, NY, and finally, everything is going well. She is on Lysodren, currently is off, and we are repeating ACTH this Saturday in hopes that her Adrenal Glands are not producing too much Cortisol. She has Pituitary Dependent Hypercortisolism.
We repeat the ACTH tests every 4 weeks- I personally feel more comfortable knowing where the Cortisol levels are at, although it costs between $250-400 each time, depending on what other lab work I have done.
(She is my everything, I could never put a price tag on her!)
If the Adrenal Glands are functioning again, and her Cortisol levels are getting high, we will start the Lysodren again & I hope that our Dr. can get a better idea, now, as to what dosage we should start with & how often to administer. This is the battle now- knowing what dosage & how often.
4 weeks ago: Pre ACTH: 0.257 Post ACTH: 0.430
She was loaded again, with Lysodren for 7 days, 500mg bid, and these were the results of that blood test. Therefore, no Lysodren has been administered & have been giving her 10mg of Prednisone due to these low results. However, she is asymptomatic & is doing GREAT! Angus is better when her numbers are much lower!

It appears to be when Pre ACTH is at .76-1.5 and Post ACTH: .430-6.3, she is at her best.

Can anyone relate to any of this? I'm so happy I found this forum, I don't feel all alone now!
Thank you!

Jessica

[labblab]

Hello Jessica, and welcome to you and Angus! I have only a moment available to type right now, but I wanted to let you know that I've moved your post so as to create a new thread that is your very own. This way, it will be much easier for our members to reply to you directly.

We are really glad you're here, too! :)
Marianne

[Harley PoMMom]

Hi Jessica,

Welcome to you and Angus from me as well! Those ACTH stimulation results, are the reporting units ug/dl, so it would look like this: Pre ACTH: 0.257 ug/dl ~ Post ACTH: 0.430 ug/dl? Also could you tell us how much Angus weighs, what loading dose she was started on and was it given twice a day with some fat, and how long she was loaded for.

With Lysodren the protocol most followed is to start the dog on a loading dosage of 50 mg/kg/day divided and given BID (twice a day). The maintenance dose is usually just about the same dose as you used to give in just one day of the loading, however how fast/slow the dog loaded needs to be taken in consideration too. A dog's pre and post should never drop any lower that 1.0 ug/dl, any lower than this can cause necrosis of the adrenal glands and they may never function properly again.

I'm including a link from our Resource Forum that has information regarding Lysodren: http://www.k9cushings.com/forum/showthread.php?t=181

Glad to hear that Angus is doing well on the predisone, and I'm crossing my fingers that her adrenal glands rejuvenate. Keep us updated please. ;)

Hugs, Lori

[molly muffin]

I just want to say hello to you and Angus also.

I do hope the pred is working and the adrenals have kicked back in. The next dose of lysodren would be lower than what he was on when his levels went low.

It will help us to give better feedback if you can tell us the loading dosage, the maintenance dose he was on and then what he was started back on.

[Angus2223]

Thank you ladies! Yes, ACTH results are measured in ug/dL. Angus currently weighs 71lbs. She ranges 67-71lbs. This last loading phase started on 2/26/16, 500mg bid, given with her canned and dry Hills Science Diet ID dog food. Lysodren was administered for 7 days, ended on 3/3/16. 2 of those doses were 250mg, my doing, as two doses had to be given earlier than usual. But, as you can see, her test results from this loading phase, both pre and post were very low! Those last ACTH test results were taken on 3/4/16. Prednisone began on 3/8/16, when I received the call with the results. She goes back Saturday, 4/2/16, for ACTH test again. The maintenance dose prior to this test was, I believe conservative, 250mg every other day. Prior to that, 250mg 3 times per week. 250mg three times/week was not enough as her cortisol levels rised and she was symptomatic: lethargic, high blood pressure, increased thirst again, increase in hunger, ALP and GGT all were high, her glucose level also increased here.
These ACTH levels went this low due to the high loading dose. I understand that this dose will be different next time and/or less loading days. I just want to be comfortable with the maintenance dose and not have to worry about Addisons Disease. From what I've read, Addisons is easier to treat, correct?
Angus also has an arrythmia, frequent PVC's, psychogenic polydipsia, she can have 1 cup of water every 3 hours, lower sodium levels in which I have to add salt to her canned dog food and a very sensitive stomach. I have to administer Metronidazole, 250mg, from time to time.
Last July, 2015, during her initial loading phase, she went into shock due to the extremely high water intake that caused her sodium levels to drop dangerously low. Shes always has consumed an awful lot of water, I never knew it was too much, which is why it is now measured. She had a GI bleed due to shock and received a blood transfusion. She was in ICU for 9 days.

Thank you all for this help! Thank you for this forum! I hope to understand this maintenance dose & any other advice you can offer!

Jessica

[Angus2223]

Angus weighed 67lbs when she was given the maintenance doses.

[molly muffin]

So her original loading dose based on 50mg per kg a day was 1500mg (recommended starting load dose)? 500mg given 3 times a day and then if that works, maintenance would be 500mg 3 times per week to maintain the load.

Was that the dosage that Angus went low on?

Yes some say that Addisons is easier to treat. But they are only addisons if the adrenal glands don't regenerate and the cortisol begin to go up on it's own.
It is tricky with the water situation for her as cushings dogs as you know drink more, they drink more because they have to stay hydrated because they are peeing so much (the kidneys work over time) With her not being Able to handle large amounts of water, this is a delicate balancing act for you.

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

So whatever she went too low on, the next load/maintenance would be lower than that. I'm just not sure that the normal protocol for load and maintenance was followed and if that might be where the trouble came from to begin with and now it's a start over.

[Angus2223]

Thank you MollyMuffin! Angus's levels went low on 500mg bid, 7 days, initially. Then the maintenance dose of 250mg every other day, caused her cortisol levels to increase, dosage prior of 250mg 3x week did not work either. So yes, starting from scratch now. Water intake is a balancing act, I get blood work done on her very often. BUN levels are good, amen! Liver enzymes normalize when cortisol comes down, as does her blood pressure, although I believe she does have white coat syndrome.
Maintenance dose at this start is crucial so I don't have to keep putting her through the higher cortisol levels and she becomes symptomatic again and not feeling well/unhappy.

Thank you so, so much for this guidance & for taking the time to help me & everyone else on here!

[molly muffin]

Okay so tomorrow you check to see where she is at now on the prednisone right?

Keep in mind that you will want to taper her off the prednisone I believe and then check to see if the adrenals are really producing again or if it was the prednisone supplementing them, before moving on to restarting lysodren therapy.