Missy, 12 year old Beagle (update: Lysodren re-loading)

[missygirl]

*** Please see my new post for new info/questions***

Hey all,

Don’t know if you remember me or not, but I was active on the old forum and had a thread for Missy, our now 12 year old Beagle.
Here is some history on Missy for everyone. It’s going to be very long so please forgive me:

Missy was diagnosed with Cushings a little more than a year and a half ago. It was a long road to diagnosis and her symptoms were severe. She was drinking a lot of water and literally peeing every 20-30 minutes. I was so sleep deprived!

We finally got her diagnosed and started the process of loading her. She was pretty resistant to the lysodren and took two rounds of trying before she loaded. She ended up loading on one pill a day. After we got her loaded, her numbers were good for quite a few months.

Our internist left the vet and we have not been able to find one since who is experienced with Cushings. This is where our problem lies now. There are 3 internists in our area and none of them are familiar with Cushings. One even told us that she wanted to push Missy into Addisons because “that is easier to treat anyway”!!

Missy’s numbers have been slowly climbing for the past 6-8 months. Last time we got her checked about 3 months ago they were at (I think) an 11 post. Our vet consulted with all the other internists in the area and all of them wanted to simply up her dose of lysodren. So, she now takes a half a pill (her whole pill is 500 mg) 3 times a week, for a total of 750 mg a week. She weighs 32 pounds.

Anyway, I don’t think it is doing the job and her symptoms are just getting worse again. I KNEW she needed to be re-loaded but no one would listen to me. I have even considered re-loading her myself, but I know it’s dangerous so haven’t done so.

She’s having frequent accidents in the house and is panting and her water drinking has increased. Her belly is very bloated like it was when her levels were high before we started treatment. It’s also 105 degrees here, so I am sure that part of it is just her being hot.

The most recent trouble we have had with her is when we had her boarded at the vet while we were on vacation last week. She was boarded for 5 nights. Since we have gotten her back she has been acting really really strange. She usually LOVES her food and gobbles it up as soon as it hits her bowl, but now she sniffs it, looks at me and walks away. It’s usually another hour or so of me trying to get her to eat it before she finally does. This is VERY unusual for her. In fact, she has never done it before.

Also, if I pet her back (near her tail, kind of by her hips) she yelps in pain. I don’t even have to apply pressure, just if I touch the fur on her back she yelps.

We called the vet and talked to one of the doctors at the vet (but not Missy’s usual doctor, so she doesn’t know about her cushings) and the vet thinks it’s one of three things:

---Kidney problems (which could explain her back pain and her peeing?)
---Back/disc injury (but she has no trouble walking and jumping up on things)
---something happened to her while she was boarded. She’s either just super stressed or some injury occurred that no one happened to see.

I kind of think it’s her levels and possibly a UTI and/or kidney infection. Honestly I don’t know though. I am hoping it’s not kidney failure but I guess it could be.

Does anyone have any opinions/advice/anything? We are so frustrated, and broke! We can’t keep on spending hundreds of dollars and get nowhere! I feel like I know more about Cushings than any of the vets in my area.

[gpgscott]

I do remember you and Missy.

Sorry I do not remember your name.

It sounds like Missy has escaped control.

This would mean another loading. A loading is 25-50mg/lb/day until control is reached and then the same dose/week once a loading is achieved.

Scott

[missygirl]

Hi Scott,

Thanks for the reply. I have a quick question for you. Do you think that we should wait about a week or so to bring Missy in to get her levels tested? She gets very stressed when she is boarded and I am worried that her stress (which is still evident even though she is home now) will throw off her test results.

Or does stress not factor in with the results?

Thanks again!

-Sandi

[Harley PoMMom]

Hi Sandi,

I believe stress and any underlying illness can skew the test results.

Is Missy still not eating the way she was before you boarded her? Because beagles usually just don't lose their appetites, you know?

Lori

[missygirl]

No, she was eating 100 percent fine/normal before she was boarded.

She will eat my other dogs food (it's a different kind) and any human treat that I give her. But, when I put her regular food in the bowl she sniffs it and runs away from it like she's afraid! It was the first thing we noticed we picked her up from being boarded.

It's almost like something happened to her while she was being boarded. Very weird.

[ventilate]

Hi;
There are 2 things I can think of. Nikes vet has me give her pred when she boards just to be sure if she gets stresses she will be OK. It is possible she was very stressed. the other thing is when i was putting nikes meds in with her food and trying to hide it she would find it and walk away. she refused to eat her food but like Missy would eat Kenais which was different or any people food, but she would sniff i first. I wonder if her meds were put in her food and she found them and now wont eat. Just a thought
Sharon

[missygirl]

That could be it. I know that they use pill pockets to put their medicine in. Maybe they put the pill pocket in her food, and now that it is just plain she doesn't want it. She eats the other dogs food just fine. I've started putting just a few pebbles of the other food in with her regular food and she eats it all.

I still can't figure out what is up with her back, though.

We are going to take her in on Monday to get her levels checked. It needed to be done anyway. I am just hoping that this time they will agree to load her again. It needed to be done months ago!

[judymaggie]

Sandi -- I wanted to address Missy's back pain. It sounds like something did happen to her while she was boarding. Beagles are prone to disc/back/neck injuries and it doesn't take much to trigger something -- one bad jump up or down. Please don't wait to get that checked -- hopefully, it is just a strain. In the meantime, you need to restrict her jumping 100% and try to limit her activity. It may be necessary for an x-ray to be taken to rule out something more serious than a strain and I know that can be expensive but I would really encourage you to get one taken.
If she is in pain (and beagles are notorious for not showing their pain level), that could be the reason for the change in her eating.
My Maggie was a beagle and I moderate an on-line beagle forum so have dealt with back issues a lot.
Gentle hugs send to Missy!

[Squirt's Mom]

Hi Sandi!

Welcome home to you and Missy! :)

I don't have anything to add to what the others have said but just wanted to say "glad to have you back with us."

Let us know what you learn.

Hugs,
Leslie and the girls

[mytil]

Hi Sandi,

Yes I remember you and your Missy well.

Have you contacted the boarding kennel to talk with anyone there - they may be able to shed some light on the change here. With her not eating her own food, but the others, it seems to me she has not really lost her appetite, just something to do with the food or an episode associated with the food.

I too would have an x-ray done just to be sure there is nothing back or neck related going on or even that she may have bruised herself somehow.

Kidney problems can be checked with blood tests to check the levels of creatinine and BUN primarily. A urinalysis is performed also, but I think the urine may be dilute anyway with the increase in Cushings symptoms.

I am not sure where you are located and I am sorry all of the internist in your area have no Cushings experience. You may be able to find one through this link (may not be as close as you would like though) http://www.k9cushings.com/forum/showthread.php?t=182.

With the post ACTH number being 11 three months ago, you are right to think it has crept up even higher during the past 3 mos and this could be causing the reoccurrences of the symptoms.

Keep us posted and I am glad you are here.
Terry

[missygirl]

Hey everyone.

Missy had her levels tested earlier this week and we got the results today. She was a 1 pre and a 14 post. Last week she had a lot of accidents in the house (several a day) and was drinking a lot, which is what prompted us to get her levels tested. This week she is much better and hasn't had an accident in a few days. It makes me think that her levels go up and down a lot.

Anyway, she is currently taking a half a pill of lysodren 3 times a week (total of 1 and a half pills). She weighs 32 pounds. The vet wants us to do a mini load given her high levels, but was honest with us and told us that she does not know what to do in terms of how long, etc. since she has never done a mini load before.

Any advice would be greatly appreciated. How long should we do the mini load for? Two or 3 days? Also, we are really worried about over loading her. Since her syptoms are sporadic, and this week she is showing very little of them, it'll be difficult for us to tell when she is loaded. During her first loading it took two tries to get her loaded, but when we actually did she was overloaded and we didn't even know it. She acted completely fine, ate as normal, no stomach upset or listlessness.

We are very weary with this mini load and would appreciate any guidance. Unfortunately there aren't any vets in our area that are experienced with cushings. The only two vets that were internists that we could consult have left the area recently.

Thank you!

[frijole]

Hi Sandi! Glad you found us again. First off - before reloading I would figure out the appetite thing. Is she back to eating her regular food? I ask because you want to have something (food or water intake) to monitor if you miniload.

My Haley took forever to load. I mean 2 1/2 months at very high levels (increased over time). She finally load well above the recommended range of 25 to 50 mgs/ per kg. You are currently at 750 mgs. a week and the range is 363 to 727 mgs... so you are a wee bit over the max already.

Plain and simple some dogs require more lysodren. It is good that you are already giving the dose over 3 days. Since you are already at 14 I don't think a couple days will get it done. But you have to monitor just like before. My dog didn't act too differently after 2+ mos of daily dosing either. LOL.

When you loaded the first time you said you didn't know when to stop. Was there anything you noticed different (appetite, water intake?) If so that is what I would use as a guide this time.

If not then you might do what I did... poop patrol. :o Every time she went out I was with her and I carried a stick... to poke at poop. I knew that if she had diarrhea she had too much lysodren.... so I watched as it got gradually thinner. I stopped when it was fairly soft. Sure enough she was at like 1.3

Obviously if her current dosage isn't maintaining her levels you have to increase a bit her weekly dose. Perhaps take it to 1000 mgs or 2 pills. That would take her from just over 50 mgs/kg to 69 mgs/kg. Assuming it works you could then give her doses of 1/2 a pill 4 times a week.

But I wouldn't do anything without the guidance of a vet....I think you said the 3 specialists have no cushing experience. Have you tried finding a regular vet that has experience? OR of the 3, have any of them TRIED to get experience? LOL Heck I didn't have any 3 years ago and went to school real fast. I just had the internet - they have books, peers, etc to lean on. The least they can do is try to get up to speed.

Again, I am not a vet but wanted to share my experience since we seem to have had similar loading issues. I hope that this helps at least a little! Hugs, Kim

[missygirl]

Thank you so much for your reply! Yes, her eating went back to normal. Although, about a month ago we had to put our other beagle down (who was her son) and since then she doesn't like to eat unless someone watches her. Her and Bear (our other beagle who we put down) used to eat together and now she doesn't eat if she's alone.

So, food wouldn't be a good way to monitor if she's loaded or not, but I will measure her water intake. I really like your idea of poop patrol as well, so we will do that!

Our vet has been researching Cushings a lot since we've come to her. She's learned a lot thus far, but still has a ways to go. It's very frustrating not being able to consult someone who knows exactly what we should do. :-(

[frijole]

Glad she is putting in some effort... if I can figure it out (well some of it) certainly a vet can with all of their resources. Heck send her this link and she has a ton of reference material on how to properly administer lysodren. http://www.k9cushings.com/forum/forumdisplay.php?f=10

And its free! :D
Kim

[missygirl]

Hey Everyone,

We are in the process of loading Missy,5 days now and still going. My question is- has anyone noticed anxiety during the loading process? She seems to have more waking hours and on edge. We are watching her water and food intake closely, still no sign of decrease in either.

Thank you again:)

[Nathalie]

Hi Sandi,
We have had to mini-load 3 times in the past 8 months and what I noticed towards the end of one of the mini-loads is that Phillip became fearful and jumpy and somewhat restless. His post came in at 1.8.

Also, he is so used to functioning on a low cortisol level that his appetite will not decrease anymore, even at a dangerously low cortisol level.
Last time I used his hind leg tremors as an indicator that he was loaded – low cortsol tremors have a different quality then the usual tremors due to muscle loss in Phillips case.

Good Luck with the mini-load.
Nathalie

[missygirl]

Thank you, I was noticing today her legs weren't quivering when she was sleeping. Good news on the doctor front/ I talked to a doctor today that seemed knowledgeable of what is going on. We are gong to talk again on Monday.

Sandi

[frijole]

Sandi, Great news that you might have found a new resource with experience!!!

Re the miniload... It has been 3 years but I vaguely remember restlessness. Don't forget poop patrol monitoring. ;) Just to be safe. You will be fine and do keep us posted. We will be on the lookout.

Good luck! Kim

[MiniSchnauzerMom]

Hi Sandi,

I don't have any advice to give.......just wanted to drop by and wish Missy (and you) well during the mini-load. Hope the loading will be complete soon and Missy can go back on maintenance. Along with Kim, I'm glad too that you have found a resource with experience. That will definitely make life easier for you and Missy!

Louise

[missygirl]

Thank you for the support, Missy is showing small signs of loading or almost there. She has slowed down her water a tiny bit and slept from 11- 5 for the first time in weeks! So hard to tell:confused:I think I will give her her morning dose and see how she does.
Her tummy is still big and hard and she is looking at me right now winning for food even though she just ate.

Yes, watching her poop :eek:

[frijole]

Keep up the good work and remember to always give the lysodren AFTER the meal so you can wait to see if there is ANY small change... eating slower, leaving a couple kibbles.... better safe than sorry. You have to go with your gut because you know your dog best. GL! Kim

[Squirt's Mom]

Hey Sandi,

Hang in there! You are doing a great job! This will over real soon it sounds like and then you and Missy can get back to a more normal, less stressful routine. ;)

Hugs,
Leslie and the girls

[missygirl]

Okay... Missy is loaded, I am going to take her in next Thursday to get her levels tested again with the new doctor. Should I wait to get her test results before I start her maintenance? I don't want to undo everything we have accomplished but at the same time I don't want to over load her.:confused:

Any advice would be greatly appreciated

Sandi :)

[lulusmom]

Hi Sandi

You really should have the acth stim test done within 48 hours of the last dose. 48 hours is when the Lysodren has reached its peak and a more accurate reading can be obtained. Timeliness of acth stims are also extremely important in assessing an appropriate maintenance and when to start the maintenance. This is basic protocol and because of the time sensitivity, most cushing's savvy vets have their patients start loading on a Saturday. The law of averages say that most dogs load in 5 to 7 days so by starting on a Saturday, there is every reason to believe that scheduling conflicts because of office closures can be eliminated. If your vet's office is closed on Sunday, which would be the best day for testing, I would hope that s/he would accomodate you for Saturday and no later than Monday. I'm very lucky in that my cushdog's specialty clinic is open 24/7.

I am a bit concerned that you mentioned that you were going to give Missy her morning dose even though you had already noticed a small change in her water consumption and sleeping habits. Signs of loading can be as subtle as a dog looking up at you for a split second, rather than gobbling the food in 10 second flat. The changes you mention most certainly can also be signs. Lysodren will continue to accumulate and erode the adrenals for up to 48 hours so if Missy was already loaded before you gave her this morning's dose, there is always the possibility that her cortisol could drop too low. Be sure to keep a very close eye on her over the weekend. You do have Prednisone on hand in case this should happen, right?

Glynda

P.S. Good job of monitoring Missy and I'm hoping that her stim test shows that the post cortisol is exactly where it needs to be.

[missygirl]

I do have some on hand and yes we are watching her closely,she is still eating and drinking good and perks up when she hears the bread bag come out of the pantry , she loves bread:) thank you for the advice. We did start loading her last Saturday and unfortunately the vet is not open on Sunday and I cant get her there any quicker.
I am going to try to get a call in to the new vet and see what she says. Ill keep you informed.

Thank you for your post,

Sandi

[lulusmom]

Hi again,

Please try to get her in sooner because Thursday really is too long to wait for a stim test. Beg your vet if you have to.

Glynda

[missygirl]

I just called her, I should hear back soon. Do you think Monday will be too late ?

[lulusmom]

Sunday would be optimum but Monday should be fine. It's a whole lot better than Thursday. Hope you can get her in then.

[missygirl]

I just realized that if I were to need to give Missy prednisone I have no idea how much to give her. Our tablets are 10 mg.


Thanks!

[AlisonandMia]

How much does Missy weigh? The physiologic dose (that is to replace missing cortisol) is around 0.25mg per kg. (1kg = 2.2lb). Giving a little bit more is probably better than too little - you often have to round the dose because of tablet/dog size - so rounding up is better than rounding down, IMO.

If she does need pred over the weekend then you need to wait 24 hours after the last pred dose before doing a stim as the pred will "read" as cortisol and make the results unreliable. If a dog is still needing pred then there is no worry about the adrenals having regenerated before the test can be run as the need for pred is a sign that too much cortisol is not being produced. So if she were to end up needing pred and needs it to feel ok till, say, Tuesday next week, then doing the stim on Wed or Thursday would be fine. If she doesn't need pred or only needs it for one day then getting it done on Monday would still be important (as long as you are 24 hours clear of any pred given). (Hope that wasn't too confusing!:p)

If she does go low and need pred then having the electrolytes checked as soon as you can would be a good idea though, just to be on the safe side.

Alison

[Sabre's Mum]

Hi Sandi

I have just read Alison's post ... and I see she has just done a typo which is quite important. The pred dose is 0.25mg/kg and as Alison has said in the past ... sometimes dogs may need a little more.

Angela, Sabre and Flynn

[AlisonandMia]

Yikes! Angela is absolutely correct - I'll go and fix it!

Alison

[frijole]

Hi again! I am curious.. what happened to make you think she is loaded? Just checking. Thanks! Kim

[missygirl]

Well several things, she slept all night for the first time in weeks, her food craziness settled a bit and she wasn't emptying her 3 water bowls I have out for her in various places in and out of the house. My daughter just took her on a walk and she said her poop was soft but not runny:eek: Sorry to be so descriptive:) but I couldn't think of any other way to put it. I did get her an appointment on Monday with the new doctor.

Sandi

[frijole]

Thanks! Those are some good signs. Just checking since you hadn't said or I missed it. As someone else said the lysodren continues to work for a couple days so just keep a close eye on her and you have the prednisone info now. You should be fine. Sounds like you are there. Hope you have a great weekend. Kim

PS. Fantastic news on getting in with the new doc! Way to go.

[missygirl]

I know, I am so excited! She called me back herself, I was expecting to have a tech call back. It was so nice to talk to someone that knew what I was saying. And...the ACTH test is 100.00 less than at my regular vet, something about being able to get it in bulk. Only bad news is that it is 45 min. away.

Sandi

[Squirt's Mom]

Hi Sandi!

Way to go watching for subtle changes in Missy! Atta girl! :D

As others have said, the Lyso will continue to work for about 48 hours and you now have the pred on hand should you need it, so I am sure you will do just fine! Just keep an eye on her over the next day or so like you have been doing.

Hugs,
Leslie and the girls

[missygirl]

We did end up giving her a prednisone Friday night, she was looking like she was feeling very bad and vomited once. I guess I over reacted because now I'm not sure if she is loaded or not but we will take her in today for a test to be sure. I hope I didn't undo all of our progress. She woke up 2 times last night thirsty and needing to pee.:confused:

I will let you know how it goes,
Sandi

[Squirt's Mom]

Hi Sandi,

How is Missy doing now? Has she seen the vet yet? Let us know what you learn when you can. We are anxiously waiting with you!

Hugs,
Leslie and the girls

[missygirl]

We just got back, we will know something tomorrow. They did a ACTH test and checked her electrolytes. I did find out that the clinic is a 24hour emergency clinic , which is a good thing for future references although it did take us 35 minutes to get there. Missy is taking a much needed nap after this little adventure. I told the Vet about the prednisone, she wasn't concerned since I only gave her one dose.

I will post her numbers as soon as I get them :)

Thanks again,

Sandi

[MiniSchnauzerMom]

Hi Sandi,

Hope Missy is all rested up this evening from her ride to the clinic and testing. $100 less for the ACTH is a +++ too. :D

Will take a peek in tomorrow to see the test results.

Louise

[lulusmom]

Hi Sandi,

Please don't beat yourself up for doing the right thing. Vomiting when loading is definitely not a good thing as this can be a sign that cortisol is too low so good for you for giving Missy a dose of prednisone. You should not administer prednisone for at least 24 hours before an acth stim test so I understand why the vet was not concerned about a dose on Friday skewing a test on Monday. You have handled everything beautifully and I'm very proud of you.

Glynda

[missygirl]

Thank you for all of the support. The crazy thing is the prescription we had( from her previous vet) for the pred was a 10 mg pill and it said take one daily as needed, she was bouncing off the walls! We had already given her the pill when I asked about the dosage. I don't know why she prescribed such a high dose. Anyway she is fine now, she slept for 7 hours straight last night and no accident on her bedding. Hurrah!

I will post her numbers as soon as I get them

Sandi

[missygirl]

Well, if I wasn't frustrated before I am now. I just heard from the vet. Missy numbers are- 1.6 pre and 1.8 after, to me that says she is too low, the vet said "we have her right where we want her" UGH. Am I wrong? Missy loaded on 1 and a half pills a day. Her instructions are to wait 2 weeks and start her on a maintenance dose of 1 whole pill 3x a week. Hugh? Thats going to kill her. Don't you think?
She ask me what her maintenance dose was before and I explained we started at 1/2 on Monday and 1/2 on Thursday. Her numbers continued to rise and we just increased her dose first by 1/4 a week that didn't work(she went to a 10.5) so we bump up another 1/4 a week to 1/2 on Monday , Thursday and Saturday to make a total of 1 1/2 a week we did that for a long time she increased to a 14. I said I thought we should have reloaded her a long time ago and felt like the increase of dose was a waste of time. She did not agree with me/ said she hardly ever re-loads dogs just increases the dose. I hope I am making sense, its been a rough morning. I think I will go to the gym and work off some of this frustration.

Let me know what you think,

Sandi

[Squirt's Mom]

Hi Sandi,


Missy numbers are- 1.6 pre and 1.8 after...

This looks like a non-stimulatory response to me, which means Missy's adrenals are not functioning well enough to produce enough cortisol. These pups need some cortisol in their systems for normal responses and that is the goal of treatment - to stop the over-production yet allow enough cortisol to function as needed. I am not sure that this is "right where we want her" either and will let others with more experience than I chime in here. ;) But I would be hesitant to start maintenance based on those numbers just yet...that's me, tho. ;)

As for the maintenance dosing - it is usually the same amount as was used for loading just split into 2-4 time over a week. I'm assuming 1 1/2 pills was 750 mg? If so, then Missy's maintenance would be 750 mg spread out over a week - for example, 250 mg on Mon, Wed and Sat. If the pill she is talking about is 250mg each, then that would be fine but if she is talking about a 500 mg pill, that seems a bit much to me. Can you tell us what mg the Lyso is that you will be using for maintenance?

Take it easy, sweetie. You will get through this and be just fine - both of you will be!

Hugs,
Leslie and the girls

[missygirl]

Yes 500MG tablets.

[Squirt's Mom]

Hey,

So that would be double the amount she was on for loading which to me is too much. Maintenance is usually started at 25-50mg/kg BW; Missy was loaded on 50mg/kg BW so her maintenance should be in that same range. Here is the link on Lysodren from our Resource section just in case you don't have it.

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

If it were me, I wouldn't start maintenance until Missy had anther ACTH with more acceptable results - but that is JMHO.

Hang in there! You are doing just great!
Hugs,
Leslie and the girls

[Squirt's Mom]

Bumping up.....

[missygirl]

Thanks Leslie for bumping me up. Missy seems to be doing okay, she is still drinking allot of water but less than before I guess. I am still worried about her low levels( if they are indeed low) and about giving her 1500 mg of lysodren a week. I have already decided I will not do that. I'm going to give her what she loaded on, 725 mg /per week.

Some of you have talked about giving the pups milk thistle for their liver. I was going to try Missy on some , can someone provide me with some info? Please. I was wondering if it would reduce the size of her liver.

Thank you , again
Sandi

[Roxee's Dad]

Hi Sande,
I can't help you with the Lyso dosage but I can provide you with a link to information about MilkThistle in our resources section. :)

http://www.k9cushings.com/forum/showthread.php?t=192

I hope Missy continues to improve. Keeping fingers and paws crossed that all goes smoothly.

[AlisonandMia]

I don't think Missy's numbers are too low - if she is doing well and not appearing that her cortisol is too low. The recommended range is 1 - 5 on the post so she is within range although at the low end.

What I am concerned about is your vet wanting to wait a full 2 weeks before starting maintenance! I would think that it is very likely that her numbers will be way too high by then (Mia's would have been and she would have been symptomatic!). As long as the dog is within the desired range and is not unwell (some don't like being at the low end) then you really want to start maintenance within 48 hours of the last loading dose (although usually it will actually be a bit longer as you need to wait on stim test results and it is optimum to do that stim as close to 48 hours post the last loading dose as possible, which you did.)

What maintenance dose was she on before this last load and how much does she weigh now? If that dose was allowing her numbers to rise then you will want a higher maintenance dose than she was on previously.

Alison

[frijole]

I think my Haley's loading dose after her miniload was exactly the same as Missy's. I believe you waited a few days prior to having the acth test so I think you are safe to start on maintenance. As always keep an eye out and you have prednisone but I don't think you'll need it.

I agree that you should stick with what worked in getting her loaded. I can't remember the weight so I can't calculate what your vet is recommending but it does sound high... Did you ask your vet why she recommended the increase? I understand why you want to stick to the loading dosage. (and I would do the same) However, I think it is important that your vet knows the dosage you are going to use. This way it is in the records.

I use Milk Thistle and it has helped Haley's liver enzymes quite a bit. I have no idea if her liver shrunk but her enzymes are much better! ha. I didn't start her on them until she had been on lysodren for over a year and her enzymes didn't go down until she took the milk thistle.. so while not totally scientific - it made a believer out of me.

So - I would agree with Alison - the loading numbers look fantastic and you should pat yourself on the back! You did it! Kim

[missygirl]

Thank you Alison. About her dose before... this is long so bear with me. She was taking 1/2 tablet twice a week after her first load( that is when we lost our wonderful vet) but her numbers started to rise first to a 7 the new vet said we should increase her dose by 1/4 tablet per week but her numbers went to 10 post then she said to raise her dose by another 1/4 tablet per week (1 1/2 500mg tablet total)she insisted it would work but would take a while. We did that for a long time- 6 mths and she went to a 14 post. She loaded this last time on 1 1/2 tablets a day. My thinking is ... when we were raising her dose when she was on maintenance it was a waste of time. What do you think? Missy weighs 34 lbs.
I hope this makes sense.

Sandi

[missygirl]

Yes, I agree. I was planning on calling her and telling her.

Thank you ladies! :)

[AlisonandMia]

Ok - looks like she was originally on 32mg/kg and her numbers rose on that (to 7). Her dose was eventually increased to 48mg/kg (1 1/2 tabs per week). On that dose it appears that her numbers still rose but ever so slowly. I think that indicates that 1 1/2 tabs per week is close but not quite enough to hold her - which means that double that (3 per week which would be 96mg/kg) would be way too much. Something more like 1 3/4 or 2 tabs a week should be more like it, I'd think.

I am concerned about waiting 2 weeks before starting maintenance - I think you could likely have the numbers go up to 10 or even more in that time. Did you vet give a reason for doing this?

It is quite rare, from what I've seen here, for an increase in dose to actually bring numbers down. The thing is that there are three possible doses of Lysodren for a dog with PDH:

1. A loading dose (a dose which is actively eroding the adrenals and thus bring the cortisol levels down)

2. A maintenance dose which is a dose that neither erodes the adrenals nor allows them to regenerate and thus holds the cortisol level stable.

3. An inadequate maintenance dose - which is a dose that allows the adrenals to regenerate and thus the cortisol level to rise.

So if you do up the maintenance to a level where it does bring down the numbers over time then what you are doing is, in fact, loading albeit very slowly. So if you were to manage to do that then a new maintenance dose would have to be found as staying on the maintenance dose that lowered the numbers will result in the dog going to low at some point. Usually the increasing-maintenance thing only works when the numbers are only slightly out of range. IMO, it is probably best (cheaper and better for the dog) in most cases to just do a mini-load, get things under control, and then take it from there rather than messing around with ever-increasing maintenance doses and multiple stims - and a dog that may be peeing all over the house in the meantime!

Alison

[missygirl]

She said she wanted to give her adrenal glands a rest. I'm with you... I will start her tomorrow on her maintenance dose. I am going to call the vet and tell her just so she will have it on her records. I think I will start her on 1 3/4 tablet per week , then get her tested in 4 weeks and see how she is doing; keeping a close eye on her for any complications.

Thank you sooo much for talking me through this,

Sandi

[AlisonandMia]

I don't think those adrenals of Missy's are going to take a rest!;) It looks like they are very busy and "enthusiastic" and pretty good at the regeneration game, like my Mia's were.

Alison

[lulusmom]

Hi Sandi,

I agree with Alison. The stim numbers look really good to me too and I'm not sure I'd want to wait two weeks either and take the risk of losing control. My Jojo's first post stim was .7 and like Missy's original loading, he never showed any signs of loading. We waited 10 days to start maintenance and as I recall, his next post was 11. Your vet is suggesting a maintenance dose of 500mg 3 x week which is twice the loading dose. I'm not sure I'd go for that if it were one of my dogs. Given that it took 7 days to go from a post of 14 to 1.8, the maintenance may need to be higher. I personally would wait a week and start maintenance of 250mg on Mon, Tues, Thurs and Friday.

I was trying to get a handle on whether or not Missy is resistant to Lysodren so I’ve gone back through your old thread and created a chronological lysodren dosing history as best I could. If a particular breed is going to appear to be resistant to Lysodren, it's been my experience here that it is going to be a Beagle. However, after looking at Missy's history, I think your vet(s) did a bad job of assessing the stim tests. It was apparent that the stim on 6/18/08 indicated that you were losing control and maintenance should have been increased at this point.


3/27/08: Started loading at ½ of 500mg tablet twice daily (30 lbs = 37mg/kg)

Unk Date 1st stim: Pre 15/ug/dl Post 22ug/dl (Vet increased loading dose to 375mg 2 x daily = 55mg/kg

Unk Date 2nd stim: Post 9 ug/dl (Continued loading)

4/23/08: 3rd stim: Pre .3 Post .6 (Missy really didn’t show signs of loading) Vet says take two weeks off Lyso and start maintenance dose of 250mg 2 x weekly.

5/15/08 1st post maintenance dose stim: Pre 1.6 Post 2.3 (No change in maintenance)

6/19/08 2nd post maintenance dose stim: Pre 3.6 Post 4.6 (No change in maintenance) This should have been a wake-up call and maintenance increased at this point.

7/15/08 3rd post maintenance dose stim: Pre 1.1 Post 5.7 (Change maintenance to ¼ tablet every other day) This is really not an increase and averages out to about the same 500 mg per week.

3/15/09 Pre 3.6 Post 10.6 (Maintenance changed to 250mg 3 x week) (32lbs) Missy is now two pounds heavier and should have done a mini load at this point.

11/6/09 pre 1 Post 14 (Maintenance stayed at 250mg 3 x week until this stim) (32 lbs) This is no surprise

11/07 Started reload. 750mg per day

11/16 Pre 1.6 Post 1.8 (Per vet wait two weeks and start maintenance of 500 3 x weekly)

Glynda

P.S. I see that you are going to start maintenance tomorrow. I agree as that would be a week since her last dose. I would still go with 250mg 4 x a week on Fri, Sat, Mon & Tues.

[missygirl]

Ahh, thank you! I agree we were loosing control of her a while back but could not find a doctor to agree with me, so frustrating.
I gave her a dose a few moments ago. I hope we didn't wait too long.

Ha ha about her adrenal glands being enthusiastic.

Sandi :D

[missygirl]

Okay, 250 mg 4x a week on Thursday Friday Monday Tuesday.

I will let you know how it goes.

Wow! You guys are awesome ;)

Sandi

[missygirl]

Hello all,
It has been 12 days since we successfully load Missy but her water consumption has not slowed down. Do you think this is unusual? About a month ago she started peeing every few feet when we would go on our walks; she will pee a lot at first then the rest of the time she drips drips drips. We have ruled out a UTI, maybe its a age thing?
We have also noticed since loading her arthritis has made a come back, do any of you have a natural arthritis medication you like to give your pups?

Thanks Again,
Sandi

[Squirt's Mom]

Hi Sandi,

There are many reasons other than Cushing's which can make a pup drink and pee excessively - diabetes being just one. Old age can certainly take it's toll on bladders, too. If it is simple incontinence, there is a drug called Proin that some members here have had success using. If it's been a month since she was checked for a UTI, I think I would have that done again just to be sure. Those sneaky little bacteria bug can hide!

Bear in mind, too, that each pup is different and will progress at their own rate. Some, like Glynda's Jojo, continue to drink and pee like mad even tho they are controlled with cush meds otherwise.

For the arthritis, we (at our house ;) ) use glucosamine/condroitin with msm, SAMe, and cold pressed salmon oil. With the salmon oil, you want high levels of EPA and DHA as they are the omegas that can help with inflammation caused by arthritis, as well as other things like coat and skin. If you have hydro-therapy for dogs in your area, that is good for them also. T-touch massage and acupuncture can also help, tho I haven't tried the acupuncture yet and barely know enough about T-touch to direct anyone in its use. You can find info on this form of massage online tho.

On a dietary note, stay away from the nightshade family of veggies when feeding Missy as these can aggravate and cause inflammation. These veggies are potatoes, tomatoes, sweet and hot peppers, eggplant, tomatillos, tamarios, pepinos, pimentos, paprika, and cayenne but does not include sweet potatoes.

You're doing a good job even tho I know are bound to be a bit frustrated. Hang in there, Mom!

Hugs,
Leslie and the girls

[AlisonandMia]

I think you need to get diabetes ruled out ASAP. Unfortunately Cushing's dogs are bit more prone than average to developing diabetes and with all urination that is going on it sounds like it could be a very real possibility.:(

Even if she tested negative for diabetes at some point (even if it was quite recently) it is still a possibility as it can come on pretty quickly.

Alison

[Harley PoMMom]

She might have diabetes insipidus.


Diabetes insipidus is a disorder in which the kidney is insensitive to a hormone, called anti-diuretic hormone (ADH) or in which there is not sufficient quantity of this hormone available. The result is excessive drinking and urination, or polydipsia and polyuria.

http://www.vetinfo.com/dencyclopedia/dedibetinsp.html

Love and hugs.
Lori

[missygirl]

Yes, we have ruled out diabetes. We were worried about that a couple weeks ago, so got her tested. It was negative thank goodness!


Sandi

[Harley PoMMom]

Diabetes mellitus and Diabetes insipidus are two entirely different things.