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Thread: Max - 14/15 yr old Maltese - kidney issues - debating continuation of Lysodren

  1. #1

    Post Max - 14/15 yr old Maltese - kidney issues - debating continuation of Lysodren

    Hello all,

    glad I found everyone at "our" new home here.

    For those that have been following Max's story, just wanted to let you know that Max has started on the maintenance dose of Lysodren (dosing at the low end of 25mg/kg/week, split into 2 doses).

    I am happy to report that Max has not had a bad reaction to the Lysodren as far as I can tell. He's had 2 doses so far and the third is tonight (62.5 mg capsule per dose - which I had compounded).

    I am relieved that we are through the first week. (I was worried about starting Max on the Lysodren, even at a maintenance dose).

    For those unfamiliar with Max's story, we did NOT go through the loading phase because Max's cortisol levels are relatively low. He had been diagnosed as Atypical Cushings and we tried the Melatonin and Flaxseed oil with Lignans route for a year, but it didn't help. I do want to note, that I recently realized that I had been giving Max an extended release type Melatonin pill (had not been evident on the bottle, but found the info on the GNC website). This is NOT what I should have been doing, and I have since changed to another brand. I also was giving Max Flaxseed Oil with Lignans and have since changed to Flax Hulls.

    I am continuing both the Melatonin and the Flax Hulls in conjunction with the Maintenance dose of Lysodren.

    My plan is to retest with an ACTH stim test in 3 weeks, and we have our fingers and paws crossed that the cortisol levels come down. If not, then I imagine we will increase the dosage.

    for reference, below is a recap of his most recent bloodwork:
    _____________________________
    March 27, 2009 adrenal panel from Univ of Tenn - baseline (baseline normal range) - post ACTH (post ACTH normal range)
    Cortisol ng/ml - 22.1 (2.0 - 56.5) - 192.7 (70.6-151.2)
    Androstenedione ng/ml - 3.1 (0.05-0.36) - 5.8 (0.24-2.90)
    Estradiol pg/ml - 84.0 (23.1 - 65.1) - 91.4 (23.3 - 69.4)
    Progesterone ng/ml - 0.11 (0.03 - 0.17) - 2.5 (0.22-1.45)
    17 OH Progesterone ng/ml - 0.08 (0.08 - 0.22) - 1.77 (0.25 - 2.63)
    Aldosterone pg/ml - 24.8 (11 - 139.9) - 238.7 (72.9 - 398.5)
    Comments: these results indicate presense of increased adrenal activity. Values are increased as indicated. The disease has progressed since the last test. Consider items 1 through 5 on the treatment option sheet attached. Traditional Lysodren treatment is probably not needed at this time.
    _____________________________

    I wanted to say THANK YOU to everyone's input when I was trying to decide which treatment plan to follow.

    Janette

  2. #2
    Join Date
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    Tennessee
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    Default Re: Max - 11 year old Maltese (Atypical Cushings) - started Lysodren Maintenance Dose

    Hi Janette.

    I'm glad you found us and that Max is doing well on his maintenance dose of Lysodren. You are right the cortisol elevation is negligible which leads me to believe the real problem is the sex hormones, especially the estradiol. Changing to the standard Melatonin and Flax Hulls was an excellent decision and I hope that between the three treatments, you will finally start to see some improvements. It may take a bit of time so don't get discouraged because I think you are on the right path.

    Glynda

  3. #3
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    Default Re: Max - 11 year old Maltese (Atypical Cushings) - started Lysodren Maintenance Dose

    Hi Janette,

    Sounds like a good plan and I hope you will start to see some real improvements in no time. The melatonin and lignans changes will help, too!

    Hugs,
    Leslie and the girls

  4. #4
    Join Date
    May 2010
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    Default Re: Max - 11 year old Maltese (Atypical Cushings) - started Lysodren Maintenance Dose

    I have had good luck with regular melatonin and flax hulls. Seems you are on the right track. Keep us updated and give Max a big hug!
    Carrol

  5. #5

    Default Re: Max - 11 year old Maltese (Atypical Cushings) - started Lysodren Maintenance Dose

    Hello,

    I just wanted to give a quick update - re: Max

    He's been on the Maintenance dose since my last posting, but we had worked our way up to Lysodren 62.5 mg three times a week.

    Max now weighs 8.5 lbs.

    The ASTM stim tests have varied, but the lowest has only been at 11 ug/dL post.

    Just did one on March 18th and the results were 3.8 ug/dL pre and 28.1 ug/dL post. The 28.1 post result is the highest result since he started on the Lysodren, so it's obviously not working well.

    I have decided to do a full loading on Max (which we never did do since we were hoping a maintenance dose would be sufficient). It won't be for a few weeks yet because I want to time it so I can take some time off from work to watch him.

    Other events since I last posted:

    Max had his spleen removed on Feb 2010 (ultrasound had shown a small nodule on it, which thankfully turned out to be benign.) As a benefit to having the spleen removed, Max seems more comfortable, with a less tight belly (I would assume that with the enlarged liver, it would be good to have some space freed up )

    Max has a heart murmur (level 4) and is on spirolactone and enalapril for his heart.

    I will post updates as they come.

    Janette

  6. #6
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    Default Re: Max - 11 year old Maltese (Atypical Cushings) - started Lysodren Maintenance Dose

    Hi Janette,

    So sorry to hear that Max's cortisol is rising. When his spleen was removed, did they take the whole organ or only a portion? My Squirt also had a tumor but they left half her spleen. I was told it was a very slight possibility that the portion left could also develop a tumor so I wondered about Max's situation with his spleen.

    If Squirt's cortisol started to rise even on maintenance, then I would be compelled to do an ultrasound before a load just to be sure there wasn't another tumor somewhere. Have you talked to your vet about this possibility?

    That was a scary time with the spleen, huh? I understand! Between the time of learning about the tumor and the actual surgery, I was petrified it would rupture. Every time I picked her up my heart went up in my throat and breathing became difficult I was so scared of making it rupture! Then she had an acute pancreatic attack right after coming home and had to go back to the hospital for several more days. She is fine and dandy today, tho, and I am so grateful! I'm glad Max has that behind him - and YOU, too!

    Let us know how things are going for him.

    Hugs,
    Leslie and the gang
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." Anne, a Corgi mom

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  7. #7

    Default Re: Max - 11 year old Maltese (Atypical Cushings) - started Lysodren Maintenance Dose

    Hi Leslie,

    With Max, they removed his entire spleen.

    While they were in there, they also biopsied the liver which had nodules (related to cushings I'm sure). Thankfully everything came back good news for us, and Max didn't have any unexpected difficulties with the surgery itself.

    I was a nervous wreck having to make the decision and then waiting to hear the day of the surgery. Recuperation went well - even though Mother Nature decided to complicate our lives with TWO 20" plus snow storms the week when Max came home.

    Poor Squirt, having a pancreatic attack right after her surgery. Misty, my other dog, seems to be prone to pancreatitis - she's been in the hospital because of it twice!!! So I know it can be scary. Glad to hear that Squirt is doing well now.

    Janette

  8. #8
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    Default Re: Max - 11 year old Maltese (Atypical Cushings) - started Lysodren Maintenance Dose

    Hi Janette,

    Just checking in on you and Max. How is Max doing today? Did you load him yet?

  9. #9

    Default Re: Max - 11 year old Maltese (Atypical Cushings) - started Lysodren Maintenance Dose

    Hello,

    Thank you for checking up and your timing is PERFECT. I was actually just doing some reading on ACTH stim results on the lower side.

    I did load Max. We started last Wednesday, and he got 93.75 mg twice a day. (Max weighs 8.5 lbs). His last dose was yesterday (Sunday) morning. I stopped it because he was coughing some and then when I offered him a treat (just in case he had swallowed something wrong like people sometimes do ) he didn't take it. That is not Max. So I stopped it.

    He had a ACTH stim this morning, and here are the results:

    pre: 0.8 ug/dL
    post: 1.1 ug/dL

    I am glad that we have reached the end of the loading, but he is obviously at the very lower bound, and I am somewhat worried that he will drop a bit lower in the next day or two.

    Do you think that is a concern as long as he is eating?

    Re: the cough. Max does have a heart murmur (grade IV or V depending on which doctor we see) so I also had them do chest xrays today. No obvious fluid but perhaps a sign of some slight congestion. The regular vet gave me Furosemide 12.5 mg (a diuretic) - Max is to get 1/4 tablet every 12 hours. She has a call into Max's cardiac vet but hadn't heard back from him yet today. She said it's a low dose and a couple of doses wouldn't hurt him and she would rather err on the side of giving it to him for a couple of doses than not give it to him and have his heart start decompensating (I believe that is the word she used). The regular vet also has a call into the IMS we saw a couple of weeks ago but had not been able to make contact with her either. Tonight or tomorrow all of Max's vets should hopefully be able to talk and I know a bit more.

    But Max hasn't had any coughing today that I have noticed and he is eating.

    My immediate concern is that the post ASTM stim of 1.1 is too low considering his last Lysodren dose was 24 hours before the ASTM stim was done.

    Thanks again for checking in on us.

    Janette and Max

  10. #10
    Join Date
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    Default Re: Max - 11 year old Maltese (Atypical Cushings) - started Lysodren Maintenance Dose

    Hi Janette,

    Yes that post stim number is low, especially considering the short time frame after the last dose. You need to keep a close eye on Max for signs that cortisol has dropped even lower. If his appetite remains off, that's a definite sign and you should give him a dose of prednisone and take him in to have his electrolytes checked. Your vet gave you Prednisone right?

    Please check in with us and let us know how Max is doing over the next 24 hours.

    Glynda

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