Down the Cushings Road Again -- Abbie, 15 year old beagle is now at peace

[judymaggie]

Hi, all! First, thanks for everyone's support! My vet was able to schedule an appointment for this morning with the IMS so was very happy we didn't have to wait until November.

The IMS's report says that Abbie was "bright and alert". I loved the "alert" part -- during my initial conversation with the IMS her eyes kept closing due to the melatonin I had given her earlier in the day although she did definitely let go with a few "aro-o-o-s" when she came back to me after the ultrasound.

Ultrasound showed:

a coarse liver, bilateral adrenomegaly and age related changes with the kidneys with no other significant findings.

Her blood pressure was in the upper end of normal but no need for any medications at this time. The IMS and I discussed trilostane vs. mitotane and he said he was comfortable with either one based on his findings and Abbie's history. Abbie weighed exactly 25 lbs. today; the IMS said he would load at 500 mg. per day, split into two doses. He said that he always recommends having prednisone on hand.

Closing comment on the report was that "Abbie was a good sport" during her visit!

I will call my vet tomorrow and schedule a meeting time to review everything and get meds. Since he is more comfortable with mitotane, I am going to go that route. Since I have no appointments the first week in November, I am thinking about starting loading on the 1st. My vet takes Wednesdays off so thought the timing would be okay.

[molly muffin]

Whoo hooo, so glad you got in today! Awesome and very good ultrasound report over all. Go Abbie!

hugs
Sharlene and molly muffin

[judymaggie]

Hi, folks! I met with Abbie's vet this afternoon to work out a treatment plan. I walked in with a pile of papers from posts and resources here -- he is used to me having a list for all of Abbie's appointments so he wasn't surprised. He asked me if I wanted to start with my notes or have him describe his usual practice. We went with his routine and there were only a few deviations from what I have learned here.

We are going to go with Lysodren as that is what he is most familiar with -- Abbie, who weighs 25 lbs., will be on 500 mg./day for loading, split into two doses. He said that his experience is that loading takes 7-10 days. When I mentioned a quicker loading period, he said he has never seen that. I think one of the reasons for this is that he leans towards more significant changes in drinking/eating before stopping. He also said that he does the ACTH the day after the last loading dose (as opposed to 48 hours recommended by Dr. Feldman). He also wants me to start on a Monday (as opposed to a Sunday).

If it turns out that the ACTH is done after less than 48 hours, do you think that is going to produce inaccurate results?

I did find the best price for Lysodren at Sam's ($5.50/one 500 mg. tablet) and my vet called in a prescription for 10 tablets with a refill and also added a prescription for prednisone. He also gave me his cell phone number and said I could certainly call him if I need him after hours. I am giving Abbie pepcid once a day now and the vet said to cut the pill in half so I can give it to her with each dose of Lysodren.

Overall, I was pleased with visit. Since I have a couple of appointments next week, I am going to start the Lysodren on 11/3.

[Harley PoMMom]

We are going to go with Lysodren as that is what he is most familiar with -- Abbie, who weighs 25 lbs., will be on 500 mg./day for loading, split into two doses. He said that his experience is that loading takes 7-10 days. When I mentioned a quicker loading period, he said he has never seen that. I think one of the reasons for this is that he leans towards more significant changes in drinking/eating before stopping. He also said that he does the ACTH the day after the last loading dose (as opposed to 48 hours recommended by Dr. Feldman). He also wants me to start on a Monday (as opposed to a Sunday).

The loading dose sounds good, however I am a bit worried about the vet's opinion with loading as there is not a set timeframe for loading a dog. During the loading phase any subtle change that the dog makes, especially while eating, can be a sign that the dog is fully loaded and if the loading were to continue an Addison's crisis is very likely.

If it turns out that the ACTH is done after less than 48 hours, do you think that is going to produce inaccurate results?

Lysodren continues to work for 48 hours after the dose is given, so this HAS to be taken in consideration when interpreting ACTH stimulation test results done in an earlier timeframe. As an example, if the ACTH test is done 24 hours after the last dose of Lysodren was given and those results show that the post number is 2 ug/dl, Lysodren will continue to work thereby causing that post number to drop even further and it could even drop too low.

Hugs, Lori

[labblab]

Hi Judy, I just wanted to add a comment about the 48-hour testing delay. I have not even had a chance to talk about this with Lori yet, but after always having cited this very same info, myself, I am now questioning whether it is really important to wait. I believe all we staffers have been giving this same recommendation for years, but a member recently questioned me about the source. And dang if I didn't have a really hard time coming up with citations and clinicians who feel it is important to wait to test. I think Glynda has found a study that suggested the opposite of what we had previously been led to believe -- that the cortisol level may actually be higher after 48 hours rather than lower. So for some folks, that might be a reason to wait to see whether enough dosing has actually occured. But for me personally, the bottom line is that it seems as though the majority of clinicians do not seem to think it is significantly important to wait, and go ahead and test as soon as there is a suspicion that the loading may be complete.

Marianne

[judymaggie]

Lori & Marianne -- thanks for quick replies! I am comfortable stopping loading as soon as I see subtle changes. I was going to ask for an article with the 48 hour reference because I couldn't find one anywhere ...

I did remember after I posted that my vet also said that I could give the Lysodren to Abbie inside her Royal Canin canned low fat food (which is how I am giving her meds now). I mentioned to him that everything I read has said to give it inside a fatty food. I don't want to use peanut butter because Abbie has a mild choking issue (mostly with water) and I am concerned that the peanut butter (and Lysodren) would get stuck in her throat. Would something like American cheese work?

[Harley PoMMom]

Hi Judy,

I apologize for the misinformation on my part regarding that 48 hour window, I've been out of sorts here latley, personal issues have been taking up my time and obviously my mind

I am glad Mariann caught my error and has corrected it (and me!)

I know some members have hid the Lysodren pill in cream cheese, would that work for Abbie?

Hugs, Lori

[judymaggie]

Lori--absolutely no need to apologize! You have always been here for everyone and you really do need to take care of yourself.

I saw the mention of cream cheese in a post but couldn't figure out how that would adhere to the pill. We don't know why Abbie is having a choking issue and, because it is not severe, finding out why is taking a back seat to starting Cushing's treatment. (The IMS believes that she probably has the very early stages of tracheal collapse.) That said, I really need to make sure that the Lysodren goes easily down her throat. She does so well with her meds in her canned food that I wish that could be used.

[labblab]

Judy, I may be missing the boat here, but as long as there is at least some amount of fat in the canned food I think you should be OK. In other words, you do want to make sure there is some fat in the stomach at the same time the Lysodren is being digested but I don't think the pill literally has to be wrapped in fat. It is recommended that you feed a meal prior to giving the Lysodren in order to assess any decrease in appetite prior to dosing. So even if the canned food is low-fat, there still will be some fat present to support the pill's digestion in the stomach. The biggest worry is to not give the Lysodren on an empty stomach that is devoid of any fat.

But having said that, I think American cheese would be fine to use in addition. That's exactly what I use for my Peg's phenobarb -- the soft processed American cheese slices. I tear off a little square and then smoosh the cheese nicely around the pill so as to make a tiny pill sandwich and she swallows it with delight.

Marianne

[molly muffin]

Is the canned food of a consistency that you can scoop it and shape it around the pill? I do that for molly to get her to take her pills. (she is not a fan of pills usually, but quite the fan of her canned food). Now if you rattle a pill bottle, she knows she'll get some canned food so she'll come running. Right past the dry food bowl, with food left in it.
They do have their own ways about them. That might help Abbie to be able to swallow the pill too.

Just throwing out thoughts here
hugs
Sharlene and molly muffin