New diagnosis - Symptoms returned after 4 wks on meds

[Skylar]

Thanks so much for your advice Leslie!!! Your math was correct. 1/4 of a 500mg tablet is 125mg. So your recommendation of 1/4 every 3 days would be too much I would think. If I gave twice a week that would be perfect. But how does that work? Would I give it every Monday and Thursday? That's 2 days between on the first week (mon-thurs) and 3 days in between on the second week (thurs-mon). I would think it would have to be the same amount of days in between dosages, but with the number of days in the week it's impossible.

Also, today is the 7th day of loading. This morning I had to coax her to eat her all her breakfast. But the drinking and peeing haven't changed, in fact it seems to be getting worse. The last few nights she has woken up in the middle of the night to drink water. She is drinking almost 3 times what she should. She had a urinalysis yesterday and didn't have a UTI. It is being sent out for a culture to see if anything grows. I'm going to get her electrolytes checked when she gets her next ACTH.

Have you heard that the water/peeing increase doesn't change at all during the loading phase? Should I plan on getting her tested on Monday even though her drinking/peeing hasn't changed at all? The only symptom change was that this morning I had to coax her to eat.

Thanks again! I have literally been obsessed with this. I'm hoping to have Molly around for many more years. She is the most important thing in my life. I know she's considered up in age at 10, but I keep hearing about small dogs living till 18.

[Squirt's Mom]

Since you had to coax her to eat STOP the load now! Watch her carefully for any signs the cortisol has gone too low - loose stool/diarrhea, nausea/vomiting, loss of appetite, and/or lethargy. Do you have any prednisone on hand? If you see any of these signs call the vet asap for an ACTH and electrolyte check.

As for the drinking and peeing - those could be caused by something unrelated to elevated Cushing's. Has her glucose been checked recently? Those are also signs of diabetes as is lack of appetite. Diabetes mellitus can come on very quickly too.

There is also a rare form of diabetes called Diabetes Insipidus that has nothing to do with blood sugar but rather with how the body processes water. And the signs you are seeing fit DI as well. Here is a link about DI - https://vcahospitals.com/know-your-p...ipidus-in-dogs

Testing for DI can be risky so most vets simply start treatment and if signs improve, there is the diagnosis. This is worth talking to your vet about soon since the drinking and peeing are not changing.

[labblab]

Hello and welcome to you and Molly from me, too! I’ve read back through your entire thread, and I do think it’s important for you to now hold up on any more Lysodren until the ACTH results are back. During the first load during an identical time period and at the same dose, Molly’s cortisol had dropped down to 1.2 both pre and post. You definitely don’t want to risk having it drop any further now which I think could be a real risk, especially since you started out at a cortisol level that was much lower than the first time around. Loss of appetite, all by itself, can signal the end of the loading period. So I think you really need to pay attention to that, regardless of the thirst/urination.

Lysodren administration should be stopped when:

1. the dog demonstrates any reduction in appetite; this might mean just pausing slightly during meal consumption, stopping to drink some water, or stopping in response to the owner's voice.

2. the polydipsic dog consumes less than 60 ml/kg/ day of water.

3. the dog vomits.

4. the dog has diarrhea

5. the dog is unusually listless.

The first two indications for stopping the medication are strongly emphasized because they are common and they precede worrisome overdosages. The occurrence of any of these signs strongly indicates that the end point in induction (loading) therapy has been achieved.

Since it will take several days for the ACTH to be analyzed, I have to say that I do think it’s unfortunate that your vet is waiting clear until Monday to test. If by some chance the load has not yet been achieved, waiting a full five days to resume dosing will set you back further again. And to be honest, given Molly’s lack of appetite and the low level of her cortisol the first time around, I might worry now that she is actually oversuppressed or that her electrolytes may be out of whack. The thing is, the excessive thirst and urination actually could be caused by something other than high cortisol. It can even be caused by oversuppression of the adrenal glands.

I must admit that Molly exhibits classic Cushing’s symptoms. But in checking her two diagnostic blood tests, the LDDS and first ACTH, they were both just barely out of normal range. Coupled with her less than ideal response to the Lysodren, I do wonder whether there’s more that’s involved here than just Cushing’s. For instance, there’s a condition called diabetes insipidus (different from the common diabetes mellitis) that can also be triggered by the same pituitary tumor that can cause Cushing’s. Diabetes insipidus results in excessive thirst and urination, too, but it has nothing to do with cortisol levels and is treated with an entirely different medication.

So all in all, I’m uneasy with the way things have been going for Molly. And even though the rebound of her symptoms is upsetting, the much bigger safety risk is a cortisol level that has dropped too low, or an electrolyte imbalance that has been caused by oversuppression of aldosterone, another adrenal hormone that can be lowered too far by Lysodren. So in summary, I would not give her any more Lysodren until she’s been tested. And if she worsens even more through the day, I’d honestly try to get her tested today. I have not been able to find any research that supports waiting for as long as your vet is recommending, and it would be good to get the info about her cortisol level and electrolytes sooner rather than later.

Please keep us updated, OK?
Marianne

Edited to add: I see Leslie and I are on the same page about this! Sorry for the duplication...

[Skylar]

I can't stress enough how blessed I am to have found this site!! Thanks for all the information on diabetes insipidus! I will have her tested for that. My vet did mention that she wasn't off the charts with the LDDS and the first ACTH. But when I started the maintenance of the Lyso, her drinking/peeing/ravenous hunger, decreased significantly.

I gave Molly 1/4 pill this morning, after coaxing her to eat all of her breakfast. I will not give her the second dose this evening. Should I ask to get the ACTH tomorrow instead of Monday? I'm concerned that if I wait until Monday morning it will be 72 hours (3 days) between the last dose and the test. But if I go tomorrow, it will only be 24 hours. Ideally it should be Sunday, but they are closed.

[Skylar]

I also wanted to let you know that when Molly was 6 she started to have small seizures. She was diagnosed with epilepsy and was on phenobarbitol. She hadn't had any seizures in years, so I tappered her off and stopped the pheno. The last dose was almost 2 years ago. The vet said this is totally unrelated to Cushings and her current symptoms.

Could she have diabetes insipidus AND Cushing's? The increased water/peeing could be the diabetes, but she also has a pot belly, increased hunger, muscle weakness, dry skin, and panting.

[Harley PoMMom]

If this were me, I would have an ACTH stimulation test done ASAP plus having her electrolytes checked should be done too. As for testing for diabetes insipidus, this includes a water deprivation period and should never be performed on a dog that is suspected of having Cushing's because those kidneys need that water. Dog's with Cushing's drink more water because that elevated cortisol causes the kidneys to work harder which in turn the dog has to make up for that loss of water by drinking more. The most beneficial way to test for diabetes insipidus is to just give a trail run of the medicine that is prescribed for it which is generally desmopressin.

Lori

[labblab]

If it were me, I’d ask for the ACTH tomorrow. And yes, a dog can have Cushing’s as well as diabetes insipidus. And as Leslie has mentioned, Cushing’s and diabetes mellitus can also occur in the same dog. I’m glad she wrote about it, because as she says, DM can come on quite suddenly and can also account for excessive urination/thirst. It can be diagnosed with a simple blood glucose level that would be part of the same general chemistry panel that tests electrolytes (most importantly, sodium and potassium levels).

Marianne

[Skylar]

Hello everyone. Thanks again for all your advice. Molly had an ACTH test and electrolyte test this morning. The results should be back in a couple days. She isn't drinking or peeing as much and her pot belly seems to be less. She is not eating very much at all though. But she is active and alert so the vet don't feel she is adisonian. The urine culture came back today and she does have another UTI, which will be treated with antibiotics.

So here is my question on the maintenance schedule.

What ever weekly dosage the vet decides to put her on (depending on the results of today's ACTH - Lets say it's 250mg per week. Would I give it every Monday and Thursday? That's 2 days between on the first week (mon-thurs) and 3 days in between on the second week (thurs-mon). I would think it would have to be the same amount of days in between dosages, but with the number of days in the week it's impossible.

And let's say she should get 200mg per week. If she got 50mg every other day, it still would work out to 4 pills one week and 3 pills the next.

This is so confusing! It would be so much easier if there were 8 days in a week. (And if each month had the same amount of days. And if daylight savings time didn't exist). hahaha

[labblab]

We’ll sure be anxious to hear how those test results turn out! I have not used Lysodren personally, but I don’t think it matters greatly if you don’t have the exact same number of days between doses. You’re aiming at an overall weekly dose that just happens to be divided into increments. So probably just adopting a regular schedule that is easy for you to follow would be best. For instance, every Monday and Thursday for twice-weekly dosing; every Monday, Wednesday, Friday for thrice-weekly dosing. Whatever schedule you pick, I believe your main goal is to maintain a consistent overall weekly total. So once again, I’d pick the days that work best for you and maintain that same schedule every week.

Hopefully, some other folks who have used Lysodren will drop by. But this is the dosing pattern I’ve observed over the years here ;-).

Marianne

[Squirt's Mom]

That always bothered me, too, and I chose to use a balanced pattern - ie every other day or every third day, and didn't worry about the "week" thing.