Mr. Bojangles - 7 y/o Beagle on Lysodren (Unresolved problems)

[mrbojangles]

We like Laura have a 7 year old Beagle who supposedly had all the visual signs of Cushings syndrome.

We like everyone here love our pet dearly, and went the complete route with a new Vet to determine if in fact Bojangles did indeed have this terrible disease.

Of course all the tests came back indicating he has it, So being responsible owners we spent thousands of dollars on Lysodren, the 8 hour test, ACTH tests , (3) to "kill" off some of his adrenal glands, We was told by our vet, his body would transform back into a respectable weight and the symptoms would subside. What a lie that was.

We're still waiting 5 months later, and his constant thirst and hunger has driven my wife and I to near hysteria. We were informed his adrenal glands were actually "killed off" to below the normal level of Cortisol (sp) and he was put on a "low dose" of Prednisone. (5mg)

He was actually a lot better off before we "cured" him. his hunger & thirst are ridiculous , Both my wife Ginny and I are at our wits end, and have spent nearly all of our meager savings to save this guy.

I'm starting to believe that he was misdiagnosed and we have no other recourse but to sit and watch our beloved boy eat himself to death shortly. We need help in what our next course of action should be. I'm ready to retain a good lawyer and start a suit against this woman and the clinic we go too.
Thank you in advance.
Any advise would be greatly appreiciated .
Joe and Ginny D

[Squirt's Mom]

Hi Joe and Ginny,

Welcome to ya'll and Mr. Bojangles! :)

One of our mods has moved your post to start a new thread that will be just for Mr. B so we can keep all his info in one place, making it easier to keep up with the details. ;)

If you could, please post all the abnormal test results on the CBC with the units of measurement (ug/dl, mnol/L, etc) and the norms for that lab. Also the results of all the cush specific tests he has had including the units of measurement and normal ranges. Is Mr Bojangles on any other meds, supplements, herbs, etc at the moment? If so what, how much and how often? How much does he weigh? What dose of Lyso are you giving and how often? What does he eat with the Lyso dose? Has he been tested for thyroid problems and diabetes? If not, those need to be ruled out asap. These conditions have many of the same signs as Cushing's and it is not at all uncommon for our pups to have concurrent conditions.

Another thought is Atypical Cushing's in which 5 other hormones can come into play. Those hormones are Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone. They can be tested for via an ACTH that is sent to the Uni. of TN in Knoxville (UTK) - they are the only lab that does this testing at this time. These other hormones can cause the same signs as typical Cushing's. Lyso will control all of them with the exception on estradiol. Estradiol can be produced in areas of the body other than the adrenals and Lyso cannot reach those areas.

I am glad you found us and we will do much more talking in the days ahead. Take a deep breath and relax just a bit. Don't sue your vet just yet. :p You have found the very best place to be to learn about Cushing's and it myriad facets. You do not have to walk this journey along any longer; we will be here to help you in any way we can. Please read in our Resource section as well as the threads here, then ask lots of questions and we will do our best to help you understand.

Hang in there!
Hugs,
Leslie and the girls - always

K9C Resource section:
http://www.k9cushings.com/forum/forumdisplay.php?f=10

[labblab]

Welcome from me, too! I'm so sorry that Bojangles' treatment path has been so rocky, but I'm really glad that you've found us. We will do our best to help you sort out the problems, and support you along the way.

Often the hardest part for a new member is answering all the questions that we tend to ask :o. But in addition to those already asked by Leslie, here's a few more...

For how long a time has Bojangles been taking the prednisone? Has the dose remained constant at 5 mg. daily? As Leslie has said, the dates and results of his monitoring ACTH tests will be really helpful (in addition to the original diagnostic tests). Also, during these past five months, was there EVER a time when his thirst and appetite were more controlled? How about prior to diagnosis -- for how long a time was he symptomatic, and were there other symptoms in addition to thirst and hunger?

Thanks in advance for any additional information that you care to share with us!
Marianne

[acushdogsmom]

Hi and welcome from me, too. :)

I'm really glad that you found us and I hope we can help you to figure out why Mr. Bojangles has not responded the way he should have responded to the Lysodren treatment.

My dog was treated with Lysodren for more than 6 years, and all of his Cushing's symptoms pretty much disappeared as soon as we got his cortisol production properly lowered with a daily "loading dose" of Lysodren and then kept at that lowered level with a weekly dose of Lysodren.

Like the others here do, I also have some questions for you. Do you know the results of the tests that were done to diagnose Cushing's - i.e. the ACTH stimulation test (a Cushing's diagnostic test that is also used to monitor treatment of Cushing's dogs) and the 8-hour test, which may have been a Low Dose Dexamethasone Suppression test (also a Cushing's diagnostic test) or a High Dose Dex Suppression test (which is used to try to determine if the Cushing's is Pituitary or Adrenal)? Do you know if the 8 hour test was the LDDS or the HDDS test? Was an ultrasound ever done?

Assuming that the diagnosis is correct, however, I am curious to know why Mr. Bojangles has been put on prednisone ... and is he still on the Lysodren too?

I see that you said:

We were informed his adrenal glands were actually "killed off" to below the normal level of Cortisol (sp) and he was put on a "low dose" of Prednisone. (5mg)

The goal of treatment with the Lysodren actually is to get the cortisol production lowered significantly, to a level much lower than a normal dog without Cushing's would usually have - to where the post number on an ACTH stimulation test is less than 5 ug/dl, which should then resolve the Cushing's symptoms either completely or at least to a satisfactory degree. And then once the cortisol is sufficiently lowered, the goal is to to keep it lowered with weekly doses of Lysodren. Sort of like getting a major haircut and then having a little trim every week to keep the hair at the desired length.

Pred is a synthetic form of cortisol and pred can cause a dog to become really thirsty and have an increased appetite, just as an overproduction of natural cortisol can cause (ie the symptoms you see before you start treatment on a Cushing's dog). And the way I learned it from the Internal Medicine Specialist Vet who treated our dog, pred is supposed to be given to the dog only if the natural cortisol production goes much TOO low, and that's the way that most Vets do it, and the way the veterinary treatment protocols that I know of are written - pred is not given unless the cortisol is way too low. And if the dog does have way too low cortisol production and really needs to be on the pred, then they wouldn't also be still on the Lysodren, which is why I'm asking if Mr. Bojangles is still getting Lysodren along with the pred.

A small minority of Vets do seem to like to have the dog on pred along with the Lysodren, but Vets who have the dog taking both Lysodren and pred seem to me to be the ones who may have less experience and expertise managing a Cushing's dog and especially regarding things like Lysodren dosing adjustments. They are likely really nervous that the Lysodren might cause the cortisol production to go too low, so they use the pred as a sort of safety net, to try to prevent symptoms of Lysodren overdose. They lower the cortisol with the Lysodren and also put some pred (which is really synthetic cortisol) back into the dog's system at the same time, the thinking being that if cortisol does get too low, that the pred is on board to counteract a possible overdose.

But that just seems to me to be a really counterproductive way to do the treatment. Sort of like taking two steps forward and one step back instead of just going forward. It makes more sense to do it the way my Specialist Vet and most other Vets do it - ie to lower the cortisol with the Lysodren to a low enough level that you get rid of the symptoms and prevent organ damage that overproduction of cortisol can cause. And then only put pred into the dog's system if they really need it.

I always had some pred on hand at home to give in case we ever needed it, but in the 6 years we treated with Lysodren, we only had to give the pred maybe three or four times. Other than those times when we had to give prednisone, we did sometimes have to adjust the Lysodren dose sometimes too when the ACTH stim tests that we did periodically as a monitoring test showed that the cortisol was a bit too high or a bit too low.

So I'd also be very curious to know the actual test number results of Mr. Bojangles' post-loading ACTH stimulation test (the ACTH stim test they do to confirm that the first stage of treatment - known as "loading" - is complete) and any other ACTH stim tests that he's had done to monitor the cortisol production since starting on the Lysodren (he should have had at least one more of those done since the initial "loading").

There are two numbers given as results on an ACTH stim test, a "pre" number and a "post" number. Those ACTH stim test numbers can tell us if his cortisol production really is so low that he needs to be taking the prednisone, so it would help us to help you if you could get those test result numbers and post them for us here.

If the ACTH stim test results show that the cortisol production is within the target range that we're supposed to be aiming for (ie between approx 2-5 ug/dl) then the the pred may not be needed, and in fact it could be the pred that is causing the current symptoms of overeating and increased thirst etc.

Hang in there - and hopefully we'll be able to help you to figure out why Mr. Bojangles is not responding to treatment the way that he should.

As for your next course of action, I am inclined to say that a referral to an Internal Medicine Specialist Vet who has more expertise in diagnosing and treating Cushing's successfully is what you need to do.

[littleone1]

Hi Joe and Ginny,

Corky and I also want to welcome you to a very special group of very caring, supportive, and knowledgeable people. I'm glad you found us.

I am so sorry that Bojangles is experiencing these problems. I hope and pray that Bojangles will improve.

I know that you have received some good advice. I wish there was something more I could offer, but Corky has been treated with Trilostane for 2 1/2 months.

Terri

[sunimist]

Hi Joe and Ginny. :) So sorry for all your problems.

Has Bojangles been diagnosed as "Addisonian"? You said the adrenals had been "killed off", so if that's true, that would mean he has Addison's disease...the oposite of cushings disease. If this is correct, the prednisone would be the acceptable treatment. The most important thing is to have his electrolytes checked and if they are out of balance, he would need medication along with the pred.
The electrolytes are very important and absolutely must be kept in range.

The prednisone can cause excessive eating and drinking, but there are other issues that have those symptoms too. Not knowing what all the vet has tested for and ruled in/out, it's hard to guess.

I would urge you to get a second opinion for Bojangles. I know it is very discouraging to have spent so much money without attaining a true diagnosis, but it sounds to me like it's the best option in order to help Bojangles. Also as someone else mentioned, there is the strong possibility of Atypical Cushings.

Please keep us posted and fill in the blanks if you can.:)

Shelba and Suni

[Franklin'sMum]

Hi Joe and Ginny,

Welcome to you both and Mr Bojangles, too. My boy Franklin treats with trilo, so I can't offer any advice about the issues Bojangles is having with the lyso. Hope you find the answers, and that you and Bojangles see some improvement and feel better soon.

Jane and Franklin xx
________
Cat wheels (http://www.catwheelcompany.com/)

[k9diabetes]

Also, was diabetes ruled out?

Natalie

[jrepac]

first thing I also thought about was diabetes....

Jeff

[mrbojangles]

Thank you all for your immediate responses,

We greatly appreciate the overall concern of the board.. Bo has been taken off the Lysodren and is on only on Prednisone once a day currently, Our Vet after the last ACTH test , told us his levels were 2.5.. so if what someone is saying, then his levels are pretty close to normal, then why is he on Prednisone once a day??? Diabetes and Thyroid have been ruled out, with tests for both, I believe the Prednisone is creating his thirst and unbelievable hunger.

I'll give everyone a little history quickly, Bo was pretty much a chubby dog from about 3 years of age, we got him at 7 weeks from a breeder in Trenton NJ who came highly recommended.

Of course learning things about pure bread Beagles , we were told by many that they will always crave food , but, never like he has been since Dr Cho, our vet tested him and found him to have canine Cushings.

His dose started out at twice a day with the Lysodren, for about ten days, and a once a day Prednisone then he was tested again, and she abruptly stopped the Lysodren, but kept him on a once a day Prednisone (5mg) since the initial testing.

He was never lethargic or any of the other symptoms we were told to look out for. Again , according to our Vet he is NOT addisonian.. But I and my husband are sceptical of what the Vet is saying or doing each time we take Bo to her.. Her Knowledge of Cushings seems limited at best...

We are concerned that from what she indicated to us, that Bo would be on Prednisone forever, and in her opinion, this constant hunger/ thirst is not from Prednisone, when all the reports we have read indicate otherwise, this causes a confusion between my husband and I and the vet.

We were never actually given the test results on paper, she verbally blurted them out after my husband lost his temper in the office after his last test, and we were told only that they ( the levels ) had elevated from 2 to around 2.5 in a few months from the last test. He has had (2) ACTH tests so far ..

We will get the test results from the very beginning and post them so everyone can see what is going on and offer any advise to us.

As a matter of fact I will call today and request them ASAP..

Thank you all, I am overwhelmed by the love and support given to us by everyone here..
Ginny and Joe.

[labblab]

Dear Ginny and Joe,

From what you have just told us, I truly believe that the best thing you can do for Bojangles is to locate an internal medicine specialist in your area, and arrange for him to be seen as soon as possible. You will probably need a referral from your current vet, but it is your right to request that the referral be made. I think there is every reason to believe that the ongoing prednisone has really complicated Bojangles' treatment. It may be the case that he actually needs the prednisone, but with only two ACTH tests over a five-month time period, it is hard to know. And since he has been taking the prednisone for five months now, the medication definitely should not be stopped "cold turkey," even if it is not appropriate for him to be continuing on it indefinitely. I believe that someone more knowledgeable than your current vet needs to be consulted, both in terms of the original Cushing's diagnosis and also the appropriate steps to be taken at this time. There are many aspects of your vet's care that seem problemmatic to me. So I truly think the single best thing you can do is to to RUN, don't walk, to a specialized consultant.

Perhaps we have some other members living in NJ who can suggest a vet to you. If not, please take a look at this link to see whether you can locate an internal medicine specialist from this list:

http://www.k9cushings.com/forum/showthread.php?t=182

Marianne

[sunimist]

Hello again Joe and Ginny,


he is NOT addisonian.. 2.5 (is this a post number?) is certainly not indicative of addison's. Of course there are exceptions.


she abruptly stopped the Lysodren, but kept him on a once a day Prednisone (5mg) since the initial testing. What reason did she give for this? And this would be considered a fairly large dose of pred for maintenance, even for Addison's. Would be great to know the exact pre and post numbers at this point.


she indicated to us, that Bo would be on Prednisone forever This I just don't understand, unless there is some other issue that requires prednisone that we don't know about. Prednisone is not a medication for true cushings disease that I know of, and she has already said he wasn't addisonian, so why then?

I hope little Bojangles gets all better real soon. I know the excessive drinking and eating can really be nerve-wracking to you and it's certainly not doing his little body any good either.

I agree with everything Marianne said.

Shelba and Suni

[labblab]

Just to add another thought...

If Bojangles' ACTH tests have always been performed while he is actively taking prednisone, even on the day of the tests (and even the very first one after the 10 days of Lysodren + daily prednisone) -- then I guess that results of 2.0 and 2.5 might indeed indicate that his own natural cortisol production was/is basically nil. So perhaps he truly does need supplementation at some dosage. But your lack of confidence in your vet -- and her seeming disregard for Bo's excessive thirst and appetite -- are still reason enough to seek a specialist's input. And we haven't yet even talked about the initial diagnostics and any related issues as to the original Cushing's diagnosis...:o

Marianne

[jrepac]

Ginny and Joe,

the entire treatment pattern for Bojangles does strike me as odd; if he is not Addisonian and he is off the lyso, at some point you would expect his adrenals to begin producing more cortisol. Odd that the vet would say he needs to stay on prednisone forever! And, the hunger and thirst, one would think SHOULD diminish if his cortisol is low. Unless there are other factors at play here....

As you live by the NJ shore, you may want to try to get over to Garden State Veterinary Specialists in Tinton Falls. They are highly recommended. Will warn you in advance, they are expensive. But they have a lot of specialists there and can do a lot of advanced stuff on site. Here is the link:

http://www.gsvs.org/

Regardless of if you choose GVS, I would get another vet to look at your pup, as things are not improving to your satisfaction.

Best of luck to you.

Jeff

[Harley PoMMom]

Hi Ginny and Joe,

Here is the usual Lysodren protocol found in the Textbook of Veterinary Internal Medicine, S. J. Ettinger and E. C. Feldman, editors. Dr E. C. Feldman is a reknown Cushings expert. We have this in our Resource Thread which I am including a link to.


Lysodren loading Instructions and related tips

Here are the Lysodren loading Instructions from the chapter on Hyperadrenocorticism in the Textbook of Veterinary Internal Medicine, S. J. Ettinger and E. C. Feldman, editors. 1995

INITIATING THERAPY - THE LOADING DOSE PHASE:

Therapy is begun at home with the owner administering Lysodren at a dosage of 50 mg/kg/day, divided and given BID (twice a day).

Glucocorticoids (prednisone) given together with the Lysodren is not advised during loading, but the owner should have a small supply of prednisolone or prednisone tablets for an emergency.

The owner should receive thorough instructions on the actions of Lysodren and should also have specific instructions on when the drug should be discontinued.

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.

Because of the potency of Lysodren, the veterinarian is encouraged not to rely on the instructions given to an owner. Never provide the owner with more than 8 days of Lysodren, initially. This drug is highly successful in eliminating the signs of hyperadrenocorticism because of its potency coupled with close communication between owner and veterinarian. Either the veterinarian or a technician should contact the owner for a verbal report regarding the dog every day beginning with the second day of therapy. In this way, the owner is impressed with the veterinarian's concern and the need to observe the animal closely.

It is wise for the owner to feed the dog two small meals each day, as previously described. The dog's appetite should be observed prior to each administration of Lysodren. If food is rapidly consumed (with or without polydipsia), medication is warranted.

If food is consumed either slowly or not at all, medication should be discontinued until consultation with the veterinarian.

Usually the initial loading dose phase is complete when a reduction of appetite is noted or after water intake approaches or falls below 60 ml/kg/day.

The water intake in polydipsic dogs may decrease to the normal range in as few as 2 days or take as long as 35 days (average is 5 to 9 days) Owners must continue to monitor the water intake daily until it falls to or below 60 ml/kg/day. Usually the water intake diminishes within days of beginning treatment, but it does not usually become normal until after some reduction in appetite is observed.

A small percentage of dogs demonstrate mild gastric irritation or systemic signs of illness from the Lysodren 1 to 3 days after medication has been started. These signs include anorexia, vomiting, diarrhea, weakness and lethargy.

If any of these signs are observed, the medication should be discontinued until the veterinarian can evaluate the dog. If the signs are the result of drug sensitivity and not because the treatment is complete, dividing the dose further may be helpful; discontinuing the medication for a few days may be necessary.

It is recommended that treatment be initiated on a Sunday, so that if illness develops after a few days, the veterinarian should be available during the regular work week rather than on a weekend.

Other related tips.


According to the protocol for Lysodren loading described above, the loading dose is usually 50 mg Lysodren per kg of the dog's weight (50 mg/kg/day) and is given each DAY of the loading period.

To calculate your dog's weight in kg, divide the weight in lbs by 2.2 (example: a 22 lb dog weighs 10 kg)

Once the dog is successfully "loaded" (also called "induced") the maintenance phase of treatment will begin. The maintenance dose is usually 25 to 50 mg of Lysodren per kg of the dog's weight per WEEK (25-50 mg/kg/week) and can be given in divided doses. Example: 500 mg Lysodren per week can be given as 250 mg twice a week, or 375 mg per week could be given as 125 mg three times a week etc. The entire weekly dose is often the same amount as the dose per day that was given during the loading phase.

The weekly maintenance dose is usually determined by weight of the dog, but the Vet will also take into account how quickly the dog becomes successfully loaded, which may help to indicate the particular dog's sensitivity to the Lysodren. A dog that loads in 3 days might be started on a lower maintenance dose than a dog who took 10 days to load, for example.

The recommended target range for good control of the cortisol production is a result of 1-5 ug/dl for both the pre and post ACTH stimulation test numbers. An ACTH stimulation test is done as soon as it is suspected that the dog is loaded, to confirm if a successful loading has been achieved. An ACTH stim test is done again after a month of giving the weekly maintenance dose and another ACTH stim test is performed after three months of maintenance therapy, to be sure that the weekly maintenance dose of Lysodren is correct for the individual dog. An ACTH stim test should then be performed every 4 to 6 months to monitor the cortisol production and to determine if any dose changes may be needed along the way. Any changes in the dog's eating or drinking habits or behavior should be reported to the Vet immediately and an ACTH stim test will likely be needed to check the dog's cortisol levels and to see if the dose needs adjusting.


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

Hugs,
Lori

[StarDeb55]

Joe & Ginny, I have been following all of the great advice that you have been given since you have joined our forum. Let me say that I'm so very sorry that Mr. Bojangles is not doing well. I know we can help you get this sorted out as soon as you can post those lab results for us.

I don't want to bash your vet, but a number of things have been posted that raise big, ugly red flags for me, too. It's fairly apparent that your vet has little to no experience in treating Cushing's. If your pup has truly gone permanently Addisonian, there are more appropriate drugs to treat this than prednisone. One of these drugs is Florinef, the other is Percorten. Florinef is to help control the electrolyte levels in your pup, percorten is the steroid replacement. I'm not sure but I believe that percorten has far fewer side affects than prednisone.

I wanted to assure you that Lysodren is a wonderful medication & a lifesaver for our pups when used by a vet that follows the standard protocols for dosage & monitoring. My 1st cushpup, Barkley, was successfully treated with lysodren for nearly 8 years, crossing the bridge at 15 for causes not related to Cushing's.

As several others have told you, I URGE you to run, not walk to the nearest internal medicine specialist. These are the vets who have the training to handle all of the various endocrine disorders including both Cushing's & Addison's.

One last thing, IMHO that the use of prednisone is what is causing your pup's continuing symptoms. Increased appetite & water consumption are side effects of steroid use. I know from experience as I have to take prednisone periodically for serious asthma flareups.

Please keep us posted on how you proceed.

Debbie

Forgot to add, that if your pup is permanently Addisonian, it would be prudent to have regular monitoring of his electrolytes, mainly sodium & potassium. If this 2 thing get seriously out of whack, your boy can become seriously ill quite quickly.

[mrbojangles]

first thing I also thought about was diabetes....

Jeff

Fortunately diabetes has been ruled out as well as Thyroid problems, every test came back within the normal limits.

I was at my family doctor today for a problem , and spoke with him about the prednisone, his feeling is that many vets misdiagnosed dogs and cats on a regular basis, his very own dog was said to have canine cushings and he being a physician knew the dangers and side effects of a steroid therapy, and refused to put his dog through this type of drug regimen.

His medical opinion is we should ween Bo from a once a day dose down to a half pill for two week, then go to a 1/2 pill every other day.. Of course we are going for another ACTH test on Monday, and once the results are in , we will decide what course of action to take. He also stated the dangers of an animal retaining water could effect his pulmonary system resulting in congenital heart failure.

Incidentally his vet told our Dr that his dog wouldn't live another year if he was not treated for the cushings..

His dog is still going strong, 6 years later.. I'm really confused now.. My husband and I both think we made a huge mistake allowing the vet to start the lyso treatment in the first place, Bo was never so possessed with getting food and water as he is now after he was treated.

He was on a prescription diet from Hills , and was hovering around 46 lbs, since the time he's been tested and treated, he's ballooned up to 54 lbs and is being fed less then originally given to him.

I will post his actual numbers of the test results tomorrow, I have requested a copy from the vet.
Thanks.

[StarDeb55]

When you started the lysodren therapy, did you do what is termed a loading phase where you were giving the drug daily, split into 2 doses? If you did load, were you instructed to give prednisone at the same time as the lysodren during loading?

Regarding your family doc's pup, based on this vet's track record, I doubt the diagnosis for this pup, too. Cushing's is a slowly progressing disease that can literally take years to its damage to the pup's internal organs. The overproduction of cortisol is what does the damage, & until you get that cortisol down to a more healthy level, this damage will continue. Over the long haul, untreated Cushing's can lead to organ failure including heart failure, kidney, lung, & liver failure.

Debbie

[acushdogsmom]

Only have a moment but I have a few quick points to make.

Yes, if you want to get Bo off the pred, you need to wean him off it. (you can't stop pred cold turkey - that could be very dangerous)

Yes, Cushing's is often misdiagnosed, but if a dog truly does have Cushing's, PROPER treatment (properly dosed and monitored by a Vet who knows how to do it correctly) will usually resolve the symptoms and improve the quality of life of a Cushing's dog tremendously and will allow the dog to live out a normal lifespan with an excellent quality of life. So if Bo really does have Cushing's, treating it was the right thing to do. It's just that it needs to be done in a proper manner, which seems to sometimes be beyond the scope of some General Practice Vets.

And treatment also goes a long way to prevent internal organ damage, which is very likely to occur as long as the overproduction of cortisol (in untreated Cushing's dogs) is not lowered and then kept well controlled.. See here for a list of things that can "go wrong" when Cushing's is left untreated:

Medical complications associated with untreated Cushings Disease :
http://www.k9cushings.com/forum/showthread.php?t=195

As for the next ACTH stim test, if Bo is still on the pred when the test is done, the test result numbers that you will get will be "cortisol+prednisone" instead of only cortisol production, because pred and cortisol are virtually identical to the lab equipment that measures the amount of cortisol in the blood. Pred "reads" as cortisol on the test. So it might be better to wait until you've weaned Bo off the pred before doing another stim test, because you really need to find out how much cortisol Bo's adrenal glands are capable of making on their own.

And I think it would be safer to do the weaning off of the pred under the supervision of a Vet who knows how to do it safely and what to do if you hit a "bump in the road". Your peoplemed Doctor's idea of how to wean Bo off the pred does sound right to me , but I'm not a Vet, just a regular layperson.

Also, interpretation of the test results is really important - and if your Vet doesn't understand that we are not aiming for "normal" results in a treated Cushing's dog, it would be best to have a Specialist looking at and interpreting the test results and knowing what to do next to help your dog get well again.

I can't urge you strongly enough - your best bet would be to get a referral to an Internal Medicine Specialist Vet and let that Vet assess your dog and come up with a proper treatment plan. If you get a Vet like that on Bo's case, an expert who who knows how to properly diagnose, treat and monitor a Cushing's dog (or a dog who doesn't have Cushing's, for that matter) you may be very pleasantly surprised at how well you can get Bo to feel and be once again. Really. I'm speaking from experience - I am sure that if we hadn't gotten my dog into the care of a Specialist, he never would have had the 6 wonderful years that he did have after the Cushing's diagnosis was confirmed. Our dog's IM Specialist Vet literally saved his life.

[labblab]

Guys, I just want to "second" what acushdogsmom has said above --even though it may feel like a financial burden now, I really think that Bojangles will be best served if you consult with a veterinary specialist. And I would save your money and wait to have the ACTH performed under the specialist's supervision, so you can be sure that the timing and interpretation is appropriate for a dog in Bo's situation. Regardless of whether or not he was correctly diagnosed with Cushing's in the first place, the extended time period during which he has been taking prednisone may have compromised the ability of his own adrenal glands to rebound normally. If it turns out that weaning is appropriate, I think Bo would be better served to have the process overseen by a canine specialist who is intimately familiar with both the effects of Lysodren and long-term steroid use in dogs.

Plus, there remains the issue of why Bo was originally diagnosed with Cushing's in the first place. He must have been exhibiting behavior that was worrisome to you. You've already mentioned the drinking and eating, and perhaps there were other issues? Even if not, my guess is that those same issues will continue to bother you in the long run. Right now, it sounds as if Bo is so much worse that you are wishing you could just return to "square one." But my guess is that once BACK at square one, those issues would continue to nag at you, and they may very well signal a medical issue -- Cushing's or otherwise -- that can be addressed effectively under informed care.

You may not need to remain with the internal medicine specialist for an extended period of time. But just long enough to receive educated guidance as to his situation and the best approach to diagnosis and treatment. While it may represent additional up-front expense, you may be saving both money and worry in the long run -- as well as Bo's long-term health.

Marianne

[mrbojangles]

When you started the lysodren therapy, did you do what is termed a loading phase where you were giving the drug daily, split into 2 doses? If you did load, were you instructed to give prednisone at the same time as the lysodren during loading?

Regarding your family doc's pup, based on this vet's track record, I doubt the diagnosis for this pup, too. Cushing's is a slowly progressing disease that can literally take years to its damage to the pup's internal organs. The overproduction of cortisol is what does the damage, & until you get that cortisol down to a more healthy level, this damage will continue. Over the long haul, untreated Cushing's can lead to organ failure including heart failure, kidney, lung, & liver failure.

Debbie

Hi Debbie,
Yes Bo was "loaded" as you say. His initial dose of Lyso was 50 mg twice a day, and then we were instructed to give him the Pred (5) once a day with that dosage for what was first planned for ten days.

We called after 7 days because Bo had become slightly lethargic and she instructed us to stop the lyso and continue with the pred as instructed.. He's been on it ever since, and the hunger and thirst continue to build to a crescendo.

I spoke to the vet's office manager this morning, and she is going to make us copies of all Bo's test results from before and after each test.

They should be ready after lunch , and I will post all the numbers ASAP.

As I stated , Bo's last known numbers I was told verbally by the vet were 2.5, after the last ACTH test about a month ago. His next test is scheduled for this coming Monday Jan 3, so we'll see what happens after that.

We are seriously considering weening him off the Pred in 2 weeks and then reducing his dosage to 1/2 pill a day and then again weening him down in 2 more weeks to a 1/2 every other day, Our family Dr suggested that to us yesterday while we were there for a office visit. I'm leaning towards trust him more than the vet right now.

His bloating is worsening everyday, and the hunger and thirst urges are at a ridiculous level.

Thanks for the response.

[Squirt's Mom]

Hi ya'll,

With a better understanding of how Bo was loaded plus the continuation of the pred, it is no wonder he is having such a hard time getting control or that his signs are worsening over time. :rolleyes: Right now, I'm willing to bet that the majority of what you are seeing is the result of the prednisone usage.

Having another ACTH while the pred in on board would be a waste of your money and an additional stressor on Bo that he really doesn't need right now. The ACTH is a stimulation test that is done using an agent designed to make the adrenals empty themselves of all the cortisol they are holding in reserve. One of our administrators refers to it as squeezing a sponge. The pred that is being given will add to that stored cortisol when the adrenals are stimulated and the test results will be based on both cortisol and pred - not an accurate reading of the adrenal's storage capability. Since the results would not be true, there is no way to base any viable plan of treatment on them. In addition, it isn't uncommon for pups who do have a confirmed diagnosis and who are being treated properly to have an adverse reaction to the stim agent following an ACTH - a rise in signs or their strength. With Bo's system already under stress from the pred, the ACTH would just add to his discomfort and increase his stress level causing more cortisol to be produced, mixing with the pred. :eek:

For now there are two things I would concentrate on - getting referred to an IMS who is cush savvy and weaning Bo off the pred as quickly and safely as possible. Once his system has been cleared of the pred, then you can proceed with determining the next step.

There is a drug called Anipryl that can help with controlling the signs. You might ask your IMS about this or something else that might help ease Bo while the weaning is in progress.

One note of caution - do not restrict his water. He isn't peeing so much because he is drinking so much, it is just the opposite. The pred is making him pee to excess therefore he has to drink to keep himself hydrated, so make sure he has plenty of fresh water at all times. If he is having accidents in the house, you might get a belly band...or 10. :p

To help with his hunger drive, give him healthy, fat-free or low-fat treats like green beans, apples, carrots, a spoon of low-fat yogurt, pears, and so forth. Do you have a Kong? They can be packed with goodies like those mentioned above then frozen. My Crys loves it when I do that and it keeps her occupied for quite a while as the stuffing defrosts and she cleans it all out. I will use sweet potatoes, peanut butter, butternut or acorn squash, or over-cooked brown rice as a sort of binder to keep all the other things together in the mix and then just pack the Kong. You can also divide his feeding into more meals a day - not more feed, the same amount just more often. If he gets many treats or a Kong in a day, you may want to adjust his feed a bit lower that day to keep the caloric levels down so he doesn't gain a lot of weight.

Looking forward to seeing those test results when you can post them! :)

Hugs,
Leslie and the girls - always

[StarDeb55]

The concurrent usage of prednisone with the lysodren during loading is against any known protocols for the use of lysodren. Some vets appear to be not totally comfortable using lysodren, & they use pred concurrently to minimize the chance of an overload, where the use of pred increases the risk of an overload. As several of the others have already explained, pred simply acts as an artificial cortisol. The use of pred during loading will mask the signs that your pup has loaded, & will frequently end up causing an overload, which sounds like what may have happened with your boy. I am in 100% agreement with Leslie, another ACTH right now is a total waste of time & financial resources. You need to wean your boy off the pred, get a referral to an IMS, let them takeover & get this sorted out. Any testing while your boy is on pred will give artificially high results because the pred is being read as cortisol on the test. If you must test in the immediate future, you will need to stop the pred for a minimum of 24 hours prior to the test being done.

Debbie

[labblab]

I know I am beating a dead horse here, but I strongly encourage you to get the specialist on board PRIOR to weaning Bo off the prednisone. If you encounter problems during the weaning, I have no confidence whatsoever that your current vet can manage the situation safely or wisely. A specialist may want to perform electrolyte checks along the way, or engage in other testing either prior or during the wean. I do not know enough about the monitoring of Addisonian dogs to be able to say for certain whether or not a specialist may actually see value in performing another ACTH prior to attempting a wean. But on your own, I don't think it's advisable for you to discontinue the prednisone prior to testing, and I don't think you would be able to interpret the significance of the results, regardless.

Bojangles' situation is a bit different from that of the typical human patient who is being weaned off prednisone after an extended course of treatment. In Bo's case, steroid replacement was precipitated by physical erosion of the adrenal cortex by the Lysodren. At this point, we don't know whether or not the adrenal glands have the capacity to functionally regenerate themselves. So the monitoring that Bo requires may be different from that generally encountered by your M.D. with his human patients. In general, I would hate for you to find yourselves in crisis, without a knowledgeable expert on board to assist you.

Marianne

[acushdogsmom]

I know I am beating a dead horse here, but I strongly encourage you to get the specialist on board PRIOR to weaning Bo off the prednisone. If you encounter problems during the weaning, I have no confidence whatsoever that your current vet can manage the situation safely or wisely. A specialist may want to perform electrolyte checks along the way, or engage in other testing either prior or during the wean. I do not know enough about the monitoring of Addisonian dogs to be able to say for certain whether or not a specialist may actually see value in performing another ACTH prior to attempting a wean. But on your own, I don't think it's advisable for you to discontinue the prednisone prior to testing, and I don't think you would be able to interpret the significance of the results, regardless.

Bojangles' situation is a bit different from that of the typical human patient who is being weaned off prednisone after an extended course of treatment. In Bo's case, steroid replacement was precipitated by physical erosion of the adrenal cortex by the Lysodren. At this point, we don't know whether or not the adrenal glands have the capacity to functionally regenerate themselves. So the monitoring that Bo requires may be different from that generally encountered by your M.D. with his human patients. In general, I would hate for you to find yourselves in crisis, without a knowledgeable expert on board to assist you. MarianneAt the risk of being broken record number 2 ;) I want to say that I absolutely agree with everything Marianne has just said.

And as Debbie has mentioned, if it does turn out to be that Bo is no longer making enough of his own cortisol for daily life, there are other meds besides prednisone - like Percorten V, which is usually given once a month as an injection by the Vet, or Florinef, which is given orally and daily (I think) at home by the owner - that should be considered for long-term use. These may be used with or without a really, really small dose of pred, I believe.

Those, if prescribed and dosed and monitored properly by a Vet who knows how to do it right, should be able to give Bo (and you) a great quality of life.

My understanding is that the dosages would need to be tweaked especially at the beginning, to get the exact right amount for the individual dog's needs and so that he has enough of what his body needs for daily life and activities without the kinds of symptoms that the current dose of pred may be causing.

Correct monitoring for a long-term too-low cortisol condition would also include testing for electrolyte imbalances - which in itself is not at all expensive to test for, by the way.

I realise that finances may play into the decision as to whether or not you decide to get a Specialist on board - but sometimes you really do get what you pay for. The Internal Medicine Specialist will have seen and treated cases like Bo's before - and likely has seen even worse case scenarios and managed to turn them into successful outcomes. It's what they do on a daily basis, whereas a GP Vet may have only seen something like this happen once or twice before, if ever.

I think one of our members (Jeff) has already told you of a Specialty Clinic he rates as first class. Is it near enough to you that you could consider going there? (below is a copy of what he said when he replied to you earlier)


As you live by the NJ shore, you may want to try to get over to Garden State Veterinary Specialists in Tinton Falls. They are highly recommended. Will warn you in advance, they are expensive. But they have a lot of specialists there and can do a lot of advanced stuff on site. Here is the link:

http://www.gsvs.org/

Regardless of if you choose GVS, I would get another vet to look at your pup, as things are not improving to your satisfaction. Best of luck to you. Jeff

I think that another of our New Jersey members has previously recommended The Red Bank Specialty Clinic as another excellent choice (to another member whose dog needed some expert input and care).

http://www.rbvh.net/

http://www.rbvh.net/about.htm

http://www.rbvh.net/services/internal.htm

[littleone1]

Hi Joe and Ginny,

I really feel that you should follow the advice that has been given to you by others.

This situation is nothing to fool around with. Believe it or not, I actually pay less for a visit to Corky's IMS than I pay for a visit to his vet.

Corky was taking prednisone a few years ago, as he had mastacatory muscle myositis. Even then, the weening off period was not as long as what you are posting about Bo.

The members that are giving you this advice have a great deal of experience and knowledge about what goes on with Cushings. Originally, Corky's vet was going to have him take Lysodren and Prednisone at the same time. His IMS felt that even though there were some vets that did this, it would mask the results of the treatment.

I hope things will go better for Bo. I really hope that you could find a good IMS that knows what he or she is doing.

I'm sorry if this might seem a little harsh, but we all care very much about our family here and our furbabies.

Terri

[mrbojangles]

Hi,

I need to understand something here.

Please, tell me why a specialist is any different then our clinic doing the testing??

I didn't have a full understanding of what a ACTH stim test actually was , I have a bit more knowledge of what it is now thanks to you wonderful people here, But what course of action other than seeing a specialist ,which frankly we just can't afford right now, would you do if it was your dog?

He is usually taken off the pred the day before the test, and he must fast for the test from the night before, with that said, is being off the oral dose of pred for one day not long enough to give you a true reading?
I'm confused for sure now.. I know and see that Bo has no other symptoms other than the excessive drinking and his insatiable hunger.

His body is bloated, but he has energy and acts like a normal puppy at the age of 7. Bo enjoys his walks everyday and he has normal solid bowel movements, and drinks plenty of spring water all day long, we of course try to limit his intake of food for obvious reasons.

I am pretty certain it is the pred that is causing these symptoms because he was never this way before he was administered the Lysodren.

I really appreciate all the posts, but until I get the results from the vets office and post them here I will continue to administer the 5 mg a day to him until a responsible professional tells me otherwise, we are going to consult with another vet in the same office tomorrow @ 4 pm then we'll see what develops from there.

Thank you all for this advise, I'll keep everyone posted on his condition tomorrow.
Ginny .

[littleone1]

Hi Ginny,

I'm so sorry you are going through this. I understand why you are confused. My post wasn't meant to sound a little harsh. I just get very concerned.

Hopefully you will be able to get some good answers when you see the other vet tomorrow.

I know I feel so much more comfortable having Corky being treated by an IMS. I do know that there are many vets that just don't have much experience treating Cushings.

It will be good for us to see Bo's test results.

I hope everything works out for Bo.

Terri

[lulusmom]

Hi Joe and Ginny.

I've been keeping track of you guys and I must say that everyone has given you some very sage advice but I wanted to weigh in to validate what the others have already told you. I couldn't stand it and had to post and give you my two cents worth. Based on the info you have provided, everything your vet has done is suspect and should be subject to great scrutiny starting with the diagnosis.

I see that you loaded Mr. B on 50mg twice daily for 7 days. My 4 pound Pomeranian loaded at that dose so with your boy being 46 pounds, 100mg per day is ridiculously low and there was certainly no need to give concurrent prednisone. Mr. B's loading dose should have been anywhere from 5 to 10 times the amount your vet prescribed so I seriously doubt that he was anywhere near loaded much less overloaded after seven to ten days of dosing. My other thought is that if your vet is that ignorant of treatment protocol, then I have serious doubts as to whether or not he knows how to interpret the results of an acth stimulation test for purposes of monitoring treatment. This isn't far fetched at all as I had to educate one of our past gp vets on how to interpret the acth stim test as it relates to a cushdog and not a normal dog. In any event, it would be very easy for us to determine the extent of your vet's ignorance once you post the results of the diagnostic test results as well as all acth stim test done after loading.

Based on my experience here, if I were to pick a type of dog that has historically been over represented as a breed that takes forever to load, at even the maximum recommended loading dose, I would have to say Beagles. For this reason, I am inclined to believe that your boy is showing severe symptoms because he was never loaded, is probably producing plenty of his own cortisol, too much if he was correctly diagnosed, and you are compounding the problem and making Mr. B's problems much, much worse by continuing to dose with prednisone.

If there is anyway possible to see an internal medicine specialist, please reconsider. A consult with a specialist may not be as expensive as you think, especially if you can provide him/her with copies of test results. Believe me, I get the expense factor...I have two cushdogs, both of whom have multiple conditons and treat with a specialist so I am no stranger to vet bills. There are a number of organization that can help with finances and I don't know what I would have done without Care Credit. I'll provide you with a link to financial resources, including Care Credit, before signing off.

To answer your question, if Mr. B were my dog and I was flying by the seat of my pants and having to place blind faith in an inexperience gp vet, I would haul butt to the vet's office, obtain copies of all of Mr. B's test results and post them here as soon as possible. Most of us know how to interpret the majority of tests that are routinely run to diagnose and monitor treatment so the faster you can get that information on this thread, the faster we can offer you up some meaningful feedback. Right now, we are all flying by the seat of our pants and that's frustrating because we want very badly to help you and Mr. Bojangles through this.

http://www.k9cushings.com/forum/showthread.php?t=212

Glynda

[Harley PoMMom]

Hi Ginny,

First let me say that we are not here to "bad-mouth" your vet. Alot of us have had some very bad experiences with former GP's and we just want to spare this grief from happening to anyone.

Now from my understanding about the pred. since Bo has been on pred. every day, and even though he is not given any the night before, the ACTH test results will still be skewed. The chances are significantly higher that an IMS would know this and an IMS would of properly diagnosed Bo in the first place. An IMS would have state-of-the-art equipment, like an ultrasound machine which regular GP's do not usually carry. Getting Bo an ultrasound, if feasible, would be my next step.

My boy Harley has PDH and Atypical Cushings, he has an IMS and a regular GP. We only see his IMS for his ultrasounds every 6 months. The thing is Ginny, you need to find a GP that you are comfortable with, that you trust and that will work with you. Harley's GP didn't know anything about Atypical cushings but she was willing to learn, she called and emailed Dr Oliver ( he is the head of the lab in University of Tennessee that tests for Atypical cushings) and she continues to do so.

Hang in there, Ginny, I know this is so confusing and frustrating but we are here to help you.

Hugs,
Lori

[ventilate]

Ginny;
There is really no difference in who runs the tests but as Marianne said the timing with the pred, and the interpration of those results is where the expertice of a specilaist will come into play. Cushings can be difficult to diag and to treat.

The issues that go along with not treating a dog with cushings are well documented, the issues of treating a dog for cushings that does not have cushings will also cause major medical issues for your dog. The specialist can figure out if your dog was misdiagnosed, and if he was, the proper treatment required now. Weaning off the pred may not be best if your dog really is requiring the pred due to cortisol being to low, this could make your dog very sick. On the other hand the cortisol may be higher and added to the pred is causing the increased water and food consumption and having to much cortisol/pred is the same as untreated cushings causing the same organ damage.

There are many things that can mimic Cushings as others have already asked about. My dog had Cushings as well as diabetes insipidus this can cause the dog to drink gallons of water and pee gallons, the specific gravity of the urine is very dilute, almost water. This is totally different than Diabetes Mellitis, the blood sugar one. This complicated my treatment of Cushings for my dog. When my reg vet could not figure out what was going on - her levels were within theraputic range but she continued to drink tons and her USGs were like water. So he sent us to a IMS, who determined she had DI and we began treatment for that as well as Cushings.

I had one visit to the IMS and my vet consulted her with test results and they worked on her treatment and required testing. My dog lived to 13 years old, almost 4 years being treated, and was a giant breed so she way outlived her life expectancy, which is about 10. Being Cushings involves the pituitary gland, the master gland of the body, there are so many other issues alone or in combination with other things that can cause what you are seeing. DI would not account for the excessive hunger, but that could be due to the pred.

You asked what we would do if were our dog. If it were me I would be saving my money, and not have any further testing done until I can get my dog to a specialist. The Gen practice vets have already had their chance and have made the situation more complicated and harder to determine what is going on. A lot of the trouble we see here with treatment of Cushings and dogs that do not do well, is due to vets that are inexperienced. I am sure this is not what you wanted to read, but your dog is not an uncomplicated cushings case, there are a lot of variables involved, therefore difficult to determine what would be the best course of treatment.

Sharon, Kenai and forever Nike

[acushdogsmom]

Sorry, just have a moment and I meant to also post this before, but got sidetracked and had to go out, and I'm actually on my way out the door again right now, but had to post to just give you this information before I forget again. :)

If it helps, I found out that both Specialty Clinics (which were previously recommended to you) take Care Credit, which may help you to be able to afford their Specialty Services. We've had members here before who have used Care Credit and who were really happy that it exists, because it helped them to be able to afford otherwise unaffordable treatment for their pets - it's sort of like a line of credit for health care services I think, that you pay back over time, with very low or even no interest if it's paid back on time and within a predetermined amount of time, or something like that.

I'm not sure if the first two links below will still work to show my search results, but I'll give them to you anyway:

Search result on Red Bank Veterinary Hospital at the Care Credit site:

http://www.carecredit.com/providerloc/results2.html?Name=Red+Bank+Veterinary+Hospital&PracticePhone=Phone&City=Tinton+Falls&State=NJ&Find2=2&x=45&y=13

Search result onGarden State Veterinary Hospital (the one Jeff recommended) on the Care Credit site:

http://www.carecredit.com/providerloc/results2.html?Name=Garden+State+Veterinary+Special ists&PracticePhone=Phone&City=Tinton+Falls&State=NJ&Find2=2&x=44&y=6

I did the search to see if those two Specialty Clinics accept care credit by using the Care Credit search feature:

http://www.carecredit.com/providerloc/index.html

And here's a link to the main pages of the Veterinary division of the Care Credit site so you can read up on what it is, how it works, etc:

http://www.carecredit.com/vetmed/

http://www.carecredit.com/vetmed/whycc.html

http://www.carecredit.com/vetmed/videos.html

There may also be other Specialty Clinics in your area that also accept Care Credit.

You said:

I will continue to administer the 5 mg a day to him until a responsible professional tells me otherwise, we are going to consult with another vet in the same office tomorrow @ 4 pm then we'll see what develops from there.I'm glad to hear that you will only wean Bo off the pred under the supervision of a responsible professional and I am also curious to see what the test results you can post will be and what the different Vet has to say about Bo's case tomorrow.

Really gotta run!

[forscooter]

Hi,

I just have a few moments and wanted to say hello, but also to offer you any help I can. Both my dogs have/had Cushing's...I lost one a year ago but not related to treatment.

I am at the Jersey Shore and my vet was wonderful. I had two of them helping me with both of them. I also have been to Garden State Vet Hospital that Cushy mentioned above. A friend of mine went to Red Bank although with a matter not related to Cushing's.

If I can help in any way in finding a vet, please PM (private message) me. I don't want to name names here but am curious if you are near me and who you may have been seeing. And I will also be happy to give you the information on my vet if you would like.

Although not a beagle, I can tell you that all three bassets I have owned have been very sensitive to most medications and anesthesia, etc...just don't metabolize these things the same. And although I have been looked at like I am nuts, I know my dogs and I know what I have seen and experienced. So, I am wondering if your pup is also very sensitive to some of this stuff as well.

As I said, if you would like me to try and help with names and vets, please PM me and I will gladly tell you who I used...

Sending my very best, Beth

I meant to add that my vet also participates in Care Credit I believe. I know I used it once there for Scooter's surgery. They also are very understanding of financial concerns and will not run tests unless they feel it is necessary. And they listen to you! They worked very closely with me and did not mind at all my million questions and suggestions. But mainly I wanted to let you know about the Care Credit....they even ran it through for me to get my account opened.

[acushdogsmom]

Yes Bo was "loaded" as you say. His initial dose of Lyso was 50 mg twice a day, and then we were instructed to give him the Pred (5) once a day with that dosage for what was first planned for ten days. One more question ...

Are you sure that it was 50 mg of Lysodren twice a day that you were giving during the "loading" period or was it 500 mg twice a day?

Because unless it is specially compounded, Lysodren usually only comes as a 500 mg pill. At least when I was giving it, it was only available as a 500 mg pill. I used to have to cut the pills into halves or quarters to get 250 mg doses or 125 mg doses, which we needed to give to my small dog.

P.S. Also, please take Beth up on her "offer" and contact her (privately if you prefer). Maybe she can help you find a Vet in your area who isn't a Specialist but who is better versed in treating Cushing's. I know that she's been really happy with the excellent quality of care that her GP Vet has provided for her two dogs.

[gpgscott]

Ginny,

It is really pretty straightforward.

If the diagnositics indicate Cushing's and you are treating with Lysodren you give up to 50mg/kg/day daily divided by two twice daily, until symtoms suggest a stim.

Once you have control of cortisol you reduce the administration of Lysodren.

Prednisone is used to counteract Lysodren. It is a synthetic form of the hormone which a cushpup produces too much of.

It is non sensical to administer prednisone in conjuction with Lysodren in most cases.

Scott

[StarDeb55]

Because unless it is specially compounded, Lysodren usually only comes as a 500 mg pill.

As far as I know, Cushy is correct. Lysodren only comes in 500 mg. tablets, unless you have smaller doses compounded. My Harley takes 250 mg. lysodren weekly, split into 3 doses. These doses are so small, I have to have them compounded because there is no accurate way to cut a 500 mg. pill into these small doses.

I do have one more comment when it comes to the extremely low loading dose, if it was only 100 mg. daily. Lysodren dosage is calculated based on mg./kg. body weight with the normal dosage being 25-50 mg./kg. To get to kg., divide your boy's weight in lbs. by 2.2. For example, if your boy weighed 40 lbs. when you did the loading, that would be 18.2 kg., therefore his dosage should be between 455-910 mg. daily, split into 2 doses as I mentioned last night. At 100 mg. daily, the actual dose based on a weight of 40 lbs. would only be 5.5 mg/kg. I'm not saying that an overload did not happen at this low a dose, but it's very unlikely. Could you please confirm that your loading dose was really only 100 mg. per day & not 1000 mg per day as Cushy has suggested?

Debbie

[jrepac]

It has been a long time since I used lyso, but I do remember it being in 500mg tabs that we had to cut into quarters....I would confirm the dosage U R using during loading. As others have said, using pred + lyso at the same time is largely counterproductive. You are giving lyso to reduce cortisol but at the same time providing prednisone which acts the same as cortisol.....hard to see the sense in that.

Maybe getting an opinion from another vet at the same practice is not a bad idea. I saw 3 different vets at my regular practice (each had a slightly different opinion) then 2 more vets at another practice (again, slightly different POVs). Then back to my original practice and more testing. Fun, fun, but as many of us know, this disease is very hard to peg sometimes.

Even if you don't go to a specialist, maybe see a vet that can do an ultrasound for you...one more test that can be of help. Full adrenal profile/ACTH from the University of Kentucky is also one that many here have done and recommend; your vet simply ships the samples off to UTK for testing.

Jeff

[Squirt's Mom]

Hi ya'll,

I have several health issues that require attention and treatment beyond what my GP can provide. That doesn't mean she is a bad GP; only that she does not have the education or training to treat those issues for me. So I see specialists in those areas because they have education, training and experience that she simply didn't need as a GP. Before the specialists were "assigned", I went to an Internist because my GP had done all that she knew to do and still couldn't resolve or identify some of the problems. This is what an IMS does for our pups. (IMS = Internal Medicine Specialist) The fact that she knew her limits had been reached and sent me on to see others who were better equipped than she, is a sign of a good GP.

None of us who have responded to you are vets and we don't intend for our suggestions/advise to take the place of your vet(s). However, the collective knowledge and experience of our members has on more than one occasion astounded our vets. We live with Cushing's daily; we know what goes on with our own pups and we have learned from our own and each others experiences. I would be hard pressed to believe any single vet has as much knowledge, experience, and hands-on training in canine Cushing's that we do. This is not to bash any vet, but to let you know what we say to you comes from our own Cushing's vaults as well as established and confirmed studies. Most of us here eat, breath, and sleep Cushing's; we are consumed with it while our GP vets have much, much more to focus on.

Finding a vet who is experienced in Cushing's is much more difficult than one might think. Here is an experience I had:

My sis lives in a rural area and I was spending a lot of time with her so I wanted to have a vet in her area just in case Squirt needed attention quickly. I called 14 vets in an area of over 50 mi. and found one, one, who treated Cushing's. :eek: All the others said things like, "we send them on to an IMS"; "we send them to X or Y town (150 mi away one way :eek: )"; or, "we don't treat Cushing's." :eek::eek::eek: This was early in our cush journey and I was simply FLOORED at these responses! How could 13 docs just turn their backs on a cush pup? Simple - they were all taught in school that treating Cushing's is a losing battle and/or had failed themselves in attempting to treat cush pups. So rather than learn different, they just passed on Cushing's when it was presented to them. This brought home to me in force the fact that not all vets are created equal when it comes to Cushing's. This also told me what these gentle folks had already said, my knowledge on the subject was going to be invaluable.

We have been very lucky with our GP vet. She didn't have that much experience with treating cush pups, but she did have some. When Squirt was diagnosed with Atypical, she had never heard of it but was more than willing to learn about it in order to help Squirt and understand what was happening with her. Dr C is very compassionate, thorough, and knowledgeable but the thing that makes her an exceptional vet is that she listens. She treats me as a partner and we work as a team to give Squirt, and all my girls, the very best life we can. That is the most important quality in a good vet - the ability and willingness to listen, to work as a team. You may need to help your vet learn a bit more about Cushing's, like several of us have, rather than find a new one. If your vet won't listen, won't work with you, then yes, RUN from them. Arrogance has killed more cush pups than the disease ever did.

All this rambling is an effort to make sure you know that we are on Bo's side first and foremost. We may make you mad or upset you at times but that isn't our intent at all. Our sole purpose is to help Bo get back his life, the life he deserves. Hopefully, along the way we will all become a team for Bo, his vets included.

Ok, I'll shut-up now. :o:p

Hugs,
Leslie and the girls - always

[jrepac]

Leslie makes some great points and good anologies here.

Most GP vets see many dogs w/many conditions; the # of cushpups they have may vary widely from vet to vet. Then amongst those who have seen cushpups, some choose to treat and some do not. And, among those who treat, I guarantee their opinions on treatment will also vary. So, this is not easy.

I would also say that the collective knowledge and experience found on this board is both helpful and empowering. Certainly, it led me to ask questions I otherwise would not have, and I found out a lot of good stuff...like the info. on Atypical. My GP vet had no knowledge of it. Same w/UTK testing. However, when I came forward w/this my GP was very open to all of it and willing to discuss the variety of treatment options.

I can tell you that even some specialists are not open minded...having visited a 2nd practice for a 2nd opinion, I found that out quickly, based on their attitude and arrogance. Made me run for the hills fairly fast. This is my 2nd go around w/this disease and I was not going to simply accept what I was told by any one vet.

So, I think Leslie's point about the vet being willing to listen and work with you is critical. YOU live w/the pet every day, YOU see how your pup responds to treatment each and every day, not the vet. So, your POV should be treated with equal importance. Anyone who says that there is only ONE way/method to diagnose and treat this disease, honestly, is a red flag to me. It just signals to me that either they are highly opinionated or uneducated on Cushings.

so, there are my 2 cents for the New Year!

Jeff

[mrbojangles]

Hi everyone,

It's been a hectic day this last day of the decade. My husband and I just got back from our consultation with a different vet in the same office, I was given the test results finally and I will post them now.

The new vet said that it would be advisable to see an internist as most of you guys stated earlier, and she is in agreement of weaning Bo off the Pred very quickly, ( by Monday) We scheduled another stim test for later in the week, when he is off the pred for two days.

She basically agreed with everything the old vet had done except keeping Bo on a daily dose of Pred. We got a referral to Garden State Vet clinic in Tinton Falls NJ because she wants to rule out a tumor on the adrenal glands etc.. I finally found out his original dose of lysodren was 40 MG not 50MG as I originally posted, so it was actually less then I thought. Again vets will not contradict a fellow vet, code of ethics and all that happy stuff, but she did admit to Joe , that the dose was a bit lower than what she would have loaded Bo with had she been the attending vet in his case.

Ok here are the results from Bo's original test.. (8 hr) ..

( low dose dexamethasone suppression test)

Performed on 9/15/09

cortisol pre----6.1

cortisol 2 -----<1.0 (4 hr interval)
cortisol 3 -----2.7 ( 4 hr interval)

Stim test on 9/27/09

cortisol pre------ <1.0

cortisol 2 -------------- <1.0

Second stim test on 10/11/09

cortisol pre------------- <1.0

cortisol 2------------ < 1.0

Final and last test administed on 11/10/09

cortisol pre--------------- <1.0

cortisol 2 --------------- 2.1

At this point in time the new vet suggested that Bo should have been taken off the Pred and then tested down the road as long as he had no adverse symptoms related to addisons .

We are going to do the next stim test this Thursday coming up and then she will make an appointment with Garden State to do a scan on Bo to rule out any other problems.

The Vet did think by staying on the Pred for so long, he is back to cushings again, and we may need to "load" him again properly.

Anyone know a good Lawyer??? J/K lol We're both satisfied of how everything was handled today, and hopefully once Bo is stablized, she will be his regular vet in the future.

Thank You all so much for your imput, if it had not been for you guys all of you, who knows what maight have happened to our boy, hopefully we are on the right track back to health.

Happy New Year everyone. ;)

[littleone1]

Ginny, I'm so glad that you saw a different vet. It means so much knowing that there are vets that will give you such good advice.

Take care. I hope everything goes well for Bo.

Have a Very Happy New Year. I wish the best for you and your family, and of course Bo.

[acushdogsmom]

Glad you will be seeing a Specialist and the new Vet you saw today sounds pretty good so far, too.

By the way, the LDDS test looks to me like it is consistent with a diagnosis of Pituitary Cushing's because there is suppression to less than 1.4 at the 4-hour mark and then an "escape" from suppression (cortisol going back up again) at the 8-hour mark. A normal result (not Cushing's) would have shown suppression that stayed suppressed all the way to the 8 hour mark. And if there was no suppression at all at 4 and 8 hours, that might suggest adrenal tumour, although it could still be Pituitary Cushing's..

And are you SURE about that Lysodren dosage? Was it maybe in a gel cap or capsule or a liquid form (which could have been specifically compounded to that very low dose) instead of a hard white round pill that you were giving? Or maybe the Vet was saying that the prescription for Lysodren was 40 mg/kg or something like that? Because the pill form (hard white round pill) that Lysodren usually comes in is a 500 mg pill. And it's hard to understand how Bo could have gotten so low on cortisol production on such a very low dose of Lysodren as 40 or even 50 mg twice a day.

[mrbojangles]

Glad you will be seeing a Specialist and the new Vet you saw today sounds pretty good so far, too.

By the way, the LDDS test looks to me like it is consistent with a diagnosis of Pituitary Cushing's because there is suppression to less than 1.4 at the 4-hour mark and then an "escape" from suppression (cortisol going back up again) at the 8-hour mark.

And are you SURE about that Lysodren dosage? Was it maybe in a gel cap or capsule or a liquid form (which could have been specifically compounded to that very low dose) instead of a hard white round pill that you were giving? Or maybe the Vet was saying that the prescription for Lysodren was 40 mg/kg or something like that? Because the pill form (hard white round pill) that Lysodren usually comes in is a 500 mg pill. And it's hard to understand how Bo could have gotten so low on cortisol production on such a very low dose of Lysodren as 40 or even 50 mg twice a day.

Yes we are positive about the dosage, the new vet told us today at the consultation. Bo was given 40 MG twice a day, plus 5MG of pred once a day during loading.. It seems contradictive one would think, like drinking coffee after you take a sleeping aid... duh... But, We like this woman , she's straight forward and to the point. So we'll go with what she wants and take it one day at a time.
Thanks.

[acushdogsmom]

Yes we are positive about the dosage, the new vet told us today at the consultation. Bo was given 40 MG twice a day, plus 5MG of pred once a day during loadingI don't mean to be a pain in the butt, but what did the Lysodren look like exactly? Was it a pill (in particular, was it a white, round pill) or was it a capsule with powder inside it?

If the new Vet was reading the dosage from the chart and not looking at the actual pills you were giving Bo during the loading, she could have just been reading whatever was written there in the chart, which could have been in error.

[acushdogsmom]

The new vet said that it would be advisable to see an internist as most of you guys stated earlier, and she is in agreement of weaning Bo off the Pred very quickly, ( by Monday) We scheduled another stim test for later in the week, when he is off the pred for two days.Wait a minute - I just saw the part where you said that the Vet wants to wean Bo off the pred by Monday .... that's only about 4 days from now ... is that really safe after being on the pred for so long? Wouldn't it be better to go a bit slower with the weaning off the pred and wait a bit longer do the stim test?

[sunimist]

Wait a minute - I just saw the part where you said that the Vet wants to wean Bo off the pred by Monday .... that's only about 4 days from now ... is that really safe after being on the pred for so long? Wouldn't it be better to go a bit slower with the weaning off the pred and wait a bit longer do the stim test?
Cushy, that jumped out all over me, so I am really glad you are bringing it to their attention. That amount of pred would take at least 2 weeks or more to wean, don't you think? JMOPO.

[AlisonandMia]

I think you are getting him off the pred in a hurry so the vet can do an ACTH stim test without the pred skewing the results. Is that right?

I too am concerned about stopping the pred so suddenly (remember what your human doc said?). There is however, a way you can do a meaningful stim test and keep him safe re stopping the pred suddenly. That would be by putting him on another steroid medication called Dexamethasone. Dex replaces cortisol the same as pred does but it has the really big advantage of not "reading" as cortisol on testing so it ideal for situations like this.

I'm wondering if you could ask your new vet about doing it this way as it could be a "win-win" Mr. B would not be in danger of suffering from the effects of suddenly stopping the pred and you'd get a good, reliable result on the stim test.

If the stim test does show that he is producing a lot of cortisol himself (which could well be the case) then you could simply stop the pred or dex quite safely. But until you know for sure (from the ACTH stim test results) that he is producing cortisol himself then it is safest for him to be on some sort of steroid medication.

The effects of too much steroid meds/cortisol is unpleasant but the effects of too little, especially if it happens suddenly, can be deadly.

Alison

[mytil]

Hi, I have not posted before but am following. One of the problems of stopping prednisone (or prednisolone - same thing basically) too quickly is that it does not give the body adequate time to adjust and start producing its own natural cortisol that the body needs. If stopped too quickly withdrawal symptoms will occur (same for humans too).

Prednisone withdrawal symptoms can include but are not limited to:

•A general ill feeling
•Muscle weakness
•Nausea and vomiting
•A fever
•Low blood pressure (hypotension)
•Dehydration
•Mental changes
•Muscle pain or joint pain
•Flaky or peeling skin
•Difficulty breathing
•Loss of appetite.

With your Bo being on prednisone for more than several months, it will take about that long to "wean" him off it so his system can adjust and he will not experience these serious symptoms. Here is the source of this information - http://drugs.emedtv.com/prednisone/prednisone-withdrawal.html

Ask you vet about this just to be sure.
Terry

[mrbojangles]

I think you are getting him off the pred in a hurry so the vet can do an ACTH stim test without the pred skewing the results. Is that right?

I too am concerned about stopping the pred so suddenly (remember what your human doc said?). There is however, a way you can do a meaningful stim test and keep him safe re stopping the pred suddenly. That would be by putting him on another steroid medication called Dexamethasone. Dex replaces cortisol the same as pred does but it has the really big advantage of not "reading" as cortisol on testing so it ideal for situations like this.

I'm wondering if you could ask your new vet about doing it this way as it could be a "win-win" Mr. B would not be in danger of suffering from the effects of suddenly stopping the pred and you'd get a good, reliable result on the stim test.

If the stim test does show that he is producing a lot of cortisol himself (which could well be the case) then you could simply stop the pred or dex quite safely. But until you know for sure (from the ACTH stim test results) that he is producing cortisol himself then it is safest for him to be on some sort of steroid medication.

The effects of too much steroid meds/cortisol is unpleasant but the effects of too little, especially if it happens suddenly, can be deadly.

Alison

Pretty much so Alison, Bo has been on that dosage since November, and in her opinion, she believes he has been back to Cushing levels , hence the insatiable hunger and thirst. Here's what made her decide to wean him off faster.. he's ballooned up to 59 lbs from 54 just two weeks ago when he was last at the vets office for his nails to be clipped.

I have to go with what she thinks is the right course right now, we have the Pred here on hand in case of any symptoms related to Addison's like Lethargy, vomiting, diarrhea, etc.

We started weaning him off slowly, we started the process two days ago, cutting the dosage in 1/2 to 2.5 MG I think it's safe to say he is back to a cushing level based on his hunger and thirst and adding the steriod is worsening his symptoms right now.
Ginny

[AlisonandMia]

Just wondering regarding the Lysodren dose that you first used - what did the Lysodren look like? Was it a round white pill, a capsule or a liquid of some kind?

Alison

[mrbojangles]

Hi Alison,

I believe they were round and white..

[StarDeb55]

If they were round & white, they were very probably the standard 500 mg. lysodren pills that are normally available. Do I recall that you said you were giving 1 tablet, twice daily? I'm sure Bo weight somewhat less than he does now when you loaded him, but using his weight of 54 lbs. 2 weeks ago, a loading dose would be from 613-1225 mg. The 1000 mg dose is well withing the target range of 25-50 mg./kg, at 41 mg/kg which is the upper end of the range. Since you were instructed to concurrently load with prednisone, IMHO, the pred masked the symptoms that Bo was loaded which is how he ended up with an overload. During loading, the things an owner should be instructed to watch for as signs of loading including a decrease in appetite or water consumption, or any change in behavior by the pup that makes you stop & go, "hmmn, that's different!" A change in appetite can be something as simple as the pup who has been inhaling his food like the proverbial vacuum cleaner in 20 secs. flat, now takes a couple of minutes to eat, or maybe even stops a minute to look at you, before resuming eating. If your 1st vet did not give you instructions on what to watch for, that is another area they were remiss. Lysodren is a long-acting drug for upwards of 48 hours in the body, so that is why it's very important to stay very attuned to your boy's behavior because once a dose of lysodren is given, you can't take it back. This is different with the other drug that is used to treat Cushing's, trilostane, as it has a very short half life of about 12 hours, then it's out of the pup's system.

Debbie

[forscooter]

Hi,
Just checking in on you ;). Glad you made out better with this new vet and you are more comfortable with things. Garden State is a great place....very busy but great. I have used them twice before and have friends who used them also.

I am too, concerned though about the weaning so quickly. Scooter was on pred for only two weeks prior to us knowing he had Cushing's. When we realized something was terribly wrong, we weaned him down rather quickly....but even though he was only on it for two weeks plus he had high cortisol from the Cushing's, we still did a weaning protocol as to not totally push things too fast in the other direction. Although he was flooding my house with the urination and was drinking like a thirsty work horse, it still took about another week to get him off comfortably. I just wanted to share that experience with you.

I'm glad you still have some pred in the house should you need it. And I know you will watch Bo with very sharp eyes for any change that goes too far too fast in the other direction...this will be very important.

It does sound like the 500mg tablets that you were giving....we used the same. Scooter was the lighter of the two boys and I believe we used the 500mg twice/day dose on him. He weighed about 75 pounds when we started.

Sending you all the best as you proceed.......Beth

[mrbojangles]

Hi everyone,

Just an update for Bojangles, he went for another ACTH Stim test today, the new Vet thinks his levels are back up to the cushings level.

We'll see either tomorrow or Wed what the lab reports say. Just for the record, I am almost positive that Bo's dosage was of a lesser MG.. When the Vet calls us about his results I will post them along with his original "loading " dosage.

As of today, we're taking it one day at a time, and we will get the referral from the vet after his follow up consultation later in the week.
Thank you all for your help and concern.
Ginny & Joe

[littleone1]

Hi Ginny and Joe,

I hope that everything goes well for Bo.

Terri

[acushdogsmom]

Just an update for Bojangles, he went for another ACTH Stim test today,

Just for the record, I am almost positive that Bo's dosage was of a lesser MG.. When the Vet calls us about his results I will post them along with his original "loading " dosage.So I take it that Bo has been weaned off the pred and is still feeling okay? Is he any less hungry than he was while on the pred?

When you ask the Vet about the dosage, be sure you are talking about apples and apples rather than apples and oranges. ;)

The Lysodren loading dose that was originally prescribed may have been 40 milligrams per kilogram of the dog's bodyweight per day (40 mg/kg/day) - which, for a 55 lb dog (i.e. a 25 kg dog) would work out to 1000 mg per day (two 500 mg pills per day) - but the pills would still have been 500 mg pills (ie with each pill containing 500 mg of Lysodren).

The Lysodren pills only come in that one "size" of 500 mg per pill. The manufacturer does not make them in other dosage amounts.

http://mitotane.com/mitotane.jpg

So unless the Vet had the Lysodren specifically compounded into a different amount per "pill", where the format would have likely been in a capsule filled with ground up Lysodren powder or in a liquid form, you [B]had to have been giving 500 mg pills. If Bo had really only been getting 40 mg of Lysodren once or even twice a day (for a total of 80 mg of Lysodren per day), it would have been nearly impossible for him to have been overdosed and for his cortisol production to have become as low as it did in just a little more than a week of loading.

Anyway, we're all looking forward to seeing the most recent ACTH stim test results when you have them. :)

[mrbojangles]

Hi everyone

We just now got the call from the Vet's office tonight, She is very happy Bo's levels were at 2.1 after the first draw of blood, and then 2.8 after the second draw ( 2 hours later). Dr Harvey still wants Bo to go for a abdominal scan to rule out anything further, but it's good news as far as I'm concerned.

His appetite is suppressed plenty since he's off the Pred, and he is not in craving frenzy for food. He lost a pound since we stopped the Pred and we're happy about that.

Finally, we found a vet that has the knowledge and the patience to explain everything in detail to us, not like the other vet that seemed clueless.

Dr Harvey ( the new vet) won't start the maintenance dosage of Lysodren until they get any results from Garden State Vet .

So, I'm hoping everything goes well tomorrow and we can get Bo in for the scan in the next week or so.

I will keep everyone updated.

Thanks ,
Ginny

[acushdogsmom]

We just now got the call from the Vet's office tonight, She is very happy Bo's levels were at 2.1 after the first draw of blood, and then 2.8 after the second draw ( 2 hours later). Dr Harvey still wants Bo to go for a abdominal scan to rule out anything further, but it's good news as far as I'm concerned.

His appetite is suppressed plenty since he's off the Pred, and he is not in craving frenzy for food. He lost a pound since we stopped the Pred and we're happy about that.

Finally, we found a vet that has the knowledge and the patience to explain everything in detail to us, not like the other vet that seemed clueless.

Dr Harvey ( the new vet) won't start the maintenance dosage of Lysodren until they get any results from Garden State Vet .

So, I'm hoping everything goes well tomorrow and we can get Bo in for the scan in the next week or so.

That's great news! :D

Those ACTH stim test numbers (pre: 2.1 and post: 2.8) are just about as perfect as you can get for a treated Cushing's dog on Lysodren. Right smack in the middle of the 1-5 ug/dl range that we aim for! There's no need for pred with those numbers, and I'm sure the Specialist will recommend starting maintenance dosing with Lysodren soon. Great news also to hear that Bo's appetite has normalised now that he's off the pred, and that you will still be seeing a Specialist for a scan. Looking forward to your updates! :)

[Roxee's Dad]

Hi Ginny,
I haven't posted to you before but have been following along. Your post is good news indeed :D and glad you found an acceptable vet. Numbers look great, off the pred, I think you and Mr. Bo are on the road to better control and improved results. :)

[mrbojangles]

Hello everyone,

Sorry we haven't been able to post any updates about Bo, we finally got him to the specialist today , we got very good news from them, they did an ultrasound and Bo has no cancer or tumors, his adrenal glands are normal in size, and they have no indication that the pituitary gland is abnormal or any tumors, or he would have had some underlying symptoms like hearing loss or vision problems.

Thank god he has no other symptoms and he was weaned off the Pred like I posted earlier, his appetite has gone back to normal as well as his thirst levels.

The specialist said she will confer with our own vet and suggest Bo is put on the maintenance regimen of Lysodren.

Thank You all so much for your information and concerns.. Bo thanks you too!

Ginny , Joe & Mr Bojangles.

[littleone1]

Hi Ginny and Joe,

This is indeed wonderful news about Bo. I'm so happy for all of you.

[jrepac]

all good news!

congrats!

[labblab]

Sorry we haven't been able to post any updates about Bo, we finally got him to the specialist today , we got very good news from them, they did an ultrasound and Bo has no cancer or tumors, his adrenal glands are normal in size, and they have no indication that the pituitary gland is abnormal or any tumors, or he would have had some underlying symptoms like hearing loss or vision problems.

Hi Ginny,

I am thrilled that Bo is doing so much better, and that he's had the chance to be evaluated by the specialist!!

I do want to clarify one thing, though. It sounds as though the abdominal ultrasound has eliminated the liklihood that Bo has the adrenal form of Cushing's (since no growths or abnormalities were seen on the adrenal glands). However, if the specialist believes that Bo does have pituitary Cushing's, then he does suffer from a tumor on his pituitary gland because that is what causes the disease -- it is just likely to be very tiny and not malignant. A very small percentage of these pituitary tumors expand and place pressure elsewhere on a dog's brain. When that happens, other symptoms develop, like the vision and hearing problems that the specialist mentioned. But in most cases, the pituitary tumors remain very small and do not produce symptoms other than those associated with the Cushing's.

I only want to mention this so that you will not be worried in the future if you are told that Bo most likely DOES have a pituitary tumor. The only way in which a pituitary tumor could be either visualized or ruled out is by performing a CT scan or MRI of the head. These are expensive procedures, and I'm certain you would have known had the specialist done either of these tests in addition to the abdominal ultrasound. But the vast majority of our Cushpups never have either of these two tests performed, and their tiny pituitary tumors remain exactly that -- small tumors that do not cause any problems other than the Cushing's.

And the news about Bo is still excellent! We'll be very anxious to get an update on his maintenance treatment.

Marianne

[mrbojangles]

Hi Ginny,

I am thrilled that Bo is doing so much better, and that he's had the chance to be evaluated by the specialist!!

I do want to clarify one thing, though. It sounds as though the abdominal ultrasound has eliminated the liklihood that Bo has the adrenal form of Cushing's (since no growths or abnormalities were seen on the adrenal glands). However, if the specialist believes that Bo does have pituitary Cushing's, then he does suffer from a tumor on his pituitary gland because that is what causes the disease -- it is just likely to be very tiny and not malignant. A very small percentage of these pituitary tumors expand and place pressure elsewhere on a dog's brain. When that happens, other symptoms develop, like the vision and hearing problems that the specialist mentioned. But in most cases, the pituitary tumors remain very small and do not produce symptoms other than those associated with the Cushing's.

I only want to mention this so that you will not be worried in the future if you are told that Bo most likely DOES have a pituitary tumor. The only way in which a pituitary tumor could be either visualized or ruled out is by performing a CT scan or MRI of the head. These are expensive procedures, and I'm certain you would have known had the specialist done either of these tests in addition to the abdominal ultrasound. But the vast majority of our Cushpups never have either of these two tests performed, and their tiny pituitary tumors remain exactly that -- small tumors that do not cause any problems other than the Cushing's.

And the news about Bo is still excellent! We'll be very anxious to get an update on his maintenance treatment.

Marianne
Hi Marianne,

While the news was good from the specialist, her thoughts have raised doubts that he was Cushings in the first place. She is saying now that it is a very likely possibility that it's been hormonal since the onset.

I'm not sure what the next step will be, but Bo is doing very well, he's lost some weight, and has gotten his energy back somewhat.

We're scheduled for another ACTH test in two weeks, and since he's been off the Pred for over three weeks now, she can get a positive reading on his levels .

Bo shows no signs of a tumor, he's attentive, and like I said, he's getting back to being that playful puppy he always was in the past.

Misdiagnosis is VERY common with Cushings from all the people I've talked with , our family doctor was the one who told me based on what I told him about how Bo was, that he thought he was not diagnosed properly.

Thank you for the insight, but we're starting to believe now he has a hormone problem rather than the Cushings they said he had originally.
Thanks,
Ginny.

[Harley PoMMom]

Hi Ginny,

There is a type of cushings known as Atypical Cushings. This is where one or more of the intermediate/sex hormones are elevated but the cortisol is not.

Pups with Atypical Cushings display the same symptoms as pups with Conventional Cushings (elevated cortisol).

The only way to test for Atypical Cushings is to have your vet/IMS do the blood draws and send them to the only lab that does the testing in Tennessee.

If you want more information about this please let us know.

Love and hugs,
Lori

[frijole]

Ginny, I was thinking the same thing... atypical cushings. That explains alot. The good news is that it is easy and inexpensive to treat! Only one test and that is from U TENN. thru Dr. Oliver. Great guy too!

We have several links to info on this in our important reference section but here is one of them.

http://www.k9cushings.com/forum/showthread.php?t=198

Kim