katie new here (13 y/o red healer) Diabetic / Lysodren

[katiesmommy]

Hi Katie and I come from the k9diabetes forum. We just got the cushings dx and started lysodren today. I am scared and unsure. I have been doing pretty well with the diabetes thing but now am completely out of my comfort zone.
Katie info:
13 yr old red healer (aka: australian cattle dog)
Weight: aprox 45 lbs (about 10 lbs over weight)
Spayed, bad teeth, dx of diabetes in Feb, blind 3 wks ago as well as pancreatitis 3 wks ago (leading to new vet and cushing test and dx)
Currently on 11 units novolin n 2X daily
Just started loading dose of the lysodren 250 mg 2X daily

Her symptoms are rough coat, pot belly, weakness in back legs, uncontrollable and irregular blood glucose on insulin, elevated fat in blood (lipids I think?).
Forgot extreme hunger
The new vet did the test that gets sent off. Results were very elevated. I have the numbers but not sure what you guys actually like to know. So what I hear most about is cortisol? Those numbers were at baseline 94.3 (normal is 2.1-58.8) post ACTH 250.3 (normal is 65.0-174.6) other things (hormones? ) were also elevated.

My questions are about the lysodren. What I have read scares me. Please tell me its gonna be ok....
My vet did not say anything about stopping once she is "loaded" or 48 hrs before next test or give me any prendisone. He wants me to do the 250 mg 2X per day until Monday then I am to take her in on Tues AM for test and he said to fast. So...is the vet instructions ok to follow? (He has several dogs he is treating with cushings) what should I watch out for? I am not sure what else to ask at this point. Just any info you guys can give would be a great help to me right now. I am really scared for my best friend. Sorry so long but tryed to get all the needed info in here however I am sure I forgot something. Lol
Thank you all :) Katie and Kristi

[doxiesrock912]

Kristi,

whenever I hear that a dog has recently gone blind along with Cushings symptoms, SARDS comes to mind. Please ask Katie's vet about this since the two diseases are often confused.

My Daisy Mae was on trilostane (Vetoryl) so I can't advise you on Lysodren but others will be along shortly to do so. Please have SARDS ruled out first and post the test that were used and the results of those tests that gave the Cushings diagnosis please.

Also, the "helpful resources"n section of this forum has a lot of useful information and I urge you to read through as much as you can and print what pertains for future reference.

Many people keep a journal of their journey with their dogs so that they have reference points for the vet visits etc.

[mytil]

Hi and welcome to you both. I am sorry you both are dealing with these multiple issues. One of my girls is part red heeler -- love those heelers. :)

Yes, SARDS came initially to my mind as well, but uncontrolled diabetes can cause this as well.

When you can post the letters that come after the numbers of the test you posted (i.e. nmol, ug/dl). And please post the elevated hormone numbers as well (hormone name, test number and any letters afterward).

Were these tests performed during her pancreatitis? If so you could have received false positives.

Not knowing all the details, I will say your vet is prescribing Lysodren in an irregular dose regime. Did your vet mention anything about having prednisone on hand in case you see the following symptoms increasing: loss of appetite, diarrhea, weakness, depression, drowsiness? And if she vomits, I would stop completely. Please take a few minutes to read through this information - http://www.k9cushings.com/forum/showthread.php?t=181.

We are all here with you and your girl
Terry

[jxeno13]

Hi Kristi! Welcome. I'm sorry your Katie is having so many problems. :( My Eli is on Vetoryl/Trilostane and I know absolutely nothing about Lysodren. But, I know the ladies will be happy to help you though. Some of the babies here have many other problems besides Cushing's. I hope your Katie is feeling better soon!

[goldengirl88]

Welcome to the forum. Although I am not using Lysodren on my Tipper I just wanted to add a few things. Did your dog have an LDDS test? If so there is three numbers to that, so am I right in saying you had an ACTH test? We will need all the abnormal numbers according to the lab reference guide to see what is going on. Did you have a blood panel done? We need those abnormals too. Any urine or ultra sound testing? If you did have this testing during the pancreatitis it could skew the numbers and your could have a false positive. Non adrenal illnesses can cause this. I am wondering why your vet decided to start treating your dog for Cushing's before having the diabetes under control?? That would be what I would concentrate on first. Cushing's is a very slow progressing disease so no rush to treat this. You said the dog had high lipids. Cushing's mobilizes a lot of fat in your dogs system so their tryglicerides can be high. You should address that also. I use fish oil for my dog it worked fairly well. High lipids can cause pancreatitis. I would work on controlling the diabetes, and the lipids, then the Cushing's afterwards. The pot belly and weak hind legs are symptoms of Cushing's. Any excessive drinking and peeing going on? Cush dogs drink buckets of water, and pee a river. Maybe you could talk to you vet about changing the drug used for diabetes, as some dogs do better on certain drugs. Maybe this would get the diabetes under control. We will all help you with this so don't worry. The others that have Lysodren experience will be here to help you too. Blessings
Patti

[katiesmommy]

Ok I am going to try to answer all the questions. Katie had just gotten over her pancreatitis when the vet did the test. Yes it was the ACTH test. And yes she had blood work done too. I dont think she has the SARD thing, she has had cataracts for some time and we could tell she was losing sight. When she had pancreatitis her blood sugars were very high at her old vet (they didnt know what they were doing at all) she came home after three days with them and no longer could see. She still can see very bright light but thats all. As for the diabetes her blood sugar wont stablize she has a couple good days and then swings high for a week or so. We tryed other insulin and had the same results so chose to stay with the cheaper. She was eating diabetic food exactly the same amount. Now she is on the WD stuff exactly the same amount at two meals still having the same swings with blood sugar.

Test results:
Cortisol ng/ml
Result (baseline) 94.3 normal range 2.1-58.8
Result (post ATCH) 250.3 normal 65.0-174.6

Androstenedione ng/ml
Result (baseline) .99 normal .05-.57
Result (post ATCH) 2.88 normal .27-3.97

Estradiol pg/ml
Result (baseline) 101.3 normal 30.8-69.9
Result (post ATCH) 87.1 normal 27.9-69.2

Progesterone ng/ml
Result (baseline) 1.35 normal .03-.49
Result (post ATCH) 4.82 normal .10-1.50

17 OH Progesterone ng/ml
Result (baseline) 1.87 normal .08-.77
Result (post ATCH) 13.66 normal .40-1.62

Aldosterone pg/ml
Result (baseline) 110.6 normal 11-139.9
Result (post ATCH) 265.0 normal 72.9-398.5

Says at bottom: indicates presence of increased adrenal activity. (Moderate-significant)

Her blood work showed elevated ALK-P cholesterol. Her thyroid was normal.

She has not had ultra sound or anything like that done. Im not so sure my pocket book can take too many more big tests.lol

As of last night after 2 doses of the lysodren she was acting much perkier than she has in a long time. And yes she pees a lot but her drinking has reduced since being on insulin.

Now I am really worried that maybe this isnt whats wrong with her after all! But why would she feel better on the medicine if thats not what is wrong? More confused than ever....help?

[Jenny & Judi in MN]

Kristi we've all seen so many incorrect cushings diagnoses that everyone's diagnosis is treated as questionable.

I'm not one of the experts but I'd think Katie sounds like a cushings dog. Jenny was the same way. Textbook. And Jenny's blood sugar wouldn't go down till we tried the Lysodren either.

It is good to question because there are so many incorrect diagnoses of cushings. but in my opinion, Katie has cushings and diabetes.

glad she is starting to feel better

Judi

edited to add: if anything I say disagrees with Glynda, listen to Glynda! :) these folks know their cushings. hang in there

[lulusmom]

Hi Kristi and welcome to you and Katie.

I have a number of questions and some Lysodren information for you and have typed those in blue text below. I find that technique easier for me to stay on track as well as allow members to more easily identify the issues I am addressing:


Hi Katie and I come from the k9diabetes forum. We just got the cushings dx and started lysodren today. I am scared and unsure. I have been doing pretty well with the diabetes thing but now am completely out of my comfort zone.

Did your vet instruct you on the signs of loading you should be looking for? Change in eating behavior is usually the best gauge unless Katie has a normal appetite in which case my suspicions about a misdiagnosis would increase. Reduction in water intake is another thing you should be monitoring. Any changes in appetite or reduction in drinking are signs that the Lysodren has sufficiently killed off enough of the adrenal cortex tissue and dosing should be discontinued. Lysodren has a cumulative effect for up to 48 hours which is why it is recommended that the acth stimulation test be done 48 hours after the last dose so as to give a much more accurate assessment of cortisol levels.

The following link is to Lysodren Loading Instructions and Related Tips which can be found in our Helpful Resource Section. http://www.k9cushings.com/forum/showthread.php?t=181
I highly recommend that you print this out and keep it handy while loading. Read it carefully and try to digest as much as possible. Both of my cushdogs loaded more than a few times on Lysodren so I am intimately familiar with the drug. If you have any questions, please ask.


Katie info:
13 yr old red healer (aka: australian cattle dog)
Weight: aprox 45 lbs (about 10 lbs over weight)
Spayed, bad teeth, dx of diabetes in Feb, blind 3 wks ago as well as pancreatitis 3 wks ago (leading to new vet and cushing test and dx)

Did your vet determine the cause of blindness? If not, I would have Katie seen by a veterinary opthamologist? Blindness caused by diabetes is different than SARDS, which can cause blindness overnight. I did not have time to properly digest the information in your thread on the diabetes site but what I did see raised a lot of questions. When did your vet deem Katie to be insulin resistant and suspect cushings to be the cause? It appears that your vet drew blood to send to the University of Tennessee for a full adrenal panel while Katie was actively sick and hospitalized with pancreatitis. If so, I would have been shocked to see normal cortisol levels on that test given Katie's state of health when that blood draw was taken. As I recall, the folks on the diabetes site told you that no cushing's tests should be done until the pancreatitis was resolved and that you had to contact the vet to tell him this piece of information. I also recall that the vet decided to that test pro bono. I suspect you didn't have to pay for that test because your call came too late and the sample had already been sent to UTK.

Currently on 11 units novolin n 2X daily

Dr. Mark Peterson, a reknown endocrinologist, defines insulin resistance at doses greater than 2.2 U/kg/injection to control hyperglycemia. You can double check with the folks on the diabetes site but based on that statement by Dr. Peterson, 11 units falls way short of a dose required to deem Katie as insulin resistant. Please use the following link to read one of Dr. Peterson's blogs on how difficult it is to diagnose cushing's in a diabetic dog. http://endocrinevet.blogspot.com/2012/01/q-diagnosing-cushings-disease-in-dogs.html. I am no expert on diabetes so would suggest you ask your fellow members on the diabetes site for feedback on their opinion as to whether they feel your vet should have deemed Katie as insulin resistant. I would also like to mention that if Katie has SARDS, you would expect to see hyperadrenal activity as noted by UTK so even if pancreatitis didn't skew the UTK results, SARDS could be the reason for all of the elevations in adrenal steroids.

Just started loading dose of the lysodren 250 mg 2X daily

Most vets experienced with treating diabetes and cushing's now prefer twice daily dosing of Vetoryl over treating with Lysodren. I suspect that your vet chose Lysodren because that's what UTK recommended in their treatment recommendations. Based on so many red flags that indicate your vet has little experience with cushing's and I am convinced he knows nothing about Lysodren and following proper protocol. I'll comment further on this below.

Most specialist who are sure of their cushing's diagnosis would have prescribed a loading dose double that of what your vet has prescribed so if Katie truly has cushing's, loading could be protracted and if she doesn't cushing's, it could go on forever. Dogs with cushing's have adrenal mass which means the adrenal glands have become big and fatty due to excess secretion of cortisol. Lysodren has an affinity for this fatty tissue and effectively kills it. Dogs with normal adrenal glands don't have adrenal mass and are therefore resistant to the effects of Lysodren.

My cushdogs were tiny, 4.5 lbs and 6.5 lbs and they loaded more than once on the maximum dose of 50mg/kg. Katie is loading on approximately 25mg/kg.

Her symptoms are rough coat, pot belly, weakness in back legs, uncontrollable and irregular blood glucose on insulin, elevated fat in blood (lipids I think?). Forgot extreme hunger.

With the exception of extreme hunger, all of the other symptoms can be due to uncontrolled diabetes. Extreme hunger is a definite symptoms of cushing's but it is also a symptom that is commonly associated with SARDS. Most dogs with SARDS usually start to disply symptoms commonly associated with cushing's before the onset of blindness. Even if cortisol is elevated at the onset of blindness, many experienced vets will choose not to treat for cushing's as these symptoms usually resolve on their own within three to four months.

The new vet did the test that gets sent off. Results were very elevated. I have the numbers but not sure what you guys actually like to know. So what I hear most about is cortisol? Those numbers were at baseline 94.3 (normal is 2.1-58.8) post ACTH 250.3 (normal is 65.0-174.6) other things (hormones? ) were also elevated.

My questions are about the lysodren. What I have read scares me. Please tell me its gonna be ok....
My vet did not say anything about stopping once she is "loaded" or 48 hrs before next test or give me any prendisone.
He wants me to do the 250 mg 2X per day until Monday then I am to take her in on Tues AM for test and he said to fast. So...is the vet instructions ok to follow? (He has several dogs he is treating with cushings) what should I watch out for? I am not sure what else to ask at this point. Just any info you guys can give would be a great help to me right now. I am really scared for my best friend. Sorry so long but tryed to get all the needed info in here however I am sure I forgot something. Lol

Your vet has been extremely irresponsible in his breach of loading protocol. He should have counseled you extensively on the drug, how to administer it (you must give with food for proper absorption), what to look for in the way of signs of loading and he never should have let you walk out the door without Prednisone. Katie has complicating issues and there are huge red flags going up everywhere as to the accuracy of a cushing's diagnosis. Pancreatitis, SARDS, Cushings, Diabetes....it's a nightmare that only a specialist can sort out. Honestly, if all of my assumptions are correct about how badly this vet screwed things up, I personally would stop the loading now and get Katie in to see an internal specialist immediately. Your vet should be happy to give you a referral. You can find a specialist at www.acvim.org or you can let us know what city and state you are in and perhaps a member may be able to provide you with a name

Thank you all :) Katie and Kristi

I am so terribly sorry for the circumstances that brought you here and my heart goes out to you and Katie for all of the complications you've both been dealing with. I'm glad the folks at k9diabetes sent you to us because you really do need the best of both world for Katie. We'll do our best to help you get your girl on the right track.

Glynda

[katiesmommy]

Thank you Glynda for all the info. I have been reseaching like crazy. I am contacting my vet this AM to discuss all the points that have been brought to my attention here. As now I am totally panicked. Yes the test was done while she was in hospital for pancreatitis but he did wait until she was eating again and doing better. He was pretty sure she had cushing given her history and didnt think the pancreatitis would upset the test too much. So now I am gonna go with information I have gotten here and see what he has to say for himself. I am so tired of vets not knowing what they are doing. So frusterating! I have limited resources and cant keep jumping vets and doing these expensive tests if I am just wasting my time and money. I am looking for specialist but dont think we have one here. I just want to scream!

[goldengirl88]

I totally understand where you are coming from. Many of our members have hadtto switch vets, do the same test over, and pay for things because the vets were not doing what they were supposed to. When you have limited funds and want to help your dog and this happens it makes things tuff. I know what you are feeling and hope you can figure a way to get what Katie needs done. There is Care Credit if you don't know about it, it is a credit card basically you can use at the vets and the payments are spread out and very small. This can help you get thru and if you have an emergency. You can apply online. Hope this helps you, I feel your frustration. Blessings
Patti

[lulusmom]

Here is a link to Kristi and Katie's thread on k9 diabetes:

http://www.k9diabetes.com/forum/showthread.php?t=5545&page=12

Kristi, you aren't the first to want scream bloody murder over the frustrations of this disease. Most of us have been there, done that but most of us were also not dealing with the complications of multiple underlying issues. Scream away, arm yourself with the resources you've been provided and hold your vet's feet to the fire. I know that specialists cost more but some of us have discovered that specialists can save you money in the long run.

[katiesmommy]

Cant seem to stop crying over this. Not good when I am stuck at work.

[jxeno13]

Cant seem to stop crying over this. Not good when I am stuck at work.

Awww...I'm sorry. I know it's hard, but with care I'm sure your Katie will be OK. It's not the end. It's not a death sentence....Katie can still have a great quality life and will probably back to her self again before you know it. :)

[katiesmommy]

Awww...I'm sorry. I know it's hard, but with care I'm sure your Katie will be OK. It's not the end. It's not a death sentence....Katie can still have a great quality life and will probably back to her self again before you know it. :)

Thank you. I feel like I am doing everything wrong.

[jxeno13]

Thank you. I feel like I am doing everything wrong.

No you're not. You're here aren't you? :D Give the senior members a chance to help you figure it out. That's what they did for Eli and me. He's alive today because of the kind people on this forum. :) ....Give it some time. Another lady (Judi) posted on page 1 of this thread,..her dog has diabetes and Cushing's as well. Perhaps, reading her thread can help lead you along. I've never used Lysodren, or had a diabetic dog...so, I'm sorry that I can't help there. :( Reading the first pages, at least, of other threads often helps me, as well........I learn new stuff all the time. When I came on here, not long ago myself, I never even heard of Cushing's before. Hang in..trust me, it'll be OK. You're NOT doing anything wrong at all! You're doing the best you can for Katie on what you know now....soon you'll have a head full of information. :)

[lulusmom]

Oh Kristi, please don't beat yourself up. You've done everything right for Katie, including coming here and k9diabetes for help. Bad owners don't do that. Most of us had never heard the word cushing's before our vets mentioned it as a possibility and if my dog were diagnosed tomorrow with diabetes, I would have to rely on the good folks at k9diabetes to educate me and point me in the right direction.

A good number of gp vets are woefully uneducated about cushing's and its treatments and unfortunately, a good number of those will fly by the seat of their pants instead of investing in some continuing education. That's a risky proposition for a cushdog and an even riskier one for a dog with Katie's complicating issues. You are just a layperson trying to do the best you can for your dog and you've done a darn good job so far so cut yourself some slack. I can promise you that things will start to make more sense. The more you learn, the calmer you will become. It won't happen overnight but stick with all of us here, and k9diabetes, and we'll get you there. We'll be with you every step of the way.

[jxeno13]

Here's the link to her thread.....

http://www.k9cushings.com/forum/showthread.php?t=3489&highlight=Jenny+Judi

She has a poodle with Diabetes and Cushing's. I believe her dog is also on Lysodren. Her thread can be a treasure trove of help for you, as well as the senior members here. :) I felt like a fool when Elii crashed on the Vetoryl...but I got over it. I knew NOTHING! I'm not sure how much my Vet knew at the time..and I really like him. But, he learns everything I do about Cushing's and Vetoryl every time I see him now. I told him they need to put my name on the door as well....I'm there enough! :D I also told him they could take my paycheck and deduct it from my bill too! LOL

BTW - Jenny is the dog. :)

[lulusmom]

Kristi,

Since I didn't read your entire thread at k9diabetes, can you tell me if Katie's blood sugar was ever stabilized? If so, at what point did you lose control? Was it prior to her going blind and/or being diagnosed with pancreatitis? Do you do home testing and if so, can you post the most recent results so we can get some feedback from the folks at k9diabetes?

[katiesmommy]

I dont know what stablize is I guess. She would jump all over the map between 250 and 400s. On 13 units. More insulin than that and she would spike into 500s. She always got exact same food AM & PM. That was before.
After pancreatitis and blind the vet started her on 9 units and we slowly worked up to the 11 she is on now. She is now on WD exactly the same AM & PM. She actually had three days of 100s to 200. Lowest ever last week. Then has started creeping back up. I dont have all her numbers with me cause I am at work. Yes I test at home.
These are numbers for last two days
6/17
6am 288 food shot lysodren
1030am 279
Noon 235
3pm 341
6pm 353 food shot pill
8pm 328
930pm 362

6/18
6am 274 foide shot pill
3pm 269
6pm 307 foid shot pill
930pm 342

6/19
6am 425 food shot pill

[lulusmom]

Hi Kristi,

I posted your curves at k9diabetes and have asked the experts to review and give me their opinion on whether they think Katie should be deemed insulin resistant. I've also asked them for an explanation as to why Katie would spike on an insulin dose greater that the current 13 units she is currently receiving.

Glynda

[molly muffin]

Glynda I wonder if the vet wasn't going straight to a maintenance lysodren dosage as opposed to a full load, treating it like an atypical diagnosis?

This is so hard with so many different things going on. You are doing awesome trying to get it all figured out.

I think that maybe I would try the twice a day dosing with trilostane as that is what is commonly prescribed now and I think you might be able to get better control beacause you'd be keeping the cortisol level at a more even keel throughout the day. If of course this is cushings.

These are just my initial thoughts.
hang in there!

Sharlene and molly muffin

[goldengirl88]

Well wishes for you and sweet Katie and hoping you get everything worked out with her diabetes. Blessings
Patti

[katiesmommy]

Hi to everyone. Wanted to give quick update on Katie and our unconventional cushings road. I had to go with my gut and decided to do what the vet was wanting. All your great info helped me ask the right things and watch for the right things. We retested her cortisol levels last Tues. Her levels were still elevated. (Which I knew because she wasnt "loaded" based on all your info.) We did another three days of the lysodren and will retest on Monday. I think she is "loaded" this time because she can now be distracted while eating. Her energy level has improved and her back legs dont seem to bother her as much anymore. Her blood sugar numbers are staying in the two hundreds now. They have never done that before. So I am keeping faith that we are heading in the right direction. I will let you know what her test on Monday says and try to remember to get the numbers. I forgot to get a copy of last weeks.
Thank you all for giving great advise and info.
:)

[goldengirl88]

Hope everything works out well this time. Blessings
Patti