Newly diagnosed and scared

[Pbalca426]

Hi everyone. My eight year old boston terrier Rambo was diagnosed with cushings last week. Vet said he seemes to be in the pretty early stages. He wants me to start giving a half of a lysodren pill twice a day starting tomorrow. He also gave me prednisone and told me to give a half tablet once a day. Has anyone had any experience with this? From what I have read the prednisone is used as an emergency pill. Any advice and experience would be greatly appreciated as I am scared to death to do the wrong thing!! Thank you all in advance!

[DoxieMama]

Hello and welcome to you and Rambo. I have no experience with lysodren but others do; with the holiday weekend in the US it may be a bit before someone else sees your post. But I'm sure when they do, the experts will be able to chime in with suggestions.

In the meantime, can you provide us any more information about Rambo's diagnosis? What symptoms does he have that led to the testing, and what were the results of those tests? Actual numbers for bloodwork that is out of range, as well as those from an ACTH or LDDS test if they were performed, would be helpful.

[labblab]

Welcome from me, too! Shana has already asked many of the questions that will help guide our thoughts and suggestions. But since you are starting the Lysodren today, I’ll cut to the chase re: the typical loading protocol with which we are familiar. Here’s a link to a post that provides a lot of helpful information:

http://www.k9cushings.com/forum/showthread.php?181-Lysodren-loading-Instructions-and-related-tips

First, in order to judge the appropriateness of the dose, we’ll need to know Rambo’s weight and also the size of the Lysodren tablet. Secondly, has your vet instructed you re: the signs to watch for that will indicate that Rambo has had enough loading doses of the Lysodren and the daily treatment should end?

I am concerned that you’ve been told to give daily prednisone in addition to the Lysodren. A few vets feel that this eases the loading process for the dog. But our experience here over the years is that the daily prednisone can make it easier for a Lysodren overdose to occur. Since the prednisone acts as a substitute for cortisol in the body, the prednisone can mask the observable effects of the Lysodren that signal that the loading phase should end (e.g., decrease in thirst, even subtle changes in appetite). As a result, you may continue giving the Lysodren for too long a time with a resultant overdose.

We are not vets, so I don’t feel comfortable with telling you to change the treatment plan without first discussing it with your own vet. But if it were me, I’d want to talk further about the pros and cons of the daily supplemental prednisone. As you’ve already discovered from your own research, it is far more common to reserve the prednisone solely for rescue use should natural cortisol drop too low.

Once again, welcome to both you and Rambo, and we’ll look forward to learning more about your boy!
Marianne

[Pbalca426]

Thank you so much for your quick responses! Incresed thirst and urination are what lead me to the vet. I noticed the symptoms beginning around 3 months ago. He also began to develop a potbelly and seemed hungrier then usual. He had both the ATCH and LDDS tests run but I don't not have a copy the full results but I will get them on Monday when my vet reopens! Rambo weighs 27 pounds and I was instructed to give him 1/2 of a 500 mg tablet twice a day. And the prednisone prescribed was 5mg and 1/2 a tablet a day. I was told decrease in appetite would be my first sign to stop dosing which is scary to me because Rambo has always loved to eat! The link you provided had great information!! Thank you both so much again!

[Squirt's Mom]

Hi and welcome to you and Rambo! :)

We are a Lyso house, or were when treating my cush baby. The loading dose is 50mg/kg/day divided into 2 even doses. At 27lbs, Rambo weighs 12.2727...kg. So the loading dose would be 12.27x50mg = 613.6363...mg a day/2 for a dose of 306.1818...mg twice a day. Since Lysodren only comes in 500mg tablets that would be rounded to around 275mg 2x a day. Half a tablet would also be acceptable (250mg 2x/day). Lysodren can be compounded to the any dose not available by using the 500mg tablet if needed. But I think this dose will be ok tho it may take a bit longer to load. The med MUST be given with a meal so the drug can be properly absorbed. Using pred along with the Lyso is a bit like trying to put out a fire with gasoline however. ;) AND the use of the pred WILL ensure it takes much longer to load than needed. Pred should be used ONLY as a rescue measure if the cortisol should drop too low.

Read the link Marianne posted on the tips for using Lyso and that should help a great deal. Don't be afraid - this drug is life-saving and used correctly will help Rambo regain much of his old self. Ask any questions you may have and NEVER hesitate to express any concerns you may have. If you see ANY of the signs listed such as a decrease in appetite (which may be very subtle such as looking up from his feed bowl if called when before he would not have done so) or a decrease in water intake (we have a spreadsheet to help track water intake here - http://www.k9cushings.com/forum/showthread.php?3583-Spreadsheet-for-Logging-Your-Dog-s-Water-Intake) stop the Lyso immediately and call the vet for an ACTH in the following 2 days. This is where the use of pred can really be an issue as Marianne explained.

I'm glad you found us and look forward to hearing more soon!
Hugs,
Leslie

[Pbalca426]

Thank you so much! I have already placed a call in with my vet and will definitely be discussing the prednisone! I was extremely nervous about starting the lysodren but am now feeling much better and more confident as you have all given great information!! I appreciate it tremendously! It's great to know I'm not alone :)

[Pbalca426]

I just wanted to update, I talked to my vet and he confirmed all you had said. Apparently he was dealing with an emergency at the time I came in to pick up the medication and the girl at the front desk had given the wrong instructions. Just wanted to say thanks again!

[Squirt's Mom]

Oh wonderful! I am so glad you talked to the vet and got that straightened out. Too often we have seen where techs get things confused so it is always good when the vet will talk with us. Way to go, Mom....that's the way to be proactive and speak up for Rambo! Good for you!

Hugs,
Leslie

[molly muffin]

Hello I just wanted to check in and see how the loading went with Rambo. Everything going alright?

[Pbalca426]

Hello, sorry I haven't posted! I've been so preoccupied with Rambo and the holidays my mind was on overload! Thank you so much for checking in!! I am beyond happy to report that Rambo has been doing great! After starting his Lysodren a little over a month ago he has had 2 ACTH tests. The first was 5 days after staring the loading phase and the results came back good so we went on to half a tablet once every 3 days. We retested a month later and got the results back today that everything is where it should be and to continue on and to retest in 3 months! He seems to be doing great and is gaining many of his "quirks" back which I had previously thought prior to diagnosis were lost due to age. His appetite and water consumptiion are back in check, but he still seems to be asking to go out a little more then before. Anyone have any input on if this is normal? It also could be due to the fact that when it is cold he likes to pee very quickly and come back in (can't blame him! We are in Ohio and in negative temperatures now!) Also prior to diagnosis I noticed his back legs would slid out a little on kitchen floor and he wasn't jumping as much. He doesn't really have any trouble with his legs sliding anymore but still hesitates to jump on couch and bed sometimes. I have tried buying steps which he wanted no part of. It's hard to know what is age related and cushings related. Does back leg strength contunue to get stronger? More exercise? Any suggestions on vitamins or natural supplements? Thank you so much, I am so happy to have found a wonderful support group! I hope you all had a great holiday!

[Harley PoMMom]

So happy to read that Rambo is doing so well!! Could you post those ACTH stimulation test results for us? Also, what Lysodren dose did he load on and what is the dosage he is taking now for maintenance? Improvement in muscle mass takes a while, hydrotherapy may help with that.

As for the urinating, cushdogs are notorious for getting UTI's so having his urine cultured to see if one may be brewing is what I would recommend.

Lori

[Pbalca426]

My mom had picked Rambo up from the vet for me after his testing and forgot to give me his paperwork but I believe when the vet had called he said his resting was 1.5 and then 10.6 . Do those numbers sound right? I could have that wrong! He loaded in 5 days on 1 tablet (500 mg) a day. He is currently taking half of the 500 mg tablet once every 3 days. His back legs do seem to be improving slowly but I will definitely continue to monitor and look into the hydrotherapy! I will also have a urine sample done at the vet to check for the uti! I plan on getting some testing strips to keep on hand as well! Thank you so much for your help!

[molly muffin]

usually with lysodren, they want the post number to be 5.0ug and under, so maybe grab a copy or call the vet and ask what the post number was?

It's great that his legs seem to be improving. I think hydrotherapy can help if it is available and feasible

[Pbalca426]

Hi again. I called my vets office this morning and the receptionist called and got Rambos result from the lab. She said his baseline was 1.4 and his one hour was 10.6. Which I am very confused because I know when my vet had called last week he had said that Rambo was right where he wanted him to be and to keep on going with the half of lysodren every 3 days and to recheck in 3 months. Could his post number continue to drop in the next 3 months? Or should this something i should talk to vet about now and have dosage adjusted? I am very nervous about increasing his dose as I have read stories of dogs levels dropping too low after an increase! Rambo seems to be doing very good with the exception of still a little more frequent urination then before the cushings but it has definitely improved since beginning the lysodren. Any advice on what I should dor next would be greatly appreciated! Any certaian questions I should be asking my vet? I love my vet and he has always taken great care of Rambo. I just want to do whats best for my boy! Thank you!!

[Pbalca426]

I should also note that Rambos last ATCH test was done 24 hours after his last pill. I read that the lysodren stays in the system for 48 hours so if I understand correctly his actual level may be even lower the 10.6?

[labblab]

Hi again from me! For quite a long time, our understanding here on the forum was that cortisol levels did continue to drop for up to 48 hours after being given Lysodren. However, several months ago, I personally tried to find any actual research evidence for this belief, and came up empty-handed. So I’m honestly not sure as to the original source of that belief, and I no longer think it’s likely to be the case. Many noted specialists proceed with ACTH testing on the day after treatment, so I tend to think that Rambo’s reading of 10.6 was an accurate reflection of the effect of the Lysodren on his adrenal function.

As mentioned above, that level is quite a bit higher than is generally recommended for a Cushpup being treated with Lysodren, and most vets would not characterize him as having completed the loading phase with a cortisol level that high. So I’m not sure why your vet feels as though this is a good level at which to maintain him. Having said that, though, there may be some reason of which we’re unaware as to why he wants to maintain him at this higher level. Also, if Rambo generally seems to be doing quite well, the vet may just not want to rock the boat. However, this higher cortisol level can easily explain why the excessive urination remains unresolved, and it may likely never resolve unless the cortisol is reduced further into the traditionally recognized therapeutic range. Even though a post-ACTH of 10 may be considered normal for a dog without Cushing’s, it is not within the treatment range for a dog taking Lysodren.

Even if you decide to stick with this maintenance dosing schedule, I most definitely would not want to wait for three months to recheck his ACTH response. Since his cortisol level has not been reduced into therapeutic range during the loading phase, I believe it’s more likely that his adrenal function may rebound fairly quickly such that’s he’s overproducing cortisol once again. And that will put you right back at square one and reloading all over again.

If it were me, I’d specifically ask the vet as to his reasoning for allowing Rambo’s cortisol to run as high as it is. You both may end up agreeing that you are satisfied even if there is no additional improvement in his symptoms. But I think it’d be good for you to know exactly what goals your vet has in mind.

Marianne

[Squirt's Mom]

I would want to be sure the vet understands the optimal ranges for Lysodren and Vetoryl are not the same. With Vetoryl (Trilostane) the post number can be as high as 9.1 ug/dl if and only if all signs are well controlled. That is not the case with Lysodren. That post number needs to be under 5.0 ug/dl. ;)

[Pbalca426]

Thank you so much for your responses. I put in a call at the vets office to have the vet call me and received a call back from the administrator who told me he had talked with vet and feels Rambos numbers are where they should be and to keep doing what I'm doing. While I really do like my vet, and I feel that it is definitely time to get a second opinion! I looked up specialists in my area and will be making an appointment! It's not so much the frequent urination I'm concerned about because it isn't terrible, I'm just worried about the possibility of Rambo developing other complications/diseases if his levels aren't where they should be! Thank you for your help! I will update with further news, and further questions I'm sure! ��

[lulusmom]

I just wanted to chime in and validate what the others have told you. A post stimulated cortisol is definitely too high and you can be assured that it will continue to increase. You absolutely need to get the post stimulated cortisol (1 hour blood draw) below 5 ug/dL and maintain it at that level for the rest of his life. I am not surprised Rambo is asking you to go out more often and unfortunately that will probably get worse. At this point in time, your vet should have recommended a mini load (full loading dose for a few days) or an increase in the maintenance dose; however, at over 10 ug/dl, increasing the maintenance dose is not likely to work. I think it's an excellent idea to get a consult with a specialist but in the meantime, you should know that without a mini load or increase in maintenance dose now, you may be wasting good money on the maintenance dose you are currently administering. I highly recommend that you print out the "Lysodren loading instructions and related tips" in our Helpful Resources subforum and share them with your vet so that he understands proper protocol. Citations for resources are at the top of the page and while dated, it still applies today. I have provided a link to that thread below. Can you please get the results of the first acth stim test that was done directly after stopping the loading phase? I'm curious as to whether Rambo's post stimulated cortisol was ever under 5 ug/dL. Regardless of whether you choose to try to educate your current vet and stick with him or you place Rambo under the care of a specialist, we are here to answer any questions you may have and help you get Rambo stabilized.

http://www.k9cushings.com/forum/showthread.php?181-Lysodren-loading-Instructions-and-related-tips

[Pbalca426]

Thank you so much! Yes I do notice Rambo asking to go out more and more which tells me his levels may be rising. Still acts happy and healthy which I am very happy about, but I do think a mini load will probably be the next step. I did make an appointment with specialist on Wednesday! My vet is faxing over his lab results over to specialist so I will find out when I go what his results after loading were. I do know that my vet had said after that initial test that he was still a little bit high but he was okay with that, which I didn't think anything of at the time I just figured it would continue to come down. They said at the specialt that they would also try and work with my current vet! So hopefully all will go well and I will update with more news! I can't thank you all enough!

[Pbalca426]

Hi just got back from specialist so wanted to check in with his update. I did get all of Rambos test results and his levels after his induction phase were 2.7 post and 6.7 at 1 hour. Doctor took sample to run another blood and urinalysis today. He told me to try giving half a lysodren tablet 3 times a week rather then 2 times a week and to recheck with stim test in 1 month. I also asked him about the 1-2 year life expectancy which I have seen on so many websites in my hours upon hours of reseraching. He said that is the average but many dogs are diagnosed later in life which could be the reasoning. I have read so many positive stories on here which give me hope! Hope all goes well! Thanks all!

[molly muffin]

He is right, dogs being diagnosed later in life can mean that 1 - 2 years might be their normal life expectancy or that something else medically was going on. It all depends on the individual situation and I don't find that there is anything set in stone.

Usually with lysodren, you are looking for a post of just under 5.0ug, so you are very close with where you are.

[Pbalca426]

Just to update: I just received a call from the vet with Rambos blood test and urinalysis today. He mentioned a couple things were a litthe high but that's to be expected with the cushings. He also mentioned that his phosphorus levels were high and that he didn't have an answer for that right now. He said its sometimes due to dehydration or kidney problems. He also mentioned some protein in his urine and said he would like to run a test on that but to wait until we do another ACTH test and get his levels down to where they need to be .

[molly muffin]

I wouldn't worry too much about what is high today if the vet isn't and do a retest after his next ACTH and see which way things are trending.

[Pbalca426]

Thank you, I was freaking out a little bit at first after hearing kidney problems! But you are right, the vet didnt seem to think it was anything too urgent to worry about so we have an appointment to retest everything in a month and will update again! Fingers crossed I will be able to update with positive news! Thank you so much for all of your help!!

[qsmom]

Hi Pbalca, We have a 9 year old Boston Terrier, Quincy (neutered male) and we are in the early stages of the diagnostic process. His ALP is slightly higher than normal and his ultrasound showed bilateral enlargement of adrenals (which suggests PD Cush). He will have an LDDS test on 2/1/18. How is Rambo doing? Is he responding well to meds? Any issues?

[Pbalca426]

Hello, I'm sorry to hear about your boy Quincy! There are definitely some great people on here to help though! Rambo started on lysodren a little over 2 months ago. After his initial loading phase his urination and water consumption had started to decrease. His last ACTH at the beginning of the month revealed his levels were a little high again so we had increased his weekly lysodren dosage from 2 times weekly to 3 times. Rambo is 27 pounds and the dose he takes is half a tablet which is 250 mg. We haven't had any of the negative side effects on the medication. He's remained his happy playful self through it all. His urination and drinking has increased some again which I'm hoping will resolve once we get his numbers back down where they need to be. The specialist i seen a couple weeks ago told me treating cushings is more of an art then a science, what works for one dog may not work for others. I know it's very scary especially at the beginning! I read so many scary on things on the internet and was scared to death starting lysodren. But after finding this site I felt much better and more prepared! Don't be afraid to ask any questions you have!

[Pbalca426]

Hello, hope everyone is doing well. Just wanted to do a quick update/get some advice and opinions. After increasing Rambos lysodren dose to 1/2 tablet every Tuesday, Thursday, and Saturday he had another ACTH test on February 12th. He also took blood to test that day which he said those results were normal and that his kidneys looked good. The ACTH results came back pre 2.8 and post 17.6, which the the previous post a month prior was 10.6 We then increased dose to alternating 1/2 tablet and 3/4 tablet Tuesday, Thursday, and Saturday. We got another ACTH done this monday 2/26 and the vet called today and said his specific gravity is about normal which is a really good sign and his ACTH numbers were virtually the same as last time. He said to keep doing the same thing and to retest in a couple months. I told vet Rambo is still drinking and peeing a lot and he said he did not want to increase the dose anymore and that specific gravity doesn't lie so we should be good

I have quite a few concerns about this and I'm going to be calling specialist to schedule another appointment with him. Rambo didn't drink any water the morning before I took him in for his testing monday, could this be the reason his specific gravity was up? Rambo has been acting happy and healthy through it all which I am sooo thankful for but am getting so frustrated at this point!! Any help, advice, or suggestions would be soooo very much appreciated!! Thank you so much!

[Harley PoMMom]

Was Rambo's urine collected at his first morning pee? Regarding the last ACTH stim results, how long was he on this alternating 1/2 tablet and 3/4 tablet Tuesday, Thursday, and Saturday regimen before the test was preformed?

[Pbalca426]

I took him to the vet at 9:00 am and they collected his urine there, so it wasn't his first pee of the morning. He had been doing his current dosing regimen for 2 weeks when he was retested this Monday.

[labblab]

I have quite a few concerns about this and I'm going to be calling specialist to schedule another appointment with him. Rambo didn't drink any water the morning before I took him in for his testing monday, could this be the reason his specific gravity was up? Rambo has been acting happy and healthy through it all which I am sooo thankful for but am getting so frustrated at this point!! Any help, advice, or suggestions would be soooo very much appreciated!! Thank you so much!
I think it’s really a good idea for you reconnect with the specialist. Typically, a post-ACTH result of either 10.6 or 17.6 would be considered too high for a dog being treated with either Lysodren or trilostane. It’s good that Rambo is generally doing well, but it seems to me that the excessive thirst/urination remains an issue regardless of the specific gravity of the urine. If he were mine, I would really like to know what the specialist thinks about things. And we’ll be interested to know, too!

Marianne

[Squirt's Mom]

Just to be sure -Rambo IS getting his Lysodren with a meal that contains fats? Lysodren NEEDS fats in order to be absorbed and used by the body. Some vets even advocate giving the Lyso in a spoon of corn or olive oil. If his diet is low in fat that may be playing a role in what is going on.

But I agree with Marianne 1010% about getting him to a specialist for some additional checking. SOMETHING is not right here - whether it's the lack of fat with the Lyso, a misdiagnosis and something entirely else is going on, or he is one of those pups who simply doesn't respond or do well with Lysodren, or some factor I have not considered...but something is off.

[Pbalca426]

Thank you! I have made an appointment and Rambo will be going to specialist Monday to have some testing done. I have been giving him his pill with a cup of his dog food and a greenie pill pocket. Both say the have min 10 % crude fat. Do you think this is enough or try something more?

[molly muffin]

With food and the pill pocket should be okay for giving the lysodren.

Do let us know what the specialist says. That post is too high from what the they normally like to see. Dechra with trilostane says up to 10 If symptoms are controlled. With Lysodren they want an under 5.0ug post.

[Pbalca426]

Thank you! I'll update this week after his appointment!

[Squirt's Mom]

Looking forward to that update and best of luck with the IMS. I hope they provide some answers and viable solutions for your sweet boy!

[Pbalca426]

Hi all! Just wanted to share a quick update. IMS Dr. called today with Rambo's test results. Post ACTH was a 16 and bloodwork came back good. He said liver enzymes were elevated which is to be expected and phosphorus was slightly high but could have been caused by slight dehydration and his kidneys looked good. He recommended to start a reloading period on Thursday and retest on Tuesday unless I see any signs (decreased appetite, vomiting, diarrhea, etc) and then we would test sooner. Fingers crossed this will finally do the trick or at least put us on the right path! Wish us luck! Thanks for all the input and advice!

[molly muffin]

Okay, so a reload to try and get Rambo back on track with the lysodren. What is the reloading dosage going to be?

[Pbalca426]

1/2 tablet twice a day

[molly muffin]

We'll all have our fingers crossed that this time it takes and holds!!!

[Pbalca426]

Thank you so much! :)

[Squirt's Mom]

How is Rambo doing? Are you seeing any changes yet in water intake or appetite? Hopefully nothing like loose stools or nausea?
Hope all is going well and this is the LAST load your sweet boy has to go thru....and you, too! ;)

[Pbalca426]

So far so good, no changes yet! We started yesterday morning so we are on day 2 now. Thank you so much, I'm hoping this will do the trick as well!

[molly muffin]

Got my fingers and toes crossed here!

[Pbalca426]

I am happy to say I can finally update with some good news! After almost a couple weeks and 3 very expensive ACTH tests, Rambo's post is finally below 5 and we are ready to start maintenance!! We will be doing 1/2 lysodren tablet on Monday's, Tuesday's, Thursday's, and Friday's. Rambo's drinking and urinating have almost returned to normal, it's so nice not to have to take him out several times in the middle of the night! Lol! Will do another ACTH rest in 3 weeks. Thank you for everyone's help and support so far it feels great to finally be able to share some good news!! Hope everyone has a great weekend! :D

[Squirt's Mom]

WOOHOO!!! Way to go Rambo and Mom!!!!

(I knew you could do it!)

[molly muffin]

Awesome news!!!! Now lets keep that load going!

[Pbalca426]

Hi all, wanted to update and get some opinions with where we are at now. Two weeks ago we left to go to South Carolina for 5 days, which is a 10 hour drive for us. Rambo has always traveled with us and never had any problems. This time however he had a couple of bouts of diarrhea when we would stop (which has happened before on long car rides) and then when we got to the hotel he vomited just a little bit. I called vet and they said to keep an eye on him and as long as he is acting okay and eating and drinking okay it was most likely due to the car ride and to continue with maintenance dosing. He was okay so I continued and he was fine the rest of the week. We got back on Saturday March 31st and then Monday was time for another pill. After giving him his pill on Monday he threw up 2 times so I immediately called the vet and they instructed me to give a half tablet of prednisone and discontinue lysodren for week and to contact them if he had any further issues. The next day I noticed Rambo had been itching a lot and he was starting to get a little bald spot on his back. I looked at his skin and it looked okay other then two round brown spots that looked like moles which just came off when I scratched them. I gave him a bath in a medicated soap hoping that would help. It's a week later now and he now has almost 5 bald spots and one on his side is pretty big about several inches. He isn't itching too much but when I scratch the areas he becomes itchy. Today is his first day back on his lysodren and haven't had any problems so far with that, he has been very picky with his dog food lately but I think it may be due to the fact that he got a lot of chicken on vacation lol he still wants to eat treats and will usually eat his food if I mix a little something in with it. I called the vet to ask about his hair loss and he didn't seem concerned and said it was most likely due to his cushings but he gave me the number for the dermatologist if I wanted to make an appointment although he didn't feel it was necessary. Does anyone have any opinions on this or what I should do next? I just seems odd to me that he was diagnosed back in November and never had any hair loss and now that we finally seem to have it managed he is losing hair now. Any help or insight would be greatly appreciated! I will try and upload a photo of Rambos hair. Sorry to write such a book. Thank you!!

[labblab]

Hello again! I'm sorry that I don't have enough time right now to address your questions about Rambo's situation. But maybe I can at least help you with posting photos. It looks as though you were trying to add them to the body of your reply. If so, they're not visible -- at least, not to me. So here's a different route to go. Here's a link to the section of our forum FAQs that will coach you re: setting up a personal photo album, and uploading your photos there. Hopefully, this will help! And I'll try to return tomorrow to talk more with you about Rambo's progress.

http://www.k9cushings.com/forum/faq.php?faq=vb3_user_profile#faq_vb3_albums

Marianne

[Budsters Mom]

I can't see the photos either.

[Harley PoMMom]

Has the diarrhea stopped? And if so, are his stools of a normal consistency? With some dogs, once the cortisol has stabilized their coat may change, they may even lose a bunch of fur, but if those spots look reddened or still bother him a trip to the dermatologist may be a good idea. I see in your 3/24 post that an ACTH stim test is going to be done in 3 weeks which will be this week, is a full ACTH stim test going to be performed?

[Pbalca426]

Thank you, I think I got the pictures right now! Yes he hasn't had any more diarrhea, his stools have been normal. His skin doesn't look bad, no redness or inflammation or sores, but he was really itchy last night so if he continues to itch I will have him checked out just to make sure nothing else is going on. As far as the ACTH test goes, we kind of just started playing everything by ear since stopping the lysodren for those days last week. They told me to call them mid week with an update on how Rambo's doing and they will tell me where to go from there.

[labblab]

Success re: uploading the photos — good job!! Since the photos are now in your album, I went ahead and deleted the two “empty” replies where you were trying to insert the pictures ;-). Seeing the photos, though, I’m unsure as to what is going on with Rambo’s skin and coat. Usually the cyclical shedding and regrowth associated with Cushing’s treatment occurs all over the body as opposed to creating discrete bald spots. If you’ve got a dermatologist available to you, I believe I’d take him in to be seen. Perhaps he’s developed a skin infection of some sort? I just dunno...

Very glad the diarrhea has cleared up, and we’ll be anxious to continue getting updates.

Marianne

[Pbalca426]

Thank you! I'm going to be calling tomorrow to schedule him an appointment!

[molly muffin]

Did you get an appointment? It is strange how there are just these patches, because outside of those areas, the coat looks pretty good. Thick and shiny. Interested to hear what the vet says

[Pbalca426]

I did schedule an appointmet but unfortunately the dermatologist didn't have have any available appointments until may 14th. I think I am going to look into getting him in somewhere sooner because he's really started itching like crazy and I feel so bad for him. His spots where he is missing hair have a bunch on tiny brownish-blackish spots and his skin is peeling. My regular vet must have gotten upset when I started seeing specialist because they called and left a message saying not to come back so I'm currently looking for a new regular vet and can hopefully get Rambo in somewhere soon! I've been bathing him in really good medicated soap but it doesn't seem to be helping.

[Pbalca426]

Just returned from vet and turns out Rambo has Demodectic Mange. Poor guy I feel so bad for him. Got a prescription for Simparica and antibiotics. Hoping for a speedy recovery for my itchy boy!

[Harley PoMMom]

I just can't believe how your vet reacted, how awful and unprofessional of them :mad::mad: Glad you took Rambo to the vet and was able to get his skin/fur issue diagnosed, and hopefully those medications will heal the mange soon. Was this a dermatologist that diagnosed the mange and was it diagnosed with a skin scraping or biopsy?

[happy2help]

Just returned from vet and turns out Rambo has Demodectic Mange. Poor guy I feel so bad for him. Got a prescription for Simparica and antibiotics. Hoping for a speedy recovery for my itchy boy!

Harley PoMMom shared your Rambo's pictures with me so comparison to my Tyrant's current skin conditions. I dis some searching on Demodectric Mange and found this site. Don't know if it will be helpful or not but wanted to share. Tyrant dose not yet have a confirmed diagnosis on his skin lesions so I have not tried this product. https://www.happydognaturals.com/demodectic-mange Just wanted to share. I agree...rude of your vet to be offended that you would want to see a specialist.
Good luck in your quest or healing.
Cheryl

[Pbalca426]

No, it was not a dermatologist. I asked around and got recommendations for a good family vet near me and they were able to get us in the next day so we went there. I do have an appointment with dermatologist on May 14th (it was the soonest they could get us in) which I am going to hold off cancelling for a bit and if I see no improvement I will take him there as well. They did two skin scrapings on him and let us go back and look at the mite in the microscope! Gross! I felt so bad for him! Thank you Cheryl for the site, I am definitely looking into ordering some of those products, especially the shampoo! I wish you the best of luck on your boy as well! It is definitely a journey but helps talking to people who understand!

[molly muffin]

Well glad there is a diagnosis and a plan to treat it. Hopefully you'll see an improvement soon, although I understand it can take awhile to clear up

[Pbalca426]

Hi just heard from vet and wanted to share a quick update. Rambo went in for bloodwork and an ACTH test yesterday. Vet said his blood work came back good, ALP (I think is what he said) was still elevated some, which isn't uncommon with cushings, but that it was down some from last time. His post ACTH was 3.6. Yay! He said after his induction (which was probably 5 or 6 weeks ago) he was at 3.9 , so just to watch him for vomiting, diarrhea, or loss of appetite to make sure it's not going down anymore. Going to recheck in 6 weeks. His skin definitely isn't getting any worse, which is good. I actually think some new hair might be starting to grow! Thankful for some good news today! Hope everyone is doing well! :D

[Squirt's Mom]

WOOHOO!! Great news at last! And talk about perfect post #s!! I know you were thrilled to see those numbers! YAY!! Hopefully it will be smooth sailing from now on.

Hugs,
Leslie

[molly muffin]

Awesome news and a very good post result. :) Congratulations.

[Pbalca426]

Hi all, hope everyone is doing well! Just wanted to check in and get some advice. Since getting over the demodex, Rambo's hair has grown back fully and is now extremely thick and wavy :D we just had a blood and stim re-test yesterday and heard back from vet today. His previous post from June was a 3.9 I believe. Yesterdays post was a 5.2 or 5.4 with his phosphorous levels slightly elevated from last time. Rambo is still doing great, maybe noticing a slight increase in appetite and water intake but nothing crazy. Vet gave two options.. option 1 is to increase weekly dose from 1/2 lyso tablet 4 days a week to 5 days a week and rechecking in 6 weeks. Option 2 is to keep doing what we are doing since it's only slightly over the 5 post and no significant changes in Rambo and to recheck in 2 months. He said hes not sure there is a right or wrong option at this point but that he would be slightly concerned that the post could continue to rise and we would need to go through another induction phase. Any opinions and thoughts would be greatly appreciated!!

[Harley PoMMom]

I'd go with the increase in the Lysodren dosage, but I'm not sure by how much. To clarify the dosage for me, he is getting 1000mg total being split into 250mg 4 times a week? And the vet wants to increase by adding in another 250mg, right?

[Pbalca426]

Yes, that's correct.

[Squirt's Mom]

Do we know if Rambo has the pituitary or adrenal form of Cushing's? I looked back thru his thread and didn't see where he's had an abdominal ultrasound. So my concern is 1) he has the adrenal form and if so we would expect his cortisol to be more difficult to control or 2) there is something else going on, like a tumor on one of his organs causing a stress response of elevated cortisol in spite of the Lysodren. 1250mg/week is a massive dose for a dog Rambo's size - about 3x what we would expect him to need. Personally, if I could afford it, I would want the ultrasound done asap then decide whether to go with a dose increase or a re-load.

Let us know what you decide and how this sweet boy is doing!
Hugs,
Leslie

[Harley PoMMom]

1/2 tablet twice a day


I am happy to say I can finally update with some good news! After almost a couple weeks and 3 very expensive ACTH tests, Rambo's post is finally below 5 and we are ready to start maintenance!! We will be doing 1/2 lysodren tablet on Monday's, Tuesday's, Thursday's, and Friday's. Rambo's drinking and urinating have almost returned to normal, it's so nice not to have to take him out several times in the middle of the night! Lol! Will do another ACTH rest in 3 weeks. Thank you for everyone's help and support so far it feels great to finally be able to share some good news!! Hope everyone has a great weekend! :D

I'm including these posts so I can get a handle on Rambo's loading dose, so please bear with me :eek: If I have this right, Rambo loaded on 500mg daily (250 mg given twice a day) and this was given for a couple weeks? Now, can you tell me exactly how long he was on this loading dose?

Generally with Lysodren the loading dose is 50mg/kg so for Rambo's weight, at that time, of 27 lbs his loading dose should have been 633 mg being split and given twice a day. However since Lysodren comes in 500mg tablets it was easier just to divide those pills in half and give that, right? Which would explain why it took longer for him to load.

Lysodren does involve tweaking to maintain the load and sometimes the dog may even need to be reloaded.

[Pbalca426]

Rambo has not been diagnosed with the adrenal or pituitary. At the time of his first appointment with the IMS which was back in January I believe we had talked about doing an ultrasound. The vet said for several reasons (which I cant remember off the top of my head right now) that he was fairly certain we could rule out adrenal so we didnt proceed with the ultrasound. As you said though, I'm thinking it may be wise to see about getting one now. What would the different treatment for adrenal vs pituitary be? I am also concerned about the high maintenance dose causing more damage to Rambo.

Rambo's last load was in March and it lasted very close to 2 weeks, I cant remember the exact number of days. He had several ACTH retest since then and was always in the 3. range and has been doing great, and still is, so it's a huge bummer to get this latest news! His most recent test which was done on Monday 9/10 at 3:00, his last pill before the test was on Friday at around 2:00. Could this have been too long of a time to make his post number rise?

[Squirt's Mom]

Treatment for both adrenal and pituitary are the same BUT the adrenal form will be more difficult to control because the tumor makes the gland just keep dumping cortisol requiring higher and higher doses to control. The big thing is that IF the dog is a candidate the Cushing's can be "cured" with the adrenal form via an adrenalectomy. It is a risky surgery for many cush pups but also offers the only possibility of a cure.

[Pbalca426]

Thank you so much! I'm going to talk with vet about doing the ultrasound!

[Harley PoMMom]

His most recent test which was done on Monday 9/10 at 3:00, his last pill before the test was on Friday at around 2:00. Could this have been too long of a time to make his post number rise?

Were all his monitoring ACTH stimulation tests done this way (2 days after last Lysodren dose)?

[Pbalca426]

The last couple tests have been done 2 days after lysodren, but usually in the morning. I doubt the 6 hours would make the difference, just trying to rule out any possible causes for the rise in post number lol