Jasper (12 yr old Mini Schnauzer) is now at peace

Hello,

I am a new member. My 8 yr old Min Schnauzer, Jasper, was diagnosed with Cushings on 6/22/12. He has the pituitary dependent type.

Let me say that I feel I have a very good vet who has experience treating dogs with Cushings, and reports having good success. We started Lysodren on 7/5. Jasper seemed to be tolerating it well, (none of the warning signs were apparent). We decided to do the ACTH stim test after he completed 5 days of treatment. He had the test on 7/11 and I got the results late in the day on Friday 7/13. The test
showed that he was too suppressed, cortisol levels were at the very low end of normal & one value was one point below normal. The Lysodren is on hold now to allow the adrenal tissue to regrow before we consider maintenance. This is what I understand at this time. I will be talking to my vet after the weekend. Jasper seems to be feeling ok currently. This has been quite stressful, especially since it is the weekend.

I found this forum right around the time we started the Lysodren, and have done a lot of reading, both from the resources and posts. Everything I have read has been so helpful.

I will be asking my vet, but I am wondering if anyone else has experienced their dog's cortisol levels going way too low with the Lysodren even though no warning signs were apparent?

I watched Jasper like a hawk once the med was started for any little change. The only thing I think he showed was some decrease in drinking, but it wasn't real dramatic. I am quite worried about the low cortisol level, even though he seems to be feeling ok now. Everything I have read about this happening scares me.

I would be most appreciative of any feedback anyone can provide. I am really trying hard to not panic over all of this, but am feeling very overwhelmed with everything.

Tina

Hi Tina!

Before I forget - please be sure to check and reply to the email sent to you so that future posts automatically show up.

Glad you found us - if you have read here you know we'll ask questions so we get up to speed.

First thing that comes to my mind is that perhaps the dosage is on the high side - to be loaded in 5 days.

Please tell us your dog's weight and the dose of lysodren you gave daily during the loading period.

Also please type out the two numbers from the acth test. If you don't have them , call and get them. You will need to start a file and keep them for future reference - comes in very handy. Note that a normal dog will have cortisol (2nd number on the test ) of 17 or higher. Cush dogs are ''loaded'' with lysodren with the goal of having the 2nd number be between a 1 and a 5.

IMPORTANT: Sometimes the lab messes up and is thinking they are testing a non cush dog. So an 8 would be too low for a normal dog but too high for a cush dog if you are following me. That is an example of why you must get the test results. :D

Was an acth test done before starting lysodren? If so, those numbers are helpful also.

OK... now I have to ask, are you giving your dog prednisone? It is often given when cortisol goes too low because it helps them feel better. Is your dog lethargic? Any diarrhea or vomiting? (signs of low cortisol)

You said the only change was a slight change in water consumption. FYI dogs all react differently so you must look for slight changes and assume. I am very glad you did the test at 5 days (which is actually faster than normal).

Tell us your dog's story , the symptoms, the whole saga. I know it is overwhelming at first but that is why we are here. :p You are no longer alone on this journey. Sorry I just realized you did tell us your baby's name is Jasper.

The key to using lysodren is a vet with experience, and an owner that gets involved and up to speed because you are your dog's voice. Lysodren is a wonderful med (I used it) that can make your dog well again - you just have to use it in the right dosage.

I see you are no longer giving lysodren. Hard to say how long you will need to wait. Better safe than sorry though.

Take care and again, welcome. Kim

Hi Kim,

Thanks so much for the quick reply and warm welcome.

I will try to answer your questions, but will tell Jasper's story on a later post. As you know, it is a little involved.

I did reply earlier to the email that was sent, just FYI.

Jasper weighs 25 lbs. The dose of the Lysodren was 250 mg twice a day.

The two numbers on the ACTH test were 15 and 14. My vet's message said that ideal is 50 to 100, and normal is 15 to 100. I understand what you are saying about the lab results. I am wondering if this lab has different reference ranges?

He did not have an ACTH test before starting the Lysodren. He had tests to rule out diabetes, thyroid problems, liver disease and kidney disease. The Cushings diagnosis was made based on a LDDS test. I'm sorry but I don't have those numbers. I know there was a 4 hr result and an 8 hr result and my vet said it was definitive that he has Cushings.

I have a prescription of prednisone on hand in case he starts not feeling well. So far he is not showing any of the signs of low cortisol. He is eating fine, no vomiting or diarrhea, and energy seems pretty normal. It has been brutally hot here (I am in Nebraska also!), so he has been a little subdued, but this is not a change.

My vet and I decided to do the ACTH test after only 5 days on the med based on the slight change in the drinking. Better safe than sorry is right, and that is always my thought. My vet said it would be at least a week before we consider restarting the Lysodren, and said it may be 10-14 days. I need to ask how that will be determined. I haven't had a chance to talk to her since it has been the weekend. She is experienced with giving Lysodren and said she has had much success.

I will tell more about Jasper in a subsequent post, kind of weary right now! Yes, it is very overwhelming, as you know.

Thank you for your questions and support!

Tina

Hi Tina and welcome to you and Jasper

I believe the unit of measurement your lab uses is nmol and if so, then yes, Jasper's pre and post stimulated cortisol is very low. One of my cushdogs loaded for 7 days and his post cortisol was almost as low as Jasper's and he never showed any sign of loading. He was perfectly fine but I gave him one dose of prednisone anyway just so I could sleep.

Most of us are more familiar with ug/dl unit of measurement so for those who may not know how to read nmol, Jasper's converted pre and post were .5 ug/dl, which is pretty scarey. The conversion for the therapeutic range your vet mentioned would be 1.8 ug/dl to 3.6 ug/dl which is definitely good. I think your vet knows what she's doing.

The weekly maintenance dose is usually equal to the daily loading dose but in Jasper's case, it may be too much for him. Jasper loaded at just under the max recommended dose of 50mg/kg so I think with him loading rather quickly and given the really low cortisol, your vet may drop the maintenance dose down to 25mg/kg, being 250mg per week. Every dog is different and my dog certainly was. His cortisol after loading was .7 so we waited two week to start maintenance. We did another stim two or three weeks later and his post stimulated cortisol was too high. That was five years ago and memory is foggy but as I recall, it was 8 ug/dl. We upped the maintenance dose a bit and that did the trick. Finding the right maintenance dose is a roll of the dice sometimes.

It sounds like you and your vet did a great job, despite the low numbers. A lot of us members have dogs who didn't read the book and sometimes they leave us scratching our heads and thanking God for dodging the bullet.

I'm glad you and Jasper found your way to us. We're here to help in any way we can. By the way, I have a little Maltese named Jasper. He's not cushingoid.

Glynda

Tina, Wow another Nebraskan! Just because I want to be 100% sure... please confirm the units of measure on the acth.

You have never mentioned any sort of an emergency or extreme lethargy and if Jasper's cortisol was as low as .5 we would expect him to be struggling to stand up, on prednisone, and maybe even on IVs. You have never mentioned any of this. I just want to make sure there isn't a lab mess up. I know the number of labs used in this state is very limited and the large majority use Idexx.

You are doing a great job - do you happen to have the ldds test results? Thanks! Kim

Welcome to you & Jasper! Kim & Glynda have given you great advice, so I will try not to repeat. I have used lysodren with 2 pups quite successfully. My first boy had been loading for 8 days, showed no change in appetite or water consumption which I had been measuring on a daily basis. I took him in for an ACTH to see where we were. I get a phone call from the vet the next afternoon asking me if I had checked water yet. I said no, & was told to check water that she would wait. Low & behold, his water consumption had dropped something like 70% overnight. She said that the stim reflected that as his numbers were so low, she told me to give him 5 mg prednisone daily for the next 3 days, then bring him back in for another stim 48 hours after the last dose of pred, so we could determine, if & when maintenance could start. Unfortunately, I don't remember the exact results of the either stim & when we were able to start maintenance as this was something like 13 or 14 years ago. My point is that you absolutely can't determine if Jasper can go to maintenance without doing another ACTH. Some dogs will regenerate their adrenals almost in the blink of an eye, other pups may take months to regenerate, some may not regenerate at all. You just can't tell without the test. Please do not let your vet start maintenance dosing without confirming that Jasper is ready.

Again welcome to both of you!

Debbie

Glynda, Kim, and Debbie - thank you all so much for the information and reassurance. I got teary reading your responses, it is so comforting to know that you all truly understand how I am feeling because you have been there.

I talked to my vet today and have some more information based on your questions.

Kim - The units of measurement on Jasper's ACTH test is nmol, just as Glynda mentioned. My vet said that the blood is overnighted to a lab in Michigan. The results and ranges are as I posted previously.

LDDS results:

Baseline cortisol 390
4 hour 28
8 hour 54

I forgot to ask the units of measurement for this test.

And Kim, you are correct, Jasper has not exhibited any of the critical warning signs of low cortisol and we have not had an emergency. I am very thankful for that. Today my vet reassured me that the cortisol level will not continue to drop while the Lysodren is on hold.

Today she said we will recheck the levels with another ACTH test before we restart the Lysodren for maintenance. I will drop him off for that on 7/25, so that will be 2 weeks since the last test, and since stopping the Lysodren.

My vet said she has consulted with an endocrinologist just to confirm that we are doing everything properly. It sounds like he concurred with my vet's treatment plan. I really appreciate that she talked to the specialist.

That is what I have up to date.

Just a little bit about Jasper - the only sign of Cushings that he has really displayed is increased drinking and urination. I think I first noticed it around the beginning of May. It got really extreme toward the end of the month. He was drinking a ton, and I had a vet appt scheduled for him, but on the night of 5/24 he jumped down off the bed and just started peeing. He couldn't stop, it sounded like a faucet had been opened on the carpet. I grabbed a bath towel from the bathroom to hold under him and he completely soaked it. The look on his face made me cry, he was so embarrassed. He has never had an accident in the house, even when he is sick.

I took him in to the vet urgently the next day, and his urine showed some mild symptoms of a UTI, and of course low specific gravity. We treated him with antibiotics, but when the drinking did not decrease, my vet wanted to do some more tests. He has not had any further accidents in the house.

We did a liver panel, thyroid test, blood glucose, electrolytes, UA, and I'm not sure what else. He had a very elevated alk phos, and elevated LDH. All the other liver values and UA were ok. Diabetes and thyroid were ruled out, as was kidney disease. My vet was then concerned about liver disease so we did a bile acid test, which was normal. That's when she said she was suspecting Cushings, and we began the tests for that.

Jasper has not shown any of the other classic symptoms of Cushings. His appetite has not seemed to increase, no fur loss or pot belly, or leg weakness. I am wondering if maybe we caught it early so that is why he hasn't shown some of those things? He is 25 lbs but is not overweight. He is just big for a min schnauzer.

He is the sweetest and most loving dog, and is such a Mama's boy. I am hopeful that we can get him stabilized and feeling better soon.

Sorry this got so long. Please let me know if you have any more questions or feedback. I am so grateful that I found this forum. Thank you all.

Tina

Tina, Thank you! I just needed that confirmation... I had probably 20 acth tests done between my two dogs and the only time the units were not ug/dl was when we sent it off to the Michigan State lab (it was used because we were getting false positives from Idexx) :D Interesting your vet selected to go there.

Glad you are doing another one prior to resuming maintenance. I agree with whoever it was that said you should lower the maintenance dose! Guess that is an obvious to do but just being cautious.

Kim

I just want to check in real quick. As I posted previously, Jasper will be having the ACTH test re-checked next Wed 7/25 after becoming too suppressed from the Lysodren. Thankfully he has continued to feel ok and has not shown any of the critical signs of low cortisol.

I have been reading so many of the stories posted here and can't begin to express how comforting it is to know that I am not alone in this journey. There are so many kind and caring people here, and everyone's knowledge is amazing. I can't believe how much I have learned.

Thank you to those of you who have given your advice and feedback so far, I am truly grateful. I will be checking in, and will post again when I have Jasper's results and know more of what the plan will be.

This is all still very scary, but I feel so much stronger and so much more prepared to make the right treatment decisions for my precious little boy. All thanks to the help and support I have received here.

Take care,

Tina

Tina, You are so sweet! FYI I found these folks in a panic over 7 yrs ago because I got a diagnosis and very little information. I read and read till my brain was beyond its capacity and realized that my vet was beyond clueless. I live in a town of 25000 people and had just moved here from Omaha. I was used to having more experienced vets and it was the beginning of a journey that continued for many years. If it wasn't for the wonderful friends I met here I would have lost my sanity... We have been in your shoes, totally understand your fears, and you are so right - you are no longer alone. We will do our best to hold your hand.

Kim