Addy got the results, rushing out the door.
Will post later, good and concerns. will let you know.
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Addy got the results, rushing out the door.
Will post later, good and concerns. will let you know.
We are seeing the IMS today for a recheck and to discuss treatment options and Lysodren. Ims orignially told me she would start Zoe on a conservative dose.
My question: I have read on a link here that 50mg per kg is loading dose. I have also read the UC Davis says if dog is not polydipsia loading dose is 25mg per kg. Another paper with a vet from UC Davis just said outright 25mgs per kg, not 50. I think that paper was in our links as well, can't remember which one, I read so many.
If dog's symptoms are mild without polydipsia or excessive hunger and panting, would the 25mg per kg be the more appropriate loading dose?
I have also read members had loading that when on forever with too conservative of a dose.
Just trying to get my thoughts in order before consultation.
Thanks for your help,
Addy
Addy,
Both of my little guys loaded at 50mg/kg but they were being treated by an IMS that has been treating dogs with Lysodren for years. I have listened to audios and read every paper I could get my hands on by Dr. Edward Feldman. He's a world reknown endocrinologist from UC Davis that I have affectionately nicknamed Mr. Cushing's. He and a few others I've followed state that vets that are leary of Lysodren will load at the lower dose while experienced vets use a higher or maximum dose. Inexperienced vets will also prescribe prednisone concurrently with the Lysodren, which is a really bad idea because the pred masks signs of loading. We've seen dogs here that have gotten into trouble because their vet used this protocol. I asked our IMS that protocol and he agreed that a lot of vets that use that protocol are uncomfortable with Lysodren.
With no polyuria, polydipsia or a voracious appetite, a lot of vets would not treat with Lysodren with so few symptoms. I personally would be very hesitant to treat my dogs with Lysodren with so few symptoms. I had a foster that was diagnosed with Cushing's. Her diagnostic tests, bloodwork and ultrasound were textbook cushing's but her only symptom was severe skin and coat issues. Her dermatologist prescribed Trilostane and she did quite well on it.
Thank you LuLu's Mom,
Zoe's other hormones are high too and she can't have Trilostane, according to the IMS because it could elevate those hormones even more. She has typical and atypical Cushings.
I am hesitant to treat now. Zoe has hair coat symptoms, licks everything and chews, does not want to jump in car anymore, she likes to eat but she doe not beg anymore than my other pup, just more voal about it. But her adrenal panel numbers were sky high. Dr. Oliver said "Significant". Her blood work is not horrible, either,
I really think her numbers were sky high because she had some active infection going on, she had colitis flare up durring all the testing and was severly stressed at the IMS. While I believe she does indeed have Cushings my dilemna is wait to treat ot treat.
After what Kim went through with Annie, I am even more concerned about Zoe and did think perhaps I should continue with the melatonin and lignans and wait for a month of good firm poops, if I can get that and then retest her.
If it was your dog?
Addy
http://www.dvmnews.com/dvm/Small+ani.../detail/460965
this article referred back to an interview with Dr. Feldman and then went on to state 25mg/kg so not sure if that can be traced back to Dr. Feldman or not. Article is from 2008.
it is in our reference links
still looking for the polydipsia article.
Addy
Dear Addy,
Sounds like you are stressed out , like me. When I started Apollo on the trilostane , I did not listen to the vet, I read on the companies web , site and called their vet specialist, because I felt 30mg was too high, I confirmed to start at 10mg, which was the right choice for Apollo. The vet said it would take longer if I started low, and I said then so be it. If they are started too high , a lot of other symptoms can make things worse. So it was me I would start at the lower dose. Most vets just go by the rules and instead of each individual circumstances. What is good for the majority is not always good for the individual. I would talk to your vet about how you are feeling. If it is a good vet , they should discuss with you.
Hopes this help. Better safe then sorry.
Hi Addy,
I have the audio of that lecture given by Dr. Feldman in Seattle and it was this lecture that he mentioned the 25mg/kg vs 50mg/kg. Every hypothetical case he used, the dog was getting 50mg/kg. I'm not quite sure why Dr. Hoskins only picked up on the 25mg/kg in the article. :confused: If you check out the Lysodren Loading Instructions in our Helpful Resources section, you will see that these instructions do indicate the loading dose to be 50mg/kg. You will also see that these instructions are from the Textbook of Veterinary Internal Medicine, which Dr. Feldman co-edited with Dr. Stephen Ettinger. These two gentlemen have written the Textbook of Internal Medicine for years and years. I actually purchased a later edition and boy are they heavy books.
I think your concerns about not having a gauge to determine if Zoe is loaded are justified. I think I mentioned before that I would be hesitant. My Lulu, was on Trilostane for two years before I switched her back to Lysodren. She has typical cushing's with elevations of all intermediate hormones. We went through more than a 30 day washout because we waited until she was symptomatic again. Despite the fact that her intermediates were sky high, she did not become symptomatic until her post cortisol was 25 ug/dl. Lulu weighs less than 5 lbs so there was no way I was going to start loading her until I had something to go on. I made sure her appetite was raging and she was drinking and peeing buckets again.
Dr. Feldman says that the appetite is very important in loading and in order to insurer that the dog has a huge appetite while loading, he recommends that pet owners decrease the dog's food by 1/3 two days before loading. If Zoe's few symptoms become problematic for you and her and you want to start loading, this is something you might want to consider.
Glynda
P.S. I meant to tell you that 25mg/kg is protocol and if you feel more comfortable loading at a low dose, then go for it but be prepared for the possibility that loading will be long and drawn out.
The article says:Quote:
Originally Posted by addy
and BID means twice a day, so the dose referred to in the article may very well mean 25 mg/kg given twice a day, which would = a total of 50 mg/kg/day, just as it says in the Textbook of Veterinary Internal Medicine.Quote:
25 mg/kg, given BID
The loading dose mentioned in the Merck Veterinary Manual does say 25 mg/kg/day, so that is indeed an acceptable protocol for loading, but I think that the Textbook of Veterinary Internal Medicine loading dose (50 mg/kg/day) is the more accepted and more commonly used loading dose protocol, especially when the Vet is an Internal Med Specialist.
Back from the IMS, I think I am stressed from the long visit. She was very patient, answered all my questions. Her first observation was that Zoe looked "harrier" than last visit. Her hair did grow out longer faster but is still thin. She checked the hair on her tummy and said she sees some new growth there and explained the hair cycles to me.
I told her about the constipation, she thought that was odd. Told her we have not used metonidazole since 7/12 and she started lignans and her poops so far have been good.
Discussed my concerns about starting lysodren without symptoms and she said we will wait 3 months, see if she can have a normal 3 months, no more diahrrea, etc and then retest. I almost fell off my chair because that was what I really wanted to do in my heart. If new symptoms develop then we have to go back to looking at lysodren.
She has different protocols for lysodren depending on symptoms. She seems to treat the symptoms, not the numbers. Don't know if that is good or bad but I feel that way about it too right now.
I asked about how can her adrenal panel numbers be so high and her symptoms so mild and her blood work not as bad as other dogs? She said their hormones can fluctuate just like ours so some vets currently don't like the adrenal panel for that reason, you get false picture with some dogs. Zoe does not follow the norm with this. Also if she was stressed and had infection going on, we get elevated numbers. So said lets retest in 3 months and only do the one test first thing in the am so Zoe does not get so stressed.
She said wait for her to be "normal" for about 4 weeks and then give rabies shot. She said with a dog that has a tendency to be snappish, she recommends the shot. Just wants me to wait a bit longer to make sure she stays healthy.
She is so patient and answers all my questions, I really like the IMS alot. I think I could have a good relationship with her. Also she seems up to date on things, so like that even more.
Hope she knows what she is talking about but right now I trust her. Looks like we enter that "gray zone" for awhile now. I know some of you have been there too.
Zoe was unbelievable, no muzzle, greeted IMS, you would not have known it was the same dog, she was so calm and quiet. I though someone switched dogs on me. She was like she used to be so sweet.
Oh, she detected a slight heart murmur she could not hear before. She said very slight, don't worry about it right now.
That was it. Opinions?
Thanks all,
Addy
Hi Addy,
IMHO, your IMS is spot on! :) Giving Zoe a chance to get healthy again and get over her recent problems, and then see if the signs stay and strengthen is the way to go. The signs are so important not only in diagnosing but in monitoring treatment. Your IMS is also right about other problems causing things to look like Cushing's when it isn't.
Treating symptoms (signs) and not the numbers is what we say here. As long as a pup is doing well, the numbers aren't that important. Some pups do better with their cortisol a bit higher, or a bit lower, than the numbers say is right. So treating the dog not the numbers is a good plan.
I am curious about her "different protocols" for using Lyso, tho. This could be an issue down the road depending on what that means if it does turn out Zoe has Cushing's.
For now, YIPEE!!! You and Zoe have a reprieve and I hope it is permanent! But, that doesn't mean you get to just disappear...oh no! You have to keep in touch and let us know how ya'll are doing, ok?
Hugs,
Leslie and the girls - always