New to Cushings

Lori is exactly right about the desired therapeutic range for a dog taking Lysodren. The ranges that the lab printed out are the normal ranges for a dog who has neither Cushing’s nor Addison’s Disease when the ACTH is being used diagnostically before any treatment has begun.

I also agree with Lori that, under the circumstances, this is probably an acceptable reading for Annie. However, I might be inclined to repeat the ACTH in another month, once things have really calmed down for a while. Her post-ACTH reading is not too far above 5.0, but it does represent a significant increase from the March reading of 1-2. You don’t want it to consistently continue to increase further over time, or else you will be risking losing the load. So I would want to retest again, sooner rather than later, so as to increase her maintenance dose if the cortisol rise continues. And especially so if her symptoms start to rebound.

Now I’m really confused because the graph on her report had her marked in the low range at 0.6 with norms of 1.0-5.0, and then “sample 2” had a reading of 6.4 with norms of 8.0-17.0. Are these numbers backwards on the report?

I do understand that the important crucial control number should fall within that 1.0-5.0 range but doesn’t that 0.6 fall under that? Maybe I’m just totally loosing it. Blessings to you all and thanks for your help. Karen

Nope, the reference ranges printed on the lab report are not backwards -- it's just that they are the reference ranges for the ACTH when it is being used diagnostically. They are basically irrelevant when it comes to monitoring the appropriate dose of Lysodren for a dog under treatment.

As you can see, there are two numbers associated with the test. The first is for the "resting" or baseline cortisol level. The second reading is taken an hour after a stimulating agent (ACTH) has been injected. This post-ACTH reading is usually the more important of the two when evaluating the appropriateness of the current dose of Lysodren (or trilostane, too, for that matter). In looking back through your thread, I had assumed that the number you had given us back in March was for Annie's first monitoring post-ACTH test result at the completion of her load (as opposed to the baseline cortisol level drawn on that same day). That's because the post-ACTH result is the one that is commonly evaluated in terms of treatment effectiveness. This is what you told us back then:

Quote:

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Her stim test #was down to 2 from 17:5 last week. I am concerned that it might be too low and push her into Addisons.

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So I was assuming that you meant that her original diagnostic post-ACTH result was 17.5 (which you'll see was slightly above the normal post-ACTH range on a diagnostic test and thus mildly "positive" for Cushing's), and that her post-ACTH at the end of her loading phase had dropped down to 2 (which is good for a monitoring result after starting Lysodren). Since you only gave us one number, I was assuming it was the post-ACTH result. But there should also have been a baseline reading taken at both times, as well. For comparison purposes with this week's test, it will be especially interesting if you can dig out the March report. That way, we can see what her baseline level was at that time, too.

So fast forwarding back to the present time. For a dog taking Lysodren, the desired ranges for both the resting cortisol and the post-ACTH reading are 1-5 ug/dL. It's true that, at 0.6, Annie's resting cortisol level is lower than the desired range for that value. If she was showing signs of being Addisonian, that resting cortisol level would be a concern. But if her electrolytes and behavior are all normal, then I'd guess that you'd mainly be focusing your attention on that post-ACTH level of 6.4. That reading is a little higher than the optimal therapeutic range for Lysodren, and reflects an increase from March. Combined with the lower baseline reading and all the medical stresses she's been under, if it were me, I wouldn't be increasing her maintenance Lysodren dose at this time. But all of this combined information is the reason why I'd retest her in another month of so, in order to see what her cortisol level is doing under more normal circumstances.

Hope this makes some sense rather than making everything more confusing!

Thanks Marianne for the clarification. I understand finally! I’m one of those people who has to read something at least three times before it sinks in.

When she was first diagnosed, Jerry and I were in Maui, in fact we were there the week it snowed over six inches on Mt. Haleakala, so I was having to absorb all the preliminary information over the phone which was horrible for me because I am not an “auditory learner”. Then when we got home she had to stay in the hospital for another two weeks and I was still trying to absorb all the information from doc over the phone or in person. It’s all such a blur at this point.

I will never increase her dose of Lysodren unless I absolutely have to. That stuff still makes me shiver with fear. Your suggestion to retest in another month was my thought too. Doc perceives me as being “over zealous” in my approach to this medical situation with Annie but I don’t care. I have been this way with all my pups over all these years and I’m too old to change now. Anyway, thanks for the validation. Blessings, Karen

Hi everyone,

An update on Annie and I’m once again in all out panic-paranoia mode. Last week Annie had her first groom since way before her surgery. We were busy all that day and I really didn’t put serious “hands on” until the next day, but when I did I just freaked out. I discovered she has two small hard lumps on the right side of her head between the middle of her right eyebrow and her right ear. The largest is the size of a frozen pea and the other is about 1/3 the size. They are definitely under the skin and flesh colored. I do know they were not there the last week in March. I’m also surprised her groomer didn’t say anything.

She was already scheduled for a bg curve tomorrow so I will ask doc to check them out and either aspirate the large one or do a biopsy or whatever he needs to do. I know they are not lipomas. They also don’t move, so yes, I’m scared.

I won’t be able to pick her up until five or six so we’ll see what doc says.

Today was also her Lysodren day and late in the afternoon I was in the kitchen with her. All I was doing was emptying some trash. I happened to look down at her just for a quick chat and I noticed her back right leg quivering. I bent over and gently touched her leg and it stopped after a few seconds. Do I need to be concerned about this too?

I was almost ready to start thinking that maybe we could catch our breath for a bit. I’ll post what I find out tomorrow. Blessings to you all. Karen

Aww Karen, it does seem like it’s always something coming up, doesn’t it :-((((((

By now, I’m guessing Annie is with the vet. I know the day will crawl by for you until she’s home again and you have some answers. Waiting right here alongside you, and surely hoping that there’s nothing serious going on. I know you’ll let us know as soon as you can.

Hugs, hugs, hugs!

Here’s the update on Annie…first of all nobody died, except the garage door and that will be part II of our today.

First and foremost, those hard lumps on her head turned out to be a pimple and a separate sebaceous cyst which doc took care of and was actually glad that I had him look at them. Her little immune system can’t tolerate any kind of infection right now. For once, I didn’t feel like he dreaded me being there. Maybe, my little baby has taught him something. She was actually there for a BG curve which I will post later on the K9D site, but for anyone here with a dual diagnosis pup, he upped her insulin from 8 units to 9 keeping her food intake the same.

I told him about the trembling in her leg and he really didn’t have an answer for me and I really hate it when I get that answer. I asked him if she should be on ursodiol since her last ALP was 874, but he said we’ll check it again in another month. He reminded me that even though she’s leaping tall buildings in a single bound, she still has a way to go in her recovery and her body is still readjusting itself to having no gallbladder. I really think at some point, he will publish something about Annie in one of the vet journals. He’s big into strange things that happen, and even though we as her parents made it happen…he’s never seen a case like hers. Plus, he likes research. Ok, enough of part I.

Part II……

I got the call about 5:30pm cst that I could pick up Annie, so I grabbed my purse, phone and car keys and headed for the garage. I had been to the grocery store earlier and everything worked fine. I pushed the garage door button…and nothing happened. I pushed it again…nothing happens…now I push the other garage door button and it opens. But that won’t do me any good because that’s where the boat is, not my car.

Now, I’m in a huge PANIC because Jerry drove to Kansas City for business this morning and won’t be back until very late tomorrow night. I called him immediately and he had no idea what was wrong. We have 11ft ceilings in the garage and there is no way I can reach that emergency pull cord to release the garage door and raise it—even with a ladder. All the neighbors are older than I and the only neighbor who could have helped was gone. I finally called 911 and they patched me through to our local police. I explained my situation to them and the dispatcher was very nice and within five minutes, one of our local town protectors was there to rescue me so I could go rescue Annie before they closed. In the meantime, Jerry had alerted the vet office of my situation and they assured him that someone would be there until I could get there. When my hero arrived, he assessed the situation, jumped up and grabbed that cord and pulled that big heavy garage door up. I opened up the side door so I could get back in the garage, closed the second garage door, jumped in my car, buckled up…..my hero dropped my dead garage door. I gave him a big “thumbs up” and away I went. At this point, I’m over an hour behind and I called the clinic to let them know I was on my way. They told me not to worry that doc was still there and would wait until I got there.

I arrived at five minutes before their closing time of 7:00pm and doc had an emergency come in so he was tied up for awhile before I could even talk to him. In the meantime, they brought in my bouncing baby girl, barking, tail wagging and wanting out. I noticed her head right away and was grateful those lumps were gone. Finally, doc came in, we talked, I payed and we were out of there and home in the driveway by 7:40. I fed her right away, she was really hungry then made myself a peanut butter, jelly and bacon sandwich. Don’t judge—it’s a really good sandwich in a pinch.

We are now settled in. Annie is sleeping in her dad’s chair, she’s such a daddy’s girl. I’m keeping tabs on a baseball game for Jerry so I can tell him the score. We’re having bad storms in our area tonight and there was a game delay. My car is sitting out in the elements for the first time in it’s life with me. I don’t care, my little brave baby is home and we are safe. I look at her sleeping and I’m just amazed at her tenacity and zest for life.
First thing in the morning, I’m calling the Overhead Door Co. for an emergency repair. Blessings to you and all your pups. Karen

Soooooo glad to get the update on Annie this morning, and surely hoping your car survived the storm! Hopefully a more peaceful weekend will be in store, all the way around!

FYI......
Since your garage door disengage handle is too high to reach, that's easily remedied. Have someone tie a rope to it, so it hangs down to where you can reach it easily in an emergency. Pulling the handle will disengage the lock and allow you to manually slide the door open by pushing it. I have had to do this several times due to power outages and a malfunctioning garage door. It won't fix the problem, but will allow you to get your car out when needed.

Hi Kathy, I have been after my husband for years to do this very thing...add an extension. Now I think it may finally happen. Blessings, Karen