Down the Cushings Road Again -- Abbie, 15 year old beagle is now at peace

It made me smile really big to hear that Abby is doing so well. Such a relief, isn't it? And no crunchy worms? Well, it sounds like our little girl is getting a more refined palate with her treatment. haha! She may just turn into a diva like Addy's Zoe and Sharlene's Molly. :)

I stick Dixie's pill into a piece of raw hotdog. Not the healthiest choice, but she looks forward to it and the pill always goes down and doesn't fall out. Cheese, hotdogs, peanut butter... whatever works. I figure if pill time can be treat time all the better for their attitude. :)

Folks: Abbie is doing good but I need some guidance for a possible Cushing's pup on my beagle forum. The owner is about to start Lysodren after positive uc:cr and positive LDDS. I was not able to get specific numbers. He reports some symptoms but normal labs. The latter raised a red flag for me and, a short while ago, he posted that his beagle has been on Rimadyl for a few months. He has opted not to have an ultrasound.

Question: can Rimadyl skew the uc:cr and LDDS tests?

I could do some searching here but thought you might be able to point me in the right direction, particularly if there is some literature from any of the veterinary experts that I can share. I have encouraged this owner to join here but he seems quite content with his vet and plans to go forward.

I don't know of Rimadyl causing increased cortisol production, but what was the Rimadyl given for? Things like arthritis that causes pain, can cause cortisol go up sometimes as a reaction to the pain.
Not every dog has high liver values, but I'd say that most do. There is an exception to everything though.

Perhaps give him the link to what to watch for with lysodren loading:

http://www.k9cushings.com/forum/showthread.php?t=181

Sometimes if they are going to do what they are going to do, the best we can do is make it as safe an experience as we can.

Glad to hear that Abbie is doing so well.
Happy Thanksgiving

hugs

Thanks, Sharlene! I have e-mailed our member the Feldman protocol and member notes. As you said, at least I know he is armed with info! He said that his beagle had shoulder pain that resulted in being put on Rimadyl. No mention of a specific diagnosis. I personally wouldn't recommend Rimadyl to any dog -- way too many bad reactions -- but I know many vets still use it. Mine does prescribe it but is very amenable to other options when Abbie has needed it.

Hi, all! Question: has anyone thought that lower cortisol can lower body temp? The reason I ask is that it was cold here this morning (as in cold for Florida ...) and Abbie was shivering outside. She has never done that before, even when we have had freezing temps (and it was not even close to that this morning). I put on a coat on her for the next walk and she was fine. Maintenance has been going fine -- she does have ups and downs in energy levels but nothing else noteworthy. One month ACTH is this Friday.

(FYI, beagle forum member's dog loaded in 7 days and first ACTH showed good levels. He said his doctor is following the Feldman protocol which I had e-mailed him.)

Quote:

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Originally Posted by judymaggie

Hi, all! Question: has anyone thought that lower cortisol can lower body temp?

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I would think so, when a dog has elevated cortisol usually one or more of their hormones can be high which can cause them to pant more often and it seems they have a warmer body, so when using Lysodren that cortisol is lowered and generally so are those hormones and it would make sense that this would lower body temp.

Hi, all! I am in need of guidance re Lysodren maintenance. I got Abbie's 30 day ACTH numbers today:

Pre # 5.6
Post # 12.7.

The numbers from her post-loading ACTH were pre--1.8 and post--1.9 so definitely a significant increase this time around. Because her first numbers were low with little stimulation, we opted to start maintenance at her loading dose of 500 mg. (she weighs 25 lbs.).
According to Feldman's protocol, the choice now is between increasing her weekly dose or repeat loading dose for 5-10 days. She is definitely drinking less water and her hunger is now back to typical "beagle hunger".

I got the numbers this evening from the head tech as my vet wasn't available. I am actually glad to have this short window to get input before I speak with him tomorrow. Thoughts on which route you think is better would be appreciated.

My inclination is to increase her dose since she had such a significant response to the loading the first time. How do you decide what the increase should be? I have 500 mg. pills which could be quartered -- not sure if pharmacies around here have any other dosage available. If we do go with an increase, would the next ACTH be in another 30 days (of course, before that if any negative changes)? If I am reading the Feldman protocol correctly and the repeat loading is following by an ACTH and a subsequent increase in dose, then I don't really see the purpose of the re-loading option.

Thanks!

The maintenance dose is typically the same as the loading dose, just spread out over a week's time. So if she loaded on 500mg a day, the maintenance would typically be 500mg a week. The dosing for maintenance is 25-50mg/kg/week. The adrenals can and do regenerate, in some pups pretty quickly if the maintenance dose isn't high enough or given often enough. You want the maintenance high enough to keep that level achieved with the load....or you have to start all over eventually.

With that post, I would look at the strength of her returning signs compared to prior to starting treatment. IF the signs are almost as strong now as they were then, redo the load. If they are just starting to come on, try an increased maintenance dose being aware that a reload is quite possible regardless.

Just because I am lazy :D - how much does Maggy weigh and what loading dose did she take?

Leslie--thanks for your reply. Abbie (my Maggie is prancing at the bridge ;)) weighs 25 lbs. and loaded in 7 days at 500mg which we continued as her maintenance dose. As I mentioned, her ACTH levels after loading were low (1.8 and 1.9).

I have not seen any return of pre-loading symptoms and was surprised her current numbers were high.

How do we decide how much of an increase?

P.S. One thing that I thought was odd--Abbie was a wild dog with tons of energy after her last ACTH. This time around she was pretty quiet the rest of the day. I took her with me to friends' home Friday evening and she was a perfect guest. I really thought that the extra cortisol would have had more effect.

Judy, do you think it's a possibility that those most recent ACTH numbers got switched somehow, meaning that the pre is 12.7 and the post is 5.6? Just grabbing at straws here :o

Hugs, Lori

Oh my gosh! I am so sorry for that gaff! :o:(

Lori--I don't think the head tech would have read them incorrectly but , of course, we all make mistakes. If the numbers were switched, what would a high pre dropping to a lower post mean?

(Leslie--don't beat yourself up--all my neighbors call Abbie "Maggie"!)

If you decide to reload Abby I don't think you want to load Abby a second load of 5-10 days. Maybe a mini load, like 2-4 days since she seems to be quite susceptible to lysodren and 12 isn't a really high mumber to bring down.

I like the idea of a mini-load. Would we have to do an ACTH after the mini-load? Or do another after a subsequent month of maintenance? I am assuming that I wouldn't be looking for any change in symptoms with the mini-load---that it would serve as kind of a jolt to the cortisol levels.

Most definitely you have to do an ACTH test after a mini load each time.

And you look for the same signs of loading just like the first time - the only difference is the anticipated load time. Abbie may reload in 36 hours. ;) So you watch just like the first time, stop the med and call for the ACTH just like the first time, and bring her back 2 weeks after restarting maintenance just like first time....ie it's just like the first time only shorter and the testing schedule starts over. So much fun the first time ya'll decided to try it again, huh? :D

Thanks--any thoughts about increasing her weekly dose rather than re-loading? My main concern about the increase option is how to decide how much to increase. I do have a compounding pharmacy nearby that I used for Maggie's meds.

Abbie had ACTH after a month on maintenance, not two weeks. Did we err?

With the mini-load, would we do the ACTH after 4 days even if no changes?

Sorry for all the questions--just trying to gather as much info as possible before speaking with vet.

It could vary by who your vet is but when we did our mini loads the days were already determined by the vet before the start of each mini loads so I think I wasn't really looking for any changes other than possible adverse reactions and I really didn't see changes in her demeanor by then.

Quote:

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Originally Posted by judymaggie

If the numbers were switched, what would a high pre dropping to a lower post mean?

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There's really not a worry when the pre is higher than the post, this can happen when a dog is very anxious, stressed and/or nervous when the pre blood draw was done.

Hugs, Lori

Hi Judy,

Yup, I agree with Lori that stress can definitely affect baseline cortisol testing values. But regardless, I don't think you would normally expect a "pre" ACTH draw to significantly exceed the "post" under a normal testing situation. This is a reply given by Dr. Mark Peterson to a vet who was treating a dog with Vetoryl. However, I think the information would also be accurate for a Lysodren patient, as well.

Quote:

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Question: I recently rechecked a dog on Vetoryl. The post-ACTH stimulated cortisol concentration was lower than the pre-value. What does this mean?

Answer: There are several explanations for discordant results, i.e., those in which the baseline cortisol is greater than the post-ACTH value. These include laboratory error, mislabeling of samples in the clinic, interference by exogenous steroids, and use of an ineffective ACTH product...

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So for what it's worth, I'm guessing those were the true results for Abbie.

Marianne

Hi, all! Talked with the vet this evening -- numbers I got previously were accurate (5.6 pre; 12.7 post). We discussed a mini-load vs. an increase in her weekly dose and it was his preference for the increased dose with the next ACTH scheduled for 30 days out (unless earlier if symptoms warrant). Rather than increase the two doses she is getting now, we are adding a third dosing day so will be giving her 250 mg., 3x a week. I mentioned that Abbie has not consistently wanted to go on walks and we both think that the arthritis she has in her back left knee is bothering her more now that her cortisol levels have decreased. Being a stubborn beagle (definitely an oxymoron), I let her dictate how far she walks.

Thanks to everyone for your input!

I don't know as much as most of the other pros here about lysodren, but I do want to know I'm keeping up with you and Abbie. Hoping this increase does the trick!

hugs

Thanks, Sharlene--with everything going on with your family and Molly and also tracking everyone here, you are definitely a super extraordinaire multi-tasker! :D

Merry Christmas Judy and Abbie and Angel Maggie!!

Hoping you have a wonderful Christmas and Holiday Season and that Abbie continues to do so well in the new year.

hugs

Hi, folks! I have posted some new pics of Abbie thanks to beagle forum friends who visited on Wednesday -- they spend all their free time taking pictures of shelter dogs with the goal of helping them get rescued. Husband, Jason, is the primary photographer and he has become quite skilled.

Love the pictures. They are very good and Abbie looks wonderful.

Hugs

Happy new year Judy and Abbie.
Wishing you all the best in the new year

Hugs

Hi, all! Had discouraging message from vet this morning. Abbie had a one month (after Lysodren increase to 750 mg a week from 500) ACTH yesterday. I was really, really hoping that her numbers had come down but that was not the case. Numbers were:

Pre- is 5.6 (same as one month ago before increase)
Post- is 14.3 (was 12.7 a month ago).

Vet will be calling me back to discuss options (mini-load vs. another increase). He also wants to find out if Abbie's symptoms have abated. He is leaning towards a 5-7 day mini-load. Abbie has lost weight (glad but not sure why that happened) so need to talk about what would be her loading dose. She now weighs 24 lbs. (down from 25). Abbie is definitely drinking less water. She still wants to go out to pee after every nap but no accidents in the house. She still hoovers down her meals (doubt this will ever change-she is a beagle ...) but is not as ravenous outside (dead worm and frog hunting is less). Her pot belly has tightened up a bit. This past week we have had cooler weather and Abbie has been much more willing to go on walks. This morning she walked for 40 minutes.

I am assuming Abbie will have to have another ACTH after mini-load. I am definitely going to ask the vet to waive the $34 eval and $29 half-day hospitalization fees!

Well dang! Not what you wanted to hear obviously. I'd keep an eye on the weight if that is a concern. You said she normally weighs 25lbs and has dropped a pound. Does she seem more active over all? Maybe eating or wanting less treats?

hugs

Sharlene -- will keep an eye on weight although, as long as weight loss isn't indicative of any disease process, it would be nice to get Abbie back to her ideal weight of 23 lbs.

Spoke with the vet this afternoon -- will start a mini-load today. He wants to load her with 500 mg./day which will be less than what her weekly dose has been this past month. His rationale for that is that Abbie's numbers are not super high and he does not want to push a huge dose of daily cortisol into her system. I am okay with that -- just hope it works. I will speak with him on Tuesday unless sooner is necessary. Depending on how she is doing, next ACTH will be on Thursday or Friday with Friday being the preference. He agreed to waive $34 eval fee but not $29 hospitalization fee for Friday's test. Every little bit helps! Abbie does have a new lump on her left shoulder which I don't think moves (like other lipomas she has); vet will check it on Friday.

So back to being hyper-vigilant ...

Well fooey. I hate you have to do a mini-load. I know they are scary. (Or they would be scary for me anyway). Hopefully this will work and you can get Abbie's numbers down where you want them. Could the swelling in her shoulder be muscular? or arthritis?

I know you will get to the bottom of it. You are a great Mom. :)

Folks: I was just reading the latest posts about Grace on Kenny's thread. I am wondering if I should reconsider using Abbie's low fat canned food to wrap the Lysodren. Since she responded so well to the first loading, I really thought that the canned food wasn't an issue. Is it possible that, on maintenance, she isn't absorbing enough Lysodren to keep her adrenals from regenerating between doses? Abbie has never tasted peanut butter but am sure she would love it. This is going to sound silly but am concerned that it would stick to the roof of her mouth and Lysodren wouldn't make it down her throat with the peanut butter.

How about cream cheese? What did you use during loading? I don't think it would make that big of a difference she is eating her food right afterwards right? So should get enough fat from that for it to be absorbed? Maybe some of the lysodren peeps will have an idea.

Lol. She's got to be the only dog in America who hasn't tasted PB.:D
Then again maybe she's before she came to you, right?:p
How about testing it out? Wrap a small piece of carrot or pea with PB and see if she gets them down. And you will also know whether she likes PB or not.;)

Song--you are absolutely right! Who knows what she ate the first seven years of her life--most of her molars were rotten and had to be pulled when she came to me. She loves to have her teeth brushed so all has been good for the last few years. I will do a peanut butter trial with her Benedryl and see how it goes. I fully expect she will love the taste. I have to go pick up more Lysodren at Target tomorrow and they sell those single serve peanut butter packs. Don't have any in the house--I don't eat it either! :D

Sharlene--I used the canned food during loading and her numbers were low. Her numbers on all subsequent ACTHs have been too high so just trying to figure out what is causing that. She gets the Lysodren after she eats, not before. Her dry food is a prescription food for diabetic dogs (after trying several different foods, it was the only one that didn't cause diarrhea) so it is pretty low in fat and I mix it with the low fat canned food.

LOL@Song. I think we have the same twisted sense of humor. ;)

How about a mini peanut butter sandwich so it wont stick to the roof of her mouth. :)

Sorry....
(>>>>bows head and walks away)

I've probably mentioned this before, but I am a huge fan of using processed American cheese slices to mold pill pockets around tablets or capsules because those slices are usually so soft and pliable. You can buy the full-fat variety, tear off a square, and completely encase the pill by molding around it. It is not so sticky nor squishy (nor messy) as PB or cream cheese, and the pill will not easily fall out or be torn out if you've totally molded it inside.

So there you have it (and no, I do not own stock in Kraft! ;) :p).

Marianne

I think I have created a peanut butter monster! :eek: I tried it with her metronidazole after she had her Lysodren. The pill and every speck of the peanut butter was consumed. Then she started jumping up and down to see if there was more coming her way.

I think she's missed her favorite treat for years and finally enjoyed it immensely. :D

Hi Judy,
As you have been a huge help to me with Poppy, and even though I am new hear I thought I would chime in. Like Marianne, I have been using the American cheese singles, whole fat, for his Lysodren. Not Kraft but Bordens:)
Even when Poppy crashed and wouldn't look at his food this was how I got his Prednisone down. He didn't take my hand off as he would before the crash and becoming loaded, but no matter how crummy he felt he still took the cheese!
Although it seems you may have found a favorite in the PB.....good luck and I hope it works out!

Greg