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

Hi, all! As much as I think you are all wonderful, I really didn't want to come back here. As some of you may recall, in 4/2009 my beagle, Maggie, passed away after a two year struggle with both atypical Cushings and "regular" Cushings.

I didn't remember that I had posted when I adopted Abbie but then saw her picture in my profile and reference in my signature. Here is a brief summary: Abbie was 7 years old when I adopted her in 5/2010 after being treated for heartworm . Two weeks after I adopted her she had to have a bilateral mastectomy, then another surgery due to infection from the internal stitches, followed a few months later by bladder surgery. To the surprise of my vet, during the bladder surgery, he discovered she had never been spayed in spite of two shelters saying she was! Since her last surgery she has been in good health with the exception of reoccurring ear infections and UTIs . Abbie was a "street dog" for an unknown period of time before being picked up by animal control. She then made her way to a beagle rescue. She is very loving, particularly towards children and infants, and was house-trained when I adopted her so I do think she had been with a family with children.

This summer Abbie had periods of lethargy which I chalked up to the very hot and humid Florida weather. She was treated for a UTI about a month ago and then she started guzzling water and this was a dramatic change for her as she used to barely drink any. After discussions with my vet (the same wonderful one who helped me with Maggie) we decided that it was time to run a full blood panel and urinalysis. I also asked that a UC:CR be run as red flags had started to pop up for me.

The UC:CR was positive and her liver enzymes were elevated (which had always been in normal range previously). We scheduled an ACTH for Tuesday at which time I will get copies of her lab results. If ACTH is positive for Cushings, I will ask for an ultrasound to be scheduled at our local hospital where Maggie's internist is now CEO.

Of course I am hoping the UC:CR was a false positive but there are those darn red flags and Abbie continues to guzzle water (and trips outside to pee every two hours -- last night was the first nocturnal trip at 1:00 a.m....).

I think my vet likes to do a LDDS before the ultrasound. I will do some refresher reading but would appreciate your thoughts on the need for the LDDS at that point.

Hi Judy, and welcome back (although we were perfectly content to let you just be a veteran visitor...:o). FWIW, if it were me, I believe I'd move straight on to the ultrasound if the ACTH is positive. In view of the excessive thirst/urination, elevated liver enzymes, and positive UC:CR, I wouldn't feel the need to add a LDDS as well. Since the ACTH is the more "specific" test of the two for Cushing's, a positive on the ACTH is actually a more reliable indicator than is a positive on the LDDS (meaning the LDDS is more easily also elevated by other, nonadrenal illness). And even if the LDDS was negative, you would probably still advance to the ultrasound, anyway, due to all the other indicators. So if it were up to me, I'd probably save my money for other diagnostics/treatment.

Marianne

Hi Judy,

It is so nice to hear from you although I wish it were under better circumstances.

Reoccuring ear infections, lethargy, and elevated liver enzymes can be attributed to hypothyroidism, has her thyroid level been checked recently? Usually this is checked when a senior blood panel is done and noted as T4, do you see this noted on her chemistry blood panel?

Hugs, Lori

Hi, Lori & Marianne! I, too, wish I was just coming by to say "hello" but so very appreciative that this forum is alive and well. I don't think I would have gotten through Maggie's ordeal without all of you.

Abbie's thyroid has been consistently normal, including the most recent check last week.

She continues to drink excessively and I decided to measure the actual amount today. I know I read somewhere what is typical but can't remember where that was. Interestingly, two of my neighbors have commented in the last week that Abbie's belly had gotten quite large. I honestly hadn't thought it had but I guess I have a different perspective, seeing her every day. She has not gained any weight so another "red flag". We go to the vet every five weeks to get her glands expressed -- will have to ask the head tech who sees her if she thinks her abdomen has expanded.

In addition to other things Abbie has had intermittent diarrhea for the last two months and is now on another round of Flagyl and Forti-flora. It has been controlled when on both and then she has a bout of liquid diarrhea. I am definitely going to use the Forti-flora long term. I am supposed to go to once daily Flagyl tomorrow (after one week of twice daily) but her noon-time bowel movement today was liquid. Will talk to the vet tomorrow when I drop off Abbie for her ACTH.

I have added a pic to Abbie's photo album (also below -- feel free to delete it if it is too large for this forum) that was taken in April on our road trip up to north Georgia to visit with friends -- Abbie hates having her picture taken so it was nice to have someone else take a photo while I was nearby.
http://www.k9cushings.com/forum/pict...pictureid=7143

Oh she is beautiful, Judy!

I'm so sorry about the diarrhea on top of everything else, Judy. If Abbie is in the midst of some sort of inflammatory flare, it does raise some concern in my mind about proceeding with the ACTH since nonadrenal illness can also elevate cortisol levels. However, I do realize you're in somewhat of a tough spot if the episodes of diarrhea have been going on for a couple of months now -- will there ever be a really good time to test? The GI issues may be totally unrelated to Cushing's, or they may be connected in some way. My Cushpup, Barkis, had intermittent diarrhea at the time of diagnosis, too, and my IMS told me that elevated cortisol levels can cause certain types of inflammatory GI responses (even though that sounds paradoxical since steroids function as anti-inflammatory agents). I had hoped that Barkis would improve after we started Cushing's treatment, but he pretty much remained the same. So I never really knew whether the two were actually connected in any way for him.

Anyway, Abbie's picture is adorable and thanks for posting it! And good luck tomorrow with whatever the appointment brings.

Marianne

Marianne -- it never occurred to me that an increase in cortisol could be related to gi problems. I found the following that was directed toward humans but, as we all know, our pups mimic so many of our issues:

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Cortisol activates the sympathetic nervous system, causing all of the physiologic responses previously described. As a rule, the parasympathetic nervous system must then be suppressed, since the two systems cannot operate simultaneously. The parasympathetic nervous system is stimulated during quiet activities such as eating, which is important because for the body to best use food energy, enzymes and hormones controlling digestion and absorption must be working at their peak performance.

Imagine what goes on in a cortisol-flooded, stressed-out body when food is consumed: Digestion and absorption are compromised, indigestion develops, and the mucosal lining becomes irritated and inflamed. This may sound familiar. Ulcers are more common during stressful times, and many people with irritable bowel syndrome and colitis report improvement in their symptoms when they master stress management.5 And, of course, the resulting mucosal inflammation leads to the increased production of cortisol, and the cycle continues as the body becomes increasingly taxed.4

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I do think today's problem might have been related to missing one dose of Forti-flora. A neighbor helped out yesterday with "pee trips" and dinner -- she was used to Abbie's regular dinner regimen and I didn't want to add showing her how to mix in the Forti-flora. Tonight was back to pretty firm ... definitely a delicate balance!

Folks: I just dropped off Abbie for her ACTH test. Normal bowel movements last night and this morning so no reason to postpone.

I did pick up copies of the recent labs. Here are the abnormal levels (with reference ranges):

Superchem(10/07/14)
ALKP - 220 High (5-131)
Total Bilirubin - 0.5 High (0.1-0.3)
Cholesterol - 661 High (92-324)
Triglycerides - 471 High (29-291)

Urinalysis(10/07/14)
Specific Gravity - 1.012 Low (1.015-1.050)
Protein - 2+ High (was 3+ on 9/19)
Blood - 3+ High

UC:CR (10/07/14)
Ratio - 18 High (^13 consistent with Cushings)

Both the vet and I continue to be concerned that there is blood in her urine. Assuming we proceed with ultrasound next, I am hoping that will ease any concerns about her bladder.

The blood in her urine is worrisome to me as well, this usually points to an UTI, has an urine culture and sensitivity test been performed? This type of test will be able to tell you exactly what bacteria is causing the infection and the proper antibiotic that can kill that bacteria.

Hi -- Abbie was treated for a UTI after a cystocentesis showed bacteria and blood in her urine. The cysto was done because she had a crusty discharge that would have contaminated a free flow sample. After 10 days on Clavamox a repeat cysto showed no bacteria but continued to show blood. Since there was no longer any bacteria, we decided there was no need for a urine culture. The urinalysis results from 10/7 were from a third cysto -- again no bacteria but an increase in the blood. My vet explained that there is occasionally a slight bit of blood contamination from the cysto process but level would still be normal or below if that were the cause. We will decide how to proceed with this aspect after ACTH results are in.

Question: I didn't think it was possible for Abbie to drink any more than she had been but, since being home after the ACTH, she is, indeed, drinking even more. Is this due to the increase in cortisol associated with the test?

Yes, exactly the ACTH dumps that cortisol into their bodies and sometimes for 48 hours or so, it could be less, they eat, drink, pee, run around like crazy. This should go back to normal soon though. Give it a couple days.

Has their been consistent protein in her urine? If so the vet might want to address that with UPC and moving to a lower protein food.

The other option and not very common, is if the cysto's have caused any problems with the bladder. It is quite common to get some blood in the urine when they do a direct draw, but this should go away and the next free catch urines shouldn't show any blood if that is what it was from.

What about crystals or a stone, those can also cause blood in the urine.

Just throwing thoughts out there for consideration.

Abbie sure is adorable.

Sharlene and molly muffin

Thanks for quick reply! I think she is cute, too. :D Effects of ACTH make sense. Abbie hasn't had the "zoomies" (how we describe crazy running around on a beagle forum I participate in) but that may be due to having to give her melatonin this afternoon for thunderstorms anxiety.

I thought that high protein in the urine was a fairly common finding in Cushings dogs so was thinking that was just one more indicator. I feed Abbie prescription Purina DCO mixed with prescription Royal Canin low-fat canned food. It was a very long process to find a food that had the right amount of fiber and the DCO finally worked. Not familiar with UPC abbreviation ...

There haven't been any crystals in the urine but stones are a possibility. We have kind of put that on the back burner until getting through the current tests.

Well, Abbie is officially a Cush pup! :( I will get copy of ACTH and post numbers. Her vet is calling Maggie's IMS tomorrow to see if he can see Abbie next week for an ultrasound. Meanwhile, due to continuing gi issues, will be adding pepcid and going back to twice daily flagyl. The vet is concerned that the Cushings may be irritating Abbie's stomach lining. Abbie's symptoms do seem to be increasing very quickly. She definitely has a pot belly and cries for food two hours before dinner time!

I know it is premature but ... if we end up treating with Lysodren (my vet has treated with both Lysodren and Vetoryl but has more experience with Lysodren), are there guidelines to using a slower loading phase due to already existing gi problems? Would we just use the lower end of the range?

Hi Judy, well, we welcome little Abbie into the fold even though ours is a club that does not recruit members other than honorary ones! :o

I think Abbie's ACTH results may have some bearing on the treatment decision -- how highly elevated her cortisol seems to be at this time. Our staffer Addy's Zoe had pre-existing IBD at the time of diagnosis, so faced some of the same issues as you and Abbie. However, Zoe was not as classically symptomatic with Cushing's. Addy corresponded with NY endocrinological expert Dr. Mark Peterson in addition to her home vets, and this is a recent summary that Addy wrote re: their situation (in reply to a dog without GI issues, however -- Sharlene's Molly).

Quote:

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Originally Posted by addy

Zoe started out without the classic Cushings symptoms, even in her blood work. Dr. Peterson told me not all Cush pups will have the elevations we normally see. Her main problems were skin/coat issues. Dr.Peterson felt her cortisol was too high for a maintenance dose of Lysodren to work and that her IBD would not tolerate the higher Lysodren doses of a load. He opted for starting at a low dose of Trilostane.

I think if it were me, I would ask if a maintenance dose of Lysodren would hurt Molly and how and if her cortisol is not sky high, perhaps a maintenance dose would be enough to bring it down. Dr. Oliver did tell me he had dogs that did respond to a maintenance dose without a load.

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Zoe's GI issues were an ongoing challenge, and I'm hoping Addy will have a chance to stop by at some point to share her experience with you.

Marianne

Hi, Marianne! I just picked up a copy of Abbie's ACTH results. If I did a correct conversion (ug/dl to nmol/l), she is swimming in cortisol!

10/14/14

Cortisol Sample 1: 3.8 ug/dl (reference range 1.0-5.0)
Cortisol Sample 2: 26.0 ug/dl (reference range 8-17 with note that any number above 20 is indicative of HAC)

If I converted correctly, 26.0 ug/dl would equal 717.34 nmol/l. From what I have read most Cushing's pups have above 600 nmol/l in post-ACTH.

If we decided to treat with Lysodren (again premature thinking before ultrasound), I am figuring Abbie's loading dose would be 580 mg., divided and given twice a day. At her last weigh-in she weighed 25.6 lbs.; converting that to 11.6 kg and multiplied by 50 would be 580 mg. of Lysodren. Still looking for literature discussing doing loading with less than 50 mg/kg. although, thankfully, no diarrhea yesterday or today.

Hi Judy,

I am sorry to read about Abbie’s problems. I am glad Marianne provided the text I wrote t and she is right that Zoe’s IBD was on going. She took a small dose of Metronidazoe usually every day as it continued. Here on the forum, part of the problem we have seen with using a lower dose to load is that it can prolong the time to load. Dr. Peterson did tell me I if I went ahead with the load, I could also give Zoe prednisone during the load.
The other thing Dr. Peterson mentioned was that he felt Zoe would be better off on Vetoryl because if she had flare ups we could start and stop the drug. With Lysodren, he said we would not be able to do that without losing the load.

Hang in there

Hi, Addy! Thanks for your input. I was really surprised to read that Dr. Peterson suggested giving Zoe prednisone during the loading phase. I don't think that would work with Abbie as she has an extreme reaction to prednisone with a significant increase in drinking/urinating. Also, since that is her most pronounced Cushing symptom, I would be concerned that I would miss any changes in that area during loading.

The IMS wasn't in today and the staff told my vet that the next available appointment is on 11/3. My vet is going to call back on Monday to speak to the IMS directly and see if he can fit Abbie into his schedule for next week as we really don't want to wait until November for the ultrasound.

Thank goodness I am retired and can work my schedule around letting Abbie out to pee at least every two hours!

I was surprised too at the recommendation, especially after everything I read here, but he did say it was possible to do. I wasn't thrilled with the idea of it.

Zoe's IBD flared even on the low dose of Vetoryl in the beginning. So in the end, it was the better drug her Zoe's IBD though I don't know that I am sure it was the best drug for her Cushings.

It is hard sometimes to have it all work out the way we hope.

Ugh, I hate it when they give you "next appt" that are far out. Same thing happened with me in August/September.

There is someone else I know who did a loading phase of prednisone and lysodren, per Dr. Petersons instructions. They did it and it worked out fine for them. I think everything depends on the dog though and how they react.

Sharlene and molly muffin

I just wanted to say "Hello" and tell you that Abbie is a doll! I have a weak spot for hound dogs. So precious and such a sweet little face! Thank you for rescuing her.

I'm sorry that you are both going thru this. I think the Creator must know who to give these pups to because everyone on this forum is exceptional parents. For you to be given a second Cush pup means you must be a great Mom!

I too am home during the day which is really a blessing because my girl is like Abbie and goes out about every 2 hours as well and unfortunately still does even with medication. I think sometimes its just become habit now. LOL. She's learned how to boss me around very well.

I do remember reading on this forum where small amounts of canned pumpkin can help firm up the bowels. I just can't remember how much to give... and the warning was that too much could cause diarrhea. That may also be something to try and see if it helps Abbie's GI symptoms. Hopefully someone will pop in and give you the exact amount.

Dixie (my doxie Cush Pup), Buttons (beagle, doxie and lord knows what else) and I are rooting for you and Abbie. I'll be following along with the others to see how things are going.

Hi, all! First, thanks for everyone's support! My vet was able to schedule an appointment for this morning with the IMS so was very happy we didn't have to wait until November.

The IMS's report says that Abbie was "bright and alert". I loved the "alert" part -- during my initial conversation with the IMS her eyes kept closing due to the melatonin I had given her earlier in the day although she did definitely let go with a few "aro-o-o-s" when she came back to me after the ultrasound. :D

Ultrasound showed:

Quote:

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a coarse liver, bilateral adrenomegaly and age related changes with the kidneys with no other significant findings.

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Her blood pressure was in the upper end of normal but no need for any medications at this time. The IMS and I discussed trilostane vs. mitotane and he said he was comfortable with either one based on his findings and Abbie's history. Abbie weighed exactly 25 lbs. today; the IMS said he would load at 500 mg. per day, split into two doses. He said that he always recommends having prednisone on hand.

Closing comment on the report was that "Abbie was a good sport" during her visit!

I will call my vet tomorrow and schedule a meeting time to review everything and get meds. Since he is more comfortable with mitotane, I am going to go that route. Since I have no appointments the first week in November, I am thinking about starting loading on the 1st. My vet takes Wednesdays off so thought the timing would be okay.

Whoo hooo, so glad you got in today! Awesome and very good ultrasound report over all. Go Abbie!

hugs
Sharlene and molly muffin

Hi, folks! I met with Abbie's vet this afternoon to work out a treatment plan. I walked in with a pile of papers from posts and resources here -- he is used to me having a list for all of Abbie's appointments so he wasn't surprised. He asked me if I wanted to start with my notes or have him describe his usual practice. We went with his routine and there were only a few deviations from what I have learned here.

We are going to go with Lysodren as that is what he is most familiar with -- Abbie, who weighs 25 lbs., will be on 500 mg./day for loading, split into two doses. He said that his experience is that loading takes 7-10 days. When I mentioned a quicker loading period, he said he has never seen that. I think one of the reasons for this is that he leans towards more significant changes in drinking/eating before stopping. He also said that he does the ACTH the day after the last loading dose (as opposed to 48 hours recommended by Dr. Feldman). He also wants me to start on a Monday (as opposed to a Sunday).

If it turns out that the ACTH is done after less than 48 hours, do you think that is going to produce inaccurate results?

I did find the best price for Lysodren at Sam's ($5.50/one 500 mg. tablet) and my vet called in a prescription for 10 tablets with a refill and also added a prescription for prednisone. He also gave me his cell phone number and said I could certainly call him if I need him after hours. I am giving Abbie pepcid once a day now and the vet said to cut the pill in half so I can give it to her with each dose of Lysodren.

Overall, I was pleased with visit. Since I have a couple of appointments next week, I am going to start the Lysodren on 11/3.

Quote:

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Originally Posted by judymaggie

We are going to go with Lysodren as that is what he is most familiar with -- Abbie, who weighs 25 lbs., will be on 500 mg./day for loading, split into two doses. He said that his experience is that loading takes 7-10 days. When I mentioned a quicker loading period, he said he has never seen that. I think one of the reasons for this is that he leans towards more significant changes in drinking/eating before stopping. He also said that he does the ACTH the day after the last loading dose (as opposed to 48 hours recommended by Dr. Feldman). He also wants me to start on a Monday (as opposed to a Sunday).

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The loading dose sounds good, however I am a bit worried about the vet's opinion with loading as there is not a set timeframe for loading a dog. During the loading phase any subtle change that the dog makes, especially while eating, can be a sign that the dog is fully loaded and if the loading were to continue an Addison's crisis is very likely.

Quote:

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Originally Posted by judymaggie

If it turns out that the ACTH is done after less than 48 hours, do you think that is going to produce inaccurate results?

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Lysodren continues to work for 48 hours after the dose is given, so this HAS to be taken in consideration when interpreting ACTH stimulation test results done in an earlier timeframe. As an example, if the ACTH test is done 24 hours after the last dose of Lysodren was given and those results show that the post number is 2 ug/dl, Lysodren will continue to work thereby causing that post number to drop even further and it could even drop too low.

Hugs, Lori

Hi Judy, I just wanted to add a comment about the 48-hour testing delay. I have not even had a chance to talk about this with Lori yet, but after always having cited this very same info, myself, I am now questioning whether it is really important to wait. I believe all we staffers have been giving this same recommendation for years, but a member recently questioned me about the source. And dang if I didn't have a really hard time coming up with citations and clinicians who feel it is important to wait to test. I think Glynda has found a study that suggested the opposite of what we had previously been led to believe -- that the cortisol level may actually be higher after 48 hours rather than lower. So for some folks, that might be a reason to wait to see whether enough dosing has actually occured. But for me personally, the bottom line is that it seems as though the majority of clinicians do not seem to think it is significantly important to wait, and go ahead and test as soon as there is a suspicion that the loading may be complete.

Marianne

Lori & Marianne -- thanks for quick replies! I am comfortable stopping loading as soon as I see subtle changes. I was going to ask for an article with the 48 hour reference because I couldn't find one anywhere ...

I did remember after I posted that my vet also said that I could give the Lysodren to Abbie inside her Royal Canin canned low fat food (which is how I am giving her meds now). I mentioned to him that everything I read has said to give it inside a fatty food. I don't want to use peanut butter because Abbie has a mild choking issue (mostly with water) and I am concerned that the peanut butter (and Lysodren) would get stuck in her throat. Would something like American cheese work?

Hi Judy,

I apologize for the misinformation on my part regarding that 48 hour window, I've been out of sorts here latley, personal issues have been taking up my time and obviously my mind :eek:

I am glad Mariann caught my error and has corrected it (and me!) ;)

I know some members have hid the Lysodren pill in cream cheese, would that work for Abbie?

Hugs, Lori

Lori--absolutely no need to apologize! You have always been here for everyone and you really do need to take care of yourself.

I saw the mention of cream cheese in a post but couldn't figure out how that would adhere to the pill. We don't know why Abbie is having a choking issue and, because it is not severe, finding out why is taking a back seat to starting Cushing's treatment. (The IMS believes that she probably has the very early stages of tracheal collapse.) That said, I really need to make sure that the Lysodren goes easily down her throat. She does so well with her meds in her canned food that I wish that could be used.

Judy, I may be missing the boat here, but as long as there is at least some amount of fat in the canned food I think you should be OK. In other words, you do want to make sure there is some fat in the stomach at the same time the Lysodren is being digested but I don't think the pill literally has to be wrapped in fat. It is recommended that you feed a meal prior to giving the Lysodren in order to assess any decrease in appetite prior to dosing. So even if the canned food is low-fat, there still will be some fat present to support the pill's digestion in the stomach. The biggest worry is to not give the Lysodren on an empty stomach that is devoid of any fat.

But having said that, I think American cheese would be fine to use in addition. That's exactly what I use for my Peg's phenobarb -- the soft processed American cheese slices. I tear off a little square and then smoosh the cheese nicely around the pill so as to make a tiny pill sandwich and she swallows it with delight. ;)

Marianne

Is the canned food of a consistency that you can scoop it and shape it around the pill? I do that for molly to get her to take her pills. (she is not a fan of pills usually, but quite the fan of her canned food). Now if you rattle a pill bottle, she knows she'll get some canned food so she'll come running. Right past the dry food bowl, with food left in it.
They do have their own ways about them. That might help Abbie to be able to swallow the pill too.

Just throwing out thoughts here :)
hugs
Sharlene and molly muffin

Sharlene--I do use the canned food with Abbie's current meds. Like Molly, Abbie loves her canned food--she will sit by the frig to remind me to take it out! :D

I am going to use it with the Lysodren. Marianne's logic re the fat issue made me go "duh"! Even though it is a low fat food, it certainly does have some fat as does her dry food.

Picked up Lysodren this morning so am all set except for being nervous about being able to pick up on subtle changes.

You can do it Judy! Nobody knows your baby like you do, so you will pick up on things that the vet would even overlook. When it first happens, it's kind of a "wow" moment. And you think "The medicine is really working." My baby is on Vetoryl, but I'm sure it happens the same way... that wow moment. That first time that they can walk by the water or food bowl and not eat or drink.

You got this girl! Go for it.

Okay, it's Monday night. Did you start Abbie on the lysodren? How's it going? Was she able to take it with the canned food?
I started the trilostand on Sunday, all good.
I know that with lysodren, the loading phase is always the most worrying part, I think you'll know even minute changes just because you're going to be watching that little girl like a hawk. I know it!! LOL

Let us know how it's going.
Hang in there, you been down this road before and you Can do this!
hugs

Sharlene--I really appreciate you checking on us but I am not starting Lysodren until next Monday. I had two appointments already set for this week that I couldn't change and I really want to stick close to home during loading. My experience with Maggie's Cushing's was so different from Abbie's that this seems very new to me.

I did order Denamarin which will arrive tomorrow so can start that this week. I always prefer to make one change at a time so will have a chance to see how Abbie does on this before starting the Lysodren. It was very expensive so not sure I will be continuing her on it after bottle of 75 is gone.

About to try to wake Abbie up and convince her to go out to pee--when I can get her to do that, we both get to sleep through the night. I'm glad all went well at your end with the trilostane--hugs to Molly!

Hi Judy, oops, guess I got a head start on you then. :)

I know it feels new and it is with Abbie, every dog is different as we all well know.

hmm, Denamarin, did you check it out on Amazon? Not sure what the price is there, but anything with sam-e and milk thistle, should do the trick. I actually do them separately right now as can't get something with both ingredients in it for some reason here in Canada and I was ordering from Amazon, but was very expensive to do that, especially with the exchange rate right now. So, I get that.
I'll check it out for you, S-Adenysol 100 has both in it, so do a couple others I think. I used that one for a bit.

I've had to wake molly a few times to go out. Not always her favorite thing if it is cold, wet or just dark and she is sleepy. :) Good luck though, it's nice to sleep through the night!

hugs

Sharlene--I just checked out prices for S-Adenysol (225 for Abbie's weight) and it is definitely less expensive than Denamarin. Lowest price was on Amazon. Thanks so much for recommendation!

Hi, all! First day of loading marked by my elevated blood pressure but Abbie seemed fine! :) I gave her the Lysodren inside a spoonful of canned food and she had no problem swallowing it. She did have a soft poop mid-day but it was normal tonight. She only ate 1/2 of the Denamarin tablet; she hasn't been too thrilled with them since I started them a few days ago. I am thinking I might just split it in half and tuck the halves into her canned food. Let me know if you think that eating a chewable tablet this way effects the benefit.

I measured water intake today and it was actually lower that previous measures -- in my mind it is way too soon for the Lysodren to be the reason but I will certainly continue to measure. She did have to go out to pee just as frequently as previously noted.

On to day 2 ...

I have given the sam-e inside dog food before. I think it is fine.

It can be nerve wrecking can't it. Hold on tight to something, at blood pressure can be a bumpy ride during loading!

hugs

Hi, all! Am confused ... it is now the end of day 2 of Lysodren loading and Abbie's drinking has significantly decreased. She is now below the "60 ml/kg" indicated on Dr. Feldman's protocol sheet. 22 oz. was that mark for Abbie and, so far, she has only had 18 oz. and had fewer outings to pee. Nothing else has changed either in terms of affect or eating. Her poops are normal.

Feldman's protocol says:

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the occurrence of any of these signs (in reference to reduction of appetite, polydipsia, etc.) strongly indicates that the end point in induction therapy has been achieved

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but later says:

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if food is rapidly consumed (with or without polydipsia), medication is warranted

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and then:

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usually the initial loading phase is complete when a reduction of appetite is noted or after water intake approaches or falls below 60/ml/kg/day.

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I am trying to make sense out of this -- it seems to me that loading, after only 2 days, would be exceptionally rare. That said, we do believe that we were able to get a diagnosis very early in the disease process so maybe a quick loading is possible. Since my vet is off tomorrow, I am leaning towards continuing loading and touching base with my vet on Thursday. Since Abbie has always scarfed down her food as well as been a scavenger outside (primarily for her favorite of crispy worms and frogs), I'm not sure that is going to change.

I would greatly appreciate your thoughts!

Hi Judy,

Cushing's can get so confusing :confused: I think you are correct in judging Abbie's load based on water consumption especially since beagles are known for their zestful appetite. And it is not common for a dog to load in 2 days but all dogs are different and react differently so loading in such a short time could be possible, however, the only way to know for sure is to have an ACTH stimulation test done. How are Abbie's stools, any diarrhea, any loose stools?