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

[Tina]

Thanks Kim! Yes, I was in quite the panic myself when I found this forum. I was so upset at first, it took me several days to pull it together enough to register and finally post.

I am blessed in that I have a vet who has experience with Cushings and treating with Lysodren. She is very thorough and did a great job explaining everything. (She knows me well, and knows that I would need to know everything and in detail). I totally trust her, but it never hurts to educate yourself. And this illness is so complicated, I just needed to read as much as I could. Fortunately what I learned confirmed the information she provided!

It sounds like you moved far from Omaha?

By the way, Your Schnauzers are adorable, of course! I have a 6 month old pup in addition to Jasper. She is quite the handful, especially since all this started with him. Who would have thought...

Tina

[molly muffin]

Tina, I too was in a panic when my molly was diagnosed. I still have moments, not a great many, but a few. I can't even begin to say how much this forum has helped though. Without it, well, I don't even want to think about it.
My vet will be treating with Trilo. Not sure when, we have another test to go through and then we'll see.
Hang in there!

Hugs,
Sharlene (and Molly muffin)

[Tina]

Hi Everyone,

I want to check in with my baby's latest labwork. Just to recap, Jasper was started on Lysodren 250 mg twice a day on 7/5. After 5 days on the medication, we did the ACTH test which showed he was over suppressed with the baseline cortisol 15 nmol, and 1 hour post 14 nmol. He did not show any of the warning signs of low cortisol. The Lysodren has been on hold for 2 weeks and he had another ACTH test on 7/25 to see where we are at. We got the results late this afternoon.

Cortisol, baseline 192 nmol
Cortisol 1 hr post ACTH 186 nmol

I know you all are more familiar with the ug/dl unit of measure but are able to convert these numbers.

I talked to my vet for quite a while. We talked about maybe giving him the loading dose again for a couple of days. She said the levels are a bit higher than ideal for a Cushings dog (ideal being 50 to 100) but after discussing, said she feels that we should go straight to the maintenance dose of Lysodren since Jasper was so sensitive to the dose during the loading period, and since his symptoms are controlled currently. I felt like this was the best option also.

So he will be getting Lysodren 250 mg twice a week. I asked about the dose since several of you mentioned giving a lower dose since Jasper's levels got so scary low during loading. My vet said we will keep the dose at 250 mg twice a week since his levels are a little higher than ideal now. (His weight is 25.5 lbs).

She said to watch for a return of the excessive drinking and urinating, and of course I will still monitor for any signs of low cortisol. We discussed that if the symptoms increased that would indicate that the med isn't holding the level and we may need to put him back on the loading dose for 2 or 3 days (rather than 5 where he got over suppressed).

The plan now is to recheck the levels with another ACTH test in 4-6 weeks.

So that is where we are at now. I am so hopeful that we can get him stabilized on the meds. That was so scary when his cortisol bottomed out.

A question that I have that I forgot to ask my vet is if it is possible for the cortisol level to decrease at all when the maintenance dose is started, or does that mainly occur with the loading dose?

Please let me know your thoughts about the labwork and our course of action. I am so grateful for all of the support and advice.

Thank you,

Tina

[Squirt's Mom]

Hi Tina,

A belated welcome to you and Jasper!

We are a Lyso household as well but my Squirt was never loaded due to the type of Cushing's she has - Atypical. We went directly to a maintenance dose schedule when she showed signs that her cortisol was rising. Squirt weighs about 15 lbs and is taking 250 mg twice a week - this has controlled her cortisol for a year now. So, yes, it is possible for a maintenance dose to lower and control the cortisol in some cases. Since Jasper did load, his adrenal glands are prepared for the maintenance dose.

What that means is this - the job of loading is to erode a miniscule layer of the outer cortex of the adrenal glands to stop the continual communication between the adrenal, the pituitary and the hypothalamus glands - the glands that dictate when and how much cortisol to release as needed. In Cushing's, this communication goes into overdrive and tells the adrenals to release cortisol all the time, flooding the body. Once the pup is loaded, this communication becomes more normal - the erosion has done its job. Then we wait for a few days for the adrenals to adjust then maintenance is started to maintain the level of erosion the load achieved. The adrenal glands can and do regenerate that eroded layer so that is the job of maintenance - to maintain what the load achieved, not further erode the cortex.

The conversion for the ACTH is - (if my math is correct! To convert nmol/L to ug/dl you divide the mmol/L by 27.59 )

6.96 ug/dl
6.74 ug/dl

So the post number, the number that counts, is a tad bit higher than we usually like to see after a load which would be between 1 and 5 ug/dl. Since Jasper did load so quickly and seems to be sensitive to the Lyso, I think you vet is being appropriately cautious. She seems to have a good handle on Cushing's from what I have read so far. And you are doing a superb job of being a diligent mom - the most critical factor in Cushing's.

I am so glad you found us and many of us here understand how you feel. When I arrived here over four years ago, I was a total basketcase. A dear friend here later told me she envisioned a woman with her hair standing on end as if her finger were in a light socket! She kindly left out the part about bulging eyeballs and flying slobber! These wonderfully kind and knowledgeable folks took my hand and gently led me along until I could breath again...then they began to teach me - not an easy job, either! The more I learned the further the fear moved away from me...and I know that will be the same for you. Never hesitate to ask questions; we will do our best to help you understand, or we will try to learn together if we don't already know. You and Jasper are now family here and this family sticks together through thick and thin!

Keep up the good work and know you and Jasper will never be alone. We will walk this path with you every step of the way.

Hugs,
Leslie and the gang

[Tina]

Hi Leslie,

Thanks for your feedback and all of the great information!

I restarted Jasper's Lysodren yesterday, 250 mg twice a week. I will be giving it on Sat and Tues. I am hopeful that this will control his cortisol level and even lower it a little bit since his post level was a bit higher than ideal.

I have been reading a lot of the other threads and it seems that it can pretty much be a roller coaster getting the right maintenance dose on board. Based on Jasper's most recent levels, I am a little scared that we will have to go through the loading process again, but will need to wait and see how he does with the current treatment plan. I am hoping for the best.

I am so thankful that I found this forum. I feel like I have a whole new set of friends who are just like me. All who love and care for their dogs as children. I do not have human children, so my pups are it for me. A lot of people, no matter how well meaning, do not understand that.

Did you happen to watch the Olympics opening ceremony? The Queen's Corgis were the highlight for me. They were just precious.

Take care,

Tina

[Squirt's Mom]

Hi Tina,

You are doing a great job with Jasper and I am sure ya'll will do just fine getting his cortisol controlled. You have that most critical factor - our diligence - down pat. Plus you are reading and educating yourself on this condition our babies are plagued with and that will carry you both a very long way.

Any time you are nervous or see something you don't quite understand, ask! Trust me, you cannot ask any dumb questions - that's MY job! Well, that and being the Queen of Guilt and Panic! I panic really, really good, too.

I loved the opening ceremony! When the Queen (the real one! ) made her entrance, I fell head over heels in love with the lady. What a grand sense of humor for the leader of a world superpower to display to the whole planet! What a class act! In my opinion, the Brits have done and are doing a great job with the Games. The US has got to get busy, tho! China is taking all the metal and we just can't have that!

Keep in touch and remember you are never alone.
Hugs,
Leslie and the gang

[molly muffin]

Tina, you hit the nail on the head, some peeps don't get just how into our animals we are. I told my husband the other day I know more about molly's medical issues than probably my own. She certainly gets more testing done than I do. LOL

I'm enjoying the games when I get a chance to catch them, which isn't as often as i'd like.

Leslie official panic persona of the forum? *wink

Hugs,
Sharlene

[Tina]

Hi Everyone,

Leslie and Sharlene, thanks so much for your feedback and support. Jasper seems to be doing ok since we restarted the Lysodren, but it has only been a week. So far so good I guess.

I have been reading many other threads and see that several folks have their pups on milk thistle and/ or Sam-e. I have done a little bit of reading about them, but need to do more. I am wondering if I should ask my vet about starting Jasper on one or both.

His last liver panel showed an alk phos of 1127 (ref range < 95), and LDH of 564 (ref range < 175). The other values were within normal limits. I don't know if the milk thistle or Sam-e would help decrease these levels or not. I am also wondering if he should be started on them to try to prevent any adverse effects on his liver that could occur from the Lysodren. I am really worrying about that.

Thanks for any advice anyone can provide. I really don't know how I would be getting along if I hadn't found this forum. Most importantly, I feel so much better equipped to provide and advocate for the best and safest possible treatment plan for my precious little guy.

Hugs,

Tina and Jasper

[frijole]

Hi Tina! Just want to put your mind at ease... Lysodren doesn't hurt the liver. It indirectly helps it. The liver issue is caused by the cushings. When you reduce the cortisol generated by cushings using lysodren those enzymes will go down. But please know that cush dogs will have elevated liver enzymes forever. That is why alot of us use milk thistle. You can actually get with SAME in it and save yourself a pill. There is no scientific proof it helps.. I can only tell you that my Haley had levels of 2000 that went down to 1200 after using lysodren... but after using the milk thistle they went below 800 and I was thrilled. She lived to 16 1/2 yrs - she used lysodren for 4 1/2. Don't fear lysodren. Kim

[Tina]

Hi Kim! Thanks for responding about the Lysodren. I was thinking I had read somewhere that it was hard on the liver and could cause damage, but I could very well be mixed up. I have pretty much been spending every fee moment reading and educating myself about this illness and all that it involves. My brain is on overload, but I feel so driven to keep reading.

Thanks for sharing how long Haley was on Lysodren, that is so good to hear. And how wonderful that she lived to 16 1/2!! You obviously took such good care of her.

Did you happen to read back in my thread about the results of Jasper's most recent ACTH test and the current plan? (It is in my 7/27 post). I would be interested to know what your thoughts are about going directly to the maintenance dose even though the cortisol levels were a bit higher than ideal. Leslie provided a lot of good information that was encouraging. I am hoping we are on the right track. Thanks for the reassurance about Lysodren. I am still a little nervous about it, but I am much more scared about all of the effects that high cortisol levels would have on Jasper's precious little body.

Hugs,

Tina