Sweet Kona has passed - Question on Lysodren loading

[chocoholic]

Hi,
I am new to posting but have been reading many informative posts here. My 8 year old chocolate lab, Kona, was recently diagnosed with Glomerulonephritis and then also pituitary dependent Cushing's. She has been taking Enalapril which has helped with her hypertension. I just completed her Lysodren load but I am afraid that I went one day too long. She will not eat her food. She only eats some cooked chicken breast. When I do manage to get a few bites of kibble in her she throws it up. I took her yesterday for her ACTH test which was as close to the 48 hours as I could get. The vet told me to just let her be until the results come back in 3-4 days. Is this normal eating after the load? I don't want to make her worse by just letting this go. My vet isn't highly experienced with Cushing's so I am not sure if she really knows what is best. Any help that you can give us would be greatly appreciated.
Thanks, Wendy

[Squirt's Mom]

Do you have any prednisone? If so give her a dose now. The rescue dose is 0.25mg/kg. To find the weight in kg if you are in the US, divide the lb by 2.2.

If you have an ER vet close by, that is where I would be headed now. Lysodren has a long life in the body - up to 48 hours. So if you did go a day too long, your baby could be in trouble and in need of pred. The electroylytes should be checked if you take her to an ER.

How much does your baby weigh?
What dose of Lyso was she taking?
How often did she take it (how many times a day)?
Did you vet tell you what to look for that would mean the load was done or just tell you to give it X days?

[Harley PoMMom]

Yikes, it does sound like Kona's cortisol may have dropped too low and if this were me I would give her that rescue dose of prednisone that Leslie calculated.

Hugs, Lori

[Squirt's Mom]

How is Kona this morning? Looking forward to hearing from you!
Hugs,
Leslie

[chocoholic]

Hi,
Thank you so much for responding so quickly. Kona started having diarrhea last night as well so I went with the prednisone as you suggested. She has managed to eat some rice and chicken today and seems more interested in food... just not her k/d kibble. I spoke with her vet this morning and she told me to keep her on the prednisone for a few days and also an antidiarrheal. Then start her lysodren maintenance on Monday.

Just a little history of my baby. Kona weighs 90 pounds. Her vet noticed that her protein levels were high in April when she had bloodwork done. She was checked for an infection which came back negative, then her protein creatinine was checked which came back at 1.4. We had an ultrasound done which only showed some inflammation on her kidneys. Since no growths were found the vet decided Kona had Glomerulonephritis. She was also hypertensive at that point so it seemed to fit. We put her on Enalapril and Hill's k/d food. One month later her blood pressure was better but her protein creatinine had gone to 2.1 so she was not getting better.

I decided to do some more research because I felt like something was being missed. When I ran across the info on Cushing's I just knew that was what she had. I asked the vet who seemed unsure because some of her other test results weren't pointing that way. I insisted that they run the initial screening test and sure enough it was positive. We then had the Dexamethasone test run and that came back as pituitary dependent Cushing's. We started the Lysodren load at 200mg once per day. I was watching her very carefully and she seemed to be eating normally until one day, 6 doses in, she didn't seem as interested in her food. She ate more slowly than normal so I stopped at the 6th dose. She just seemed to get worse after that though. She wouldn't eat at all. Then I got her to eat some chicken so I just fed her a little of that. At almost exactly 48 hours her test was run. She is still not feeling well for sure though and that was 2 days ago. Her test came back at 1.8 so the vet said the load was good. I hope she is right and that my baby starts feeling better soon.

Thanks again for your help! Any additional input is greatly appreciated as this is no easy road to travel. I just hate seeing her so sick.

Thanks,
Wendy

[My sweet Ginger]

Hi Wendy,

I'd like to know two things to make sure.
You mean 2000mg a day instead of 200mg, right? Then the dosage was correct for her weight but it should've been divided by 2, morning and evening 2 pills (500mg) at each meal time.

Can you tell us both numbers from the ACTH stim test, the pre and post? We are missing one number which I'm guessing the pre number.
If the post number is 1.8 that would make me worry and I'm worried therefore I wouldn't hurry to start her on maintenance so soon.

I hope she gets better with prednisone and a break from Lysodren.
Song

[chocoholic]

Hi Song,
Yes it was 2000 mg per day but all in one dose instead of split up. Guess the vet didn't know as much as she claimed.

The pre stim number was <1.0 and the post was 1.8. I don't know enough to have a clue what that means so maybe you can help with that.

Thank You!
Wendy

[My sweet Ginger]

I'm worried about Kona being under your vet' care re Cushings treatment who says it was a good load looking at the numbers of <1 & 1.8. Together they are too low and there is not much stimulation.
1.8 maybe a good enough pre number but not an ideal number for a post. Kona's electrolytes need to be checked for Addison's if she isn't doing well even on prednisone and you may need to look for a vet with more experience on Cushings.
How is she doing tonight?

[chocoholic]

I may have to look for a vet that is more experienced with Cushing's I guess. She ate her chicken and rice and so far seems to be about the same. She is definitely not herself. Normally she has a ball in her mouth and is happy. She is really just laying around and seems uncomfortable I hope the prednisone brings her back. What would good levels be for these tests? Is there any way to fix this?

Thanks,
Wendy

[My sweet Ginger]

I don't remember the exact numbers but I think we'd want to see pre number no lower than 1.5 and post number higher than that but somewhere under 5. Also in cases like this you'd want to run an ACTH before you start maintenance.
I'd call your vet and have her check Kona's electrolytes if she doesn't get better by tomorrow morning.
How much prednisone is she getting?
I hope other more experienced members will chime in.