New diagnosis - Symptoms returned after 4 wks on meds

[Skylar]

Good news! Molly's ACTH came back at pre 2.5 and post 2.6 and her electrolytes were normal. She weighs 14 pounds (6.36 kg). The recommended maintenance dose is 25-50mg per kg per week. The vet wants to put her on maintenance at 100mg every other day.

The first time the vet calculated the dose at the low end of the scale (25mg/kg/week). She prescribed 50mg every 3 days. It was too low as her symptoms returned in 3 weeks and her ACTH after 8 weeks was pre 5.2, post 5.6

She now wants to put her at the high end of the recommended dose (50mg/kg/week), which would be 318mg per week. She said to give her 100mg every other day.
She recommends to have it evenly spaced out (every other day or every 3 days), rather than 2 or 3 times a week (ex. Mon, Wed, Friday)

So if I give her 100mg every other day, she will get 300mg one week and 400mg the next.

Do you think this is too high? The vet doesn't, but I wanted to see what your thoughts were.

Thanks again for all your advice!!!

[Harley PoMMom]

Good news! Molly's ACTH came back at pre 2.5 and post 2.6 and her electrolytes were normal. She weighs 14 pounds (6.36 kg). The recommended maintenance dose is 25-50mg per kg per week. The vet wants to put her on maintenance at 100mg every other day.

She now wants to put her at the high end of the recommended dose (50mg/kg/week), which would be 318mg per week. She said to give her 100mg every other day.
She recommends to have it evenly spaced out (every other day or every 3 days), rather than 2 or 3 times a week (ex. Mon, Wed, Friday)

So if I give her 100mg every other day, she will get 300mg one week and 400mg the next.

Do you think this is too high? The vet doesn't, but I wanted to see what your thoughts were.

Thanks again for all your advice!!!

I think this is too high given the fact that her ACTH stimulation test was performed 3 days after the last dose of Lysodren was administered and the results being pre 2.5 ug/dl and post 2.6ug/dl.

With her reloading on 2/9 with 250mg of Lysodren her maintenance dose should be 250mg weekly, which divided and given 3 days a week would be 83.3mg. Since the Lysodren pill is 500mg that 83.3mg would be impossible to achieve, so if this were me, I would give 100 mg twice a week say Monday and Friday and than 50mg on Wednesday, which totals 250mg a week.

This is just my opinion so hopefully others with more experience with Lysodren will offer their advice as well.

Hugs, Lori

[Squirt's Mom]

No I don't think that's too low at all! I would absolutely start with 100mg every other day and see how that works. Keep an eye on her for any signs the dose is too much OR too low. Then you can adjust the dose if needed. The ACTH is PERFECT and I am so glad the electrolytes are good! Keep in close touch with us over the next few weeks and let us know how she is doing, about any changes you see, or any concerns you have. You're doing great, Mom!

Hugs,
Leslie

[Skylar]

So I've given Molly 100mg of Lysodren every other day (started 2/14). I'm also giving her Enrofloxacin 22.7mg once a day for 21 days for her UTI. Twenty one days seems like a long time, but she had 3 different bacteria strains.

Since the 7th day (last day of her loading), she hasn't eaten one bite of her dry kibble dog food. I bought some canned food and she instantly ate all of it. And she will eat other human foods (turkey, cheese, carrots). So it's not like she's not hungry, but she has an aversion now to her regular dog food. I don't think her cortisol is too low because she has a lot of energy and hasn't thrown up or have diarrhea.

She is still drinking/peeing a lot, but not as much as before she was on Lysodren and the antibiotic. This could be from the UTI.

Has anyone else heard of a dog stop eating their dog food, but eat other food?

I'm so frustrated with the ups and downs. First being ravenous to not eating at all. At least she's eating the canned food and human food, but I don't want her to get used to only eating that.

I was thinking of maybe giving her some pepcid AC. Would that interfere with the antibiotic? How much should I give her? She is 14 pounds.

Thanks!!!

[Squirt's Mom]

The UTI could certainly account for the peeing and drinking so I wouldn't be too concerned about that just now. And as long as she's not refusing all foods I wouldn't worry about the appetite. It's not uncommon for a pup to simply decide they no longer care for the food they have been eating, Cushing's or not. I have a Pug who used to do that fairly often. I seem to have finally found a food she likes tho. LOL At times we humans are easily trained, too...they learn pretty quickly how to get us to feed them what they want. As long as you aren't seeing loose stools or diarrhea, nausea or vomiting I wouldn't worry about the cortisol being too low. If you see any of those and she refuses to eat anything, then there could be a problem.

Be very careful with human foods...make ABSOLUTELY sure there are no onions, "flavors", "seasonings", etc before you let her have it.

As for giving Pepcid AC along with the antibiotic, 1-800-Pet-Meds has this to say:

What other drugs will affect famotidine?

Tell your veterinarian if your pet is being given antacids, metoclopramide, Sucralfate, digoxin, or ketoconazole as interactions can occur. Give famotidine 2 hours before or 2 hours after the other medications. When given with azathioprine, famotidine may further decrease white blood cell counts. Drugs other than those listed may also interact with famotidine. Talk to your veterinarian or pharmacist before giving any prescription or over the counter medicines including vitamins, and supplements.

About Enrofloxacin, Diamondback Drugs has this to say:

Enrofloxacin Interactions and Possible Side Effects

Enrofloxacin may interact with one or more medications. Common culprits include iron supplements, antacids and stomach protectants. When given to animals, avoid giving with dairy products (such as cheese, cream cheese, or yogurt) because the calcium can bind to the drug, limiting its effectiveness. Disclosing the existing drug regimen of your pet is essential in order to prevent a possible drug interaction. This medication may cause some animal patients to experience certain side effects, generally diarrhea or loose stools. On very rare occasions, an animal may experience a seizure, while younger animals may experience swollen joints, general lethargy and in some cases, cartilage damage when dosed above the recommended range and below the recommended age.

Drs. Foster and Smith has this to say:

Drug, Food, and Test Interactions
Consult your veterinarian before using enrofloxacin with vitamins and supplements, probenecid, oral cyclosporine, since interactions may occur.

Do not use within 2 hours of giving antacids, sucralfate, or iron, aluminum, calcium, or dairy products, as absorption will be decreased.

May cause increased theophylline blood levels.

I would talk to her vet or a pharmacist about using it along with the antibiotic....but as long as she is eating ok and not showing signs of tummy upset I think I would forget about the Pepcid AC until the antibiotics were finished if it were me.

[Skylar]

So since Saturday evening Molly has only eaten a few bites. I tried hot dogs, roast beef, peanut butter, even her treats. She doesn't have diarrhea and isn't listless. She is still drinking and peeing a lot. I just called the vet and she said to stop the Lysodren and give her prednisone every 12 hours.

So now what? Does this mean her Lysodren is now too high? So first it was too low and now too high? I'm concerned that stopping the Lysodren and starting predisone will now push her have too high of cortisol. I don't want to have to load her again.

How is the "right" dosage determined? It's expensive to keep getting the ACTH test. She just had the test a week ago (2/12) and started the maintenance on 2/14 of 100mg every other day.

I'm so frustrated and worried! She's been on the antibiotic since 2/14 (6 days) and is still drinking and peeing a lot. The antibiotic is prescribed for 21 days, so maybe it just takes time to work. Between that and now her not eating is taking a toll on me. Let alone her! I'm glad I have this forum to vent.

Thanks for your help!

[labblab]

Good news! Molly's ACTH came back at pre 2.5 and post 2.6 and her electrolytes were normal. She weighs 14 pounds (6.36 kg). The recommended maintenance dose is 25-50mg per kg per week. The vet wants to put her on maintenance at 100mg every other day.

The first time the vet calculated the dose at the low end of the scale (25mg/kg/week). She prescribed 50mg every 3 days. It was too low as her symptoms returned in 3 weeks and her ACTH after 8 weeks was pre 5.2, post 5.6

She now wants to put her at the high end of the recommended dose (50mg/kg/week), which would be 318mg per week. She said to give her 100mg every other day.
She recommends to have it evenly spaced out (every other day or every 3 days), rather than 2 or 3 times a week (ex. Mon, Wed, Friday)

So if I give her 100mg every other day, she will get 300mg one week and 400mg the next...

I do think it’s possible that the amount of Lysodren she’s getting now is too high. For comparison purposes, her initial maintenance dose was approx. 150 mg. per week ( some weeks it was a total of 200 mg.). Now you’ve fully doubled the dose to 300-400 mg. per week, and that may be oversuppressing her at this point.

On the other hand, the lack of appetite may still be resulting from the antibiotics. Antibiotics are notorious for causing upset stomachs in dogs and humans alike.

Under these circumstances, it probably does make sense to try giving her prednisone for a day or two in order to see if that improves her appetite. If so, you can probably conclude that it’s the Lysodren dose that is the problem, and that you need to back off on it by waiting a few more days to resume at a lower dose. You don’t need to worry that the prednisone will cause a permanent increase in her natural cortisol production — the prednisone serves only as a supplement on the days that she takes it.

Unfortunately, here’s one more complicating factor. Prednisone itself can be hard on the stomach if it’s not taken with some food. So if Molly’s stomach is already upset from the antibiotic, then she may be getting a double whammy with the pred. I know you’re kinda between a rock and a hard place here, so all you can do is experiment a little bit for a couple of days.

Hang in there! I know it’s really hard to do so, especially with a dog who’s not eating. That’s one of the toughest things to handle as a parent, I think. So come on, Molly girl, please eat something for us all!

Marianne

[Harley PoMMom]

Marianne has a really good point regarding that if the predisone perks her appetite up than her cortisol is more than likely to be too low.

I know how worrisome it is when your furbaby doesn't want to eat. Some food toppers I have used are: tripe, grated parmesan cheese, yogurt, warm meat broth, baby food (make sure it doesn't contain onion or onion powder), scrambled eggs, cat food, or fish (tuna, sardines) and boiled potatoes. Sometimes just heating up the food will entice them to eat. Dogaware has a really informative article on their website that pertains to a dog with a loss of appetite, here is the link: http://dogaware.com/articles/wdjinappetence.html

Hugs, Lori

[DoxieMama]

How is Molly doing today?

[Skylar]

Thanks so much everyone for the advice and support! The prednisone hasn't helped yet with Molly's appetite. I've tried everything. She only ate 1 hot dog (had to break into small pieces and feed by hand) and a few of her treats yesterday and today.

How long does it usually take for the prednisone to increase the appetite? I'm giving her 1/4 of a 5mg tablet every 12 hours. The last time she was weighed (2/14) she was 13.8 pounds. I'm sure she weighs less now because she's hardly eaten since Friday night. I started the prednisone on Tuesday evening, so with this morning's pill she has had 4 dosages of 1.25mg each dose. I'm not sure if her stomach is upset from the Lysodren being too much or the antibiotics. Or does she need a higher dosage of the prednisone? She is still drinking and peeing a lot.

I'm so worried about her!

I would