Nikki may need re-load

[nikkismom]

Hi, all, I am really glad I found you again!I had to board Nikki for six days while I went to Florida for my daughter's wedding.When I picked her up yesterday she was totally despondent. Her caregiver said she hardly ate, had really loose stools and just slept the whole time.I was going to take her to the vet today but she started to rally a little, so I decided to wait and see, because the vet is so stressful for her.Before our trip, I had her stimmed and her acth was post 8.7 after 2 months on maintenance at 200mg twice a week.The vet wants to re-load but Nikki feels so bad and is so weak now I don't know what to do.Is it possible that stress made her cortsol go down or would it go up? I was thinking about waiting til the end of the month to re-stim because I don't think her number would change that much, and she needs to recover from this stress, if possible.Any advice would be greatly appreciated!

[Wylie's Mom]

I hope she starts to feel better after being back with you!! They say you shouldn't treat a dog with Lysodren if they are sick or not feeling well. IMO, I agree with your vet that you will have to re-load, but I would definitely wait until she feels better. I can't comment on other factors influencing her cortisol levels - I would just be guessing - I can't figure it out with Wylie either!

I'm glad you found us!

-Susy

[Squirt's Mom]

Hi Sharon,

I'm glad you and Nikki found us! :D

I second what Susy said about treating a sick pup. Typically, stress will cause the cortisol production to increase, but with these cush pups, you just never know. Some of them simply don't do "typical" ! :rolleyes::D Did the people where she was boarded have to dose her while she was there? Did they dose her with her not eating, etc?

Trying to get an accurate result if she is that stressed might be difficult. But if she is not improving steadily and fairly quickly, I think I would have her checked out just to be sure nothing else is going on. Maybe your vet's staff would let you and Nikki stay in your car until it was time for her to be seen and that might lessen the stress on Nikki.

Hoping she is better soon!
Hugs,
Leslie and the girls

[nikkismom]

Thanks Leslie and Susy! They did dose her on Friday when she wasn't eating much.She's not eating dog food now but will eat any human snack I give her. She has terrible diarrhea, so it's probably best she doesn't eat today.Maybe her insides will get a rest, then I'll try pumpkin and Forta Flora tomorrow. If she's not getting better she will go to the vet Thursday, or I will at least talk to her.I knew when I left her she would have some problems. I just hope she can recover.

[stardeb55]

Sharon, as we discussed before your trip, & the site went down, a reload is going to be unavoidable with that post of >8. Illness/stress will normal raise the cortisol level even further. As the others have already mentioned, you DON'T GIVE lysodren to a sick pup EVER, no matter what the problem is.

Debbie

[AlisonandMia]

Hi Sharon,

I think it sounds like Nikki needs to see the vet sooner rather than later - it sounds like it is possible that she has picked up some sort of infection while at the kennel. If the diarrhea is bad she may well be quite dehydrated and her electrolytes may be depleted especially if she isn't eating and if the diarrhea has been going on for some time.

Until you can get her to the vet offering her some Pedialyte or similar may help her a lot. If it is late at night and you can't get hold of any then something like a pinch of salt and a teaspoon of sugar in 2 pints of water is a fair substitute. I'm not 100% sure on those measurements so I'll go check and edit if necessary.


Oops! Not enough salt - or sugar! Good thing I checked. See: http://rehydrate.org/faq/how-to-prepare-ors.htm
http://rehydrate.org/faq/how-to-prepare-ors.htm

and another one: http://www.recipezaar.com/Oral-Rehydration-Salts-230966

One other thing - be very careful regarding your hygiene while cleaning up and handling Nikki while she is sick - depending on what is causing the problem some of these things can be passed on to humans!

Good luck and keep us posted.

Alison

[ventilate]

I understand what you are going through. I have to leave my dogs at a kennel 3 times a year at 10 days at a time. I leave them at the same kennel as they are very good to them. About a year or more ago, I left them,when I got home for the first time I had to consider the thought that I was going to have to set Nike free from her pain. She was lethargic, could hardly stand or walk. I cried and cried then gave her pred thinking it cant hurt and it did not. In fact within a couple hrs she was back to her normal self. So even though her stim numbers were excellent she still dropped down, I believe due to the stress. Have you talked to your vet about giving pred to see if it helps your pup now? Now when I leave them, Nike gets 5 mg of pred daily ( she is a 85 lb dog so the 5 mg is a tiny bit for her) but it has made the difference and I wean her off when I get home.
Good luck with your pup and I hope Nikki feels better soon.
Sharon, Nike and Kenai

[AlisonandMia]

Another thing just occurred to me - you may want to check that Nikki's medication (Lysodren) was done correctly while you were away. Is it possible they thought it was an every-day med?

Alison

PS: I see Leslie has touched on that already but it might be worth double checking especially if more than one person was involved with her care.

[nikkismom]

Thankfully, I only left one capsule plus a pill pocket. I am worried that it was probably given when she was not eating, ie empty stomach.But Nikki seems better today, but still won't eat her dog food.She'll eat anything else. I'll probably try cooking egg and rice with chicken broth if she doesn't eat her normal food later today. I do know she will never be boarded again.

[ventilate]

Did you speak to your vet about maybe trying a bit of pred to see if that helps?

[nikkismom]

I didn't because she is really against it except in emergency situations. Every time I've given it has been on my own. But Nikki is much better. She ate the dinner I cooked her and we'll see what it does to her stomach. So far so good.:)

[ventilate]

Great; Hope it continues
S

[nikkismom]

I need help! Just got off the phone with the vet and Nikki will have an acth tomorrow. The problem is Nikki feels better than she has in a while. I'm sure her post number is high because before our trip it was 8.7.My vet says there is no maximum dose of lysodren.She said she has had dogs on twice the recommended dose and they are fine. Nikki is already on 400 mgs/week and her number is creeping up. I asked if she ever splits the dose into three and she said it wouldn't make any difference. Is this right? She acts like she is very experienced in cushings, but I don't know. She did say she will treat the dog and not the disease, so if Nikki needs to maintain a higher number that's okay.When her post was 8.7, her pre was 7.8, which means she was really stressed,so that post number wasn't so bad, right? I'm so confused! She said Nikki isn't feeling bad because of the lysodren but because of the reduction in cortisol, but how do you know that? And if the reduction in cortisol makes them feel bad, how is that good? When her cortisol was 50, she felt fine except she was starving and drinking and peeing.She certainly had more energy. Wow, this is so hard! Sharon

[Wylie's Mom]

(I'm trying to reply like Glynda sometimes does)

My vet says there is no maximum dose of lysodren.
My first impression is that they are wrong, but maybe they need to clarify what they mean by this.
She said she has had dogs on twice the recommended dose and they are fine.
They need to specifically define (in mgs/kg) what they are referring to as recommended dose - and recommended for loading or mantenance - maybe they are misunderstanding the actual recommendation
Nikki is already on 400 mgs/week and her number is creeping up.
This is why we think she may need a reload
I asked if she ever splits the dose into three and she said it wouldn't make any difference. Is this right?
IMO, it absolutely does make a difference. Please read through Bagel's thread:
http://www.k9diabetes.com/forum/showthread.php?t=743&page=2
When her post was 8.7, her pre was 7.8, which means she was really stressed,so that post number wasn't so bad, right? I'm so confused!see below from Bagels thread
She said Nikki isn't feeling bad because of the lysodren but because of the reduction in cortisol, but how do you know that? I don't think she can know for sure, but maybe the stim test can give a leaning towards a reason
And if the reduction in cortisol makes them feel bad, how is that good?
I believe sometimes the pace of the reduction can make a difference
When her cortisol was 50, she felt fine except she was starving and drinking and peeing.She certainly had more energy. Wow, this is so hard! Sharon
Yes, that may be the case, but if left untreated over time, the high cortisol can do more visible damage - skin infections, ear infections, high blood pressure, liver issues...you know!



This is from Bagel's thread:
One thing I'm curious about, and maybe someone can please clarify this for me, is the pre of 7. I'm not sure if the high pre means anything. Does it matter that the pre-7 is only 1.8 lower than the post-8.8??:confused:

When interpreting an acth stimulation test for purposes of monitoring cushing's treatment, the pre or basal number is of little value. The normal basal range (most labs) is 1 - 6 so 7 is a bit high and is probably due to the stress of being at the vet's office. I hope this helps.

Glynda

[Wylie's Mom]

Oh yeah - I think she wants to do another stim because you are going to re-load:confused:? How long ago (in weeks) was her last stim where post was 8.7 & pre was 7.8?

I have to go now, but I will check back later;).

-Susy

[nikkismom]

It was the first week in April- I had to do it because I was going out of town and knew she would be stressed. I also knew I would have to do another when I returned, but have put it off until now because she is just now recovering from that stress. Going to the vet upsets her so much. At least she's only there for two hours.

[Roxee'sDad]

Hi Sharon,


When her cortisol was 50, she felt fine except she was starving and drinking and peeing.She certainly had more energy. Wow, this is so hard!

Just wanted to let you know. When our Roxee was dx'd almost 3 years ago, we chose not to treat. She felt great, swimming, running chasing balls and the cat on occasion.:p She was fine except for the normal signs. Thirst, panting, huge appetite, stealing food and hair loss. I could live with that. I didn't know enough about this disease or syndrome:mad:.

Mid to end of last year, Roxee started losing her strength. By Nov, I had to carry her outside to do her business. BTW, we have a doggy door with 3 steps leading down to her doggy yard. Had to replace the steps with a ramp. Finally could not use the ramp anymore so then the carring her outside 6 to 10 times a day.

Then I found cc.net and learned so much and found out that her muscle Deterioration was due to the cortisol eating away at her muscle tissue thus making her weak. So weak in fact that we had to hold her up to pee and poop in December:(.

So what I am trying to say is yes, the higher cortisol was making her feel good until it started eating away at her skeletal muscles and she then went downhill quickly. If I hadn't found this site when I did, she would be at the rainbow bridge already. I just wanted her to have one more Christmas with us.

Today she is improving,:D:D:D but it continues to be confusing as we all try to tweak and improve treatment, continuously watching for signs of improvements or declines, looking for ways to make our pups life better. This is what we do and why you and I and the rest of us are here.:):D

In yours and Nikki's case it might have been cortisol withdrawl but there really is a long term price to pay for that feel good feeling they are experiencing today.

All my best to you and your Nikki.
John (Roxee's Dad)

[Wylie's Mom]

Great example, John!

Sharon,

If you want to hold off for a week or so to give Nikki more time to "recover", I don't see an issue with that (but, that's just my opinion). I did a mini-load on Wylie about 3 weeks ago, but I waited a week longer to do the (after mini-load) stim. He had a stim done 3 weeks previous, and I just wanted to give him an extra week longer before being a pin cushion again;). They have a hard time finding his vein and he often develops a bruise afterward.

-Susy

[nikkismom]

Thanks so much John and Susy. I have been treating since November and will continue to do so, but it is frustrating, to say the least.She's had one re-load already and we just can't seem to get control. I didn't mean to imply that I have any intention of giving up or not continuing with treatment.This forum has taught me so much! If we ever get on real maintenance I will be so happy! I will post results of her stim tomorrow when I get it.

[Squirt's Mom]

Hi Sharon,

Sorry Nikki is still having problems getting control. :( Bless her heart and yours too!

Refresh my memory...has she been tested for Atypical? the UTK panel? If so, what were the results and is she being treated for it? If not, talk to your vet about adding some melatonin and lignans. If her Estradiol is elevated and being produced someplace other than the adrenals, this could be playing a role in her difficulties. Just a thought I managed to grab! ;)

Hugs,
Leslie and the girls

[Wylie's Mom]

And can you refresh our memory on how you re-loaded:

-stim results before reload
-maintenance dose before reload
-dosage for re-load & how many days
-stim results after reload
-maintenance dose after reload

-Susy

[nikkismom]

Thanks, Leslie,she hasn't been tested for atypical because her cortisol in the beginning was post 50, although I suppose she could have hormone problems. I just printed out Dr. Felman's protocol about splitting doses of lyso into as many doses as possible, and I'll show it to her vet tomorrow when I take Nikki for her stim. She'll probably get really mad, but I feel like if the dose is split more,it can be more controlled.I know she will get mad, because when I asked about splitting the dose, she said it wouldn't make any difference, that all that matters is the total for the week. Oh, well, mad she will have to be!

[stardeb55]

Sharon, as Susy has already mentioned, we need those reminders about loading dosages, especially. We, also need Nikki's current weight.

I respectfully disagree with your vet about max dosage for lyso. Dosage is based on 25-50 mg/kg body weight. Some pups do better at the higher end of that range, some at the lower end, but each pup is an individual. Harley recently dropped 1.4 lbs. for no apparent reason which bumped his maintenance dose over limits at 54 mg/kg, his GP vet cut the dose immediately. Yes, some dogs do ok with posts >5, but that is really the exception to the rule. Harley, who always seems to be the exception to the rule, has been running a post in the low 7's on his last 2 stims, & feels fine, totally symptom free. With his pre-existing gallbladder/GI tract issues & being 14, my GP vet does not want to attempt to take him lower, as long as he remains SYMPTOM-FREE, which is the key.

Debbie

PS- Dr. Feldman is probably the foremost authority in the world on Cushing's, & he has advocated splitting the maintenance dose into as many doses a possible during the week for a very long time. If you vet wants to argue with the expert, then, perhaps, you may need to consider getting another vet. When it comes to splitting the dose, Harley gets his 250 mg., split into 3 doses during the week.

[nikkismom]

Sorry, Debbie, I always feel like I'm repeating myself and boring everyone! Nikki weighs 15 pounds and is currently taking 200mgs twice a week, which I know is too high. If her number comes back high, like I know it will, the vet wants to increase it even more after a reload. Nikki does not have symptoms like thirst or hunger but her legs are very weak and she moves really slowly and sleeps most of the time. She eats and drinks normally.

[stardeb55]

Sharon, we also need the last loading dose when you did the last re-load. This is important, so we can offer input on what may be a more appropriate loading dose, if you do another re-load.

Debbie

[Wylie's Mom]

Hi Sharon,

So, did you do a re-load or mini-load, or did you just keep increasing the maintenace dose? I don't recall...I only remember the orange dye thing:p.

-Susy
(Sorry...can't wait for a response...gotta go tend to Wylie.)

[nikkismom]

Last loading was a "miniload", 200 twice a day for three days. Her acth after that was 4.7, I think, but my vet forgot about me, was gone for several days and by the time I started maintenance again at 200 twice a week it had gone up to 5.7.

[Truffa's Mom]

Nikki, we will be praying for you. Let's hope that your vet listens to your mommy, because I totally agree with Debbie:

Dr. Feldman is probably the foremost authority in the world on Cushing's, & he has advocated splitting the maintenance dose into as many doses a possible during the week for a very long time. If you vet wants to argue with the expert, then, perhaps, you may need to consider getting another vet.

and you don't need to deal with more frustration around your baby's health.

And BTW you are not boring anyone.

Choco kisses flying your way.

Marcela & The Choco labs

[nikkismom]

Good news for Nikki. Her post yesterday was 7.1 which the vet thinks is good for Nikki since it was 8.7 beginning of April with no change in meds.Seems really strange but I'll take it. She has agreed to letting me split doses into three/wk so maybe that will help some with stomach gurgling and GI upsets. She also said if I ever have to leave her again to have the caregiver give her 1/4 pred per day for stress.I should have done that.Anyway, I was really afraid to give her the printout from Dr. Feldman about splitting doses, but she was great about it, all things considered.I enclosed a note with it and was very careful with the wording. I said "please read this and see what you think. Since you said it makes no difference, maybe we could experiment with Nikki by splitting her doses and just see what happens." She actually asked me how many doses I would like to give per week. I think I'll try 3 for 3 months and see. So she will stay on 400/week for three months. I have learned that you cannot predict what that post number will be by the way they act. I was sure her number was high because she seems more energetic than she has for a while. Anyway, I am happy!:) Thanks for all the help! Sharon

[Roxee'sDad]

Hi Sharon,

Great to hear the good news. Really great that you have a vet that is open to treatment options and gaining new experiences.

HAPPY FOR YOU AND NIKKI. :):):)

Keeping fingers and paws crossed for continued improvements.

Good job!:D:D

John (Roxee's Dad)

[Wylie's Mom]

Hi Sharon,

Good news on the lowered stim results:D:D.

I'm glad she agreed to split the dose - great job on the note;):D.

BTW - my Wylie's tummy makes all kinds of weird noises. I actually started to record them on a digital voice recorder (his tummy is still pretty bear from the September ultrasound so I had easy access). I thought I would play them for the IMS and ask her about them. Then one day, I recorded my belly...it sounded just as weird as Wylie's and I feel fine...so, I nevered played the recordings for the IMS - I think she thinks I'm weird enough as it is:p.

-Susy

[nikkismom]

That's funny, Susy!:D It's probably always gurgled and I never noticed until she got cushings. Now I notice every little thing:( Every time she has a sip of water I'm sure she's drinking too much! I guess moms and dads just worry too much!