Kwiggles' Joe has passed

[Roxee'sDad]

Re: Kwiggles' Joe is starting lysodren

Hi Karen,
Finger and paws crossed here too. Hope all goes well for Joe tomorrow.
John (Roxee's Dad)

[Rusty's Mom]

Re: Kwiggles' Joe is starting lysodren

I'll join in with the crossed fingers!!

MJ

[Kwiggles]

Re: Kwiggles' Joe is starting lysodren

Thanks everybody for your good wishes & crossed fingers (& paws) for Joe- He is at the vet's right now for his stim test.

There's been something else going on which I hope is just something minor-I mentioned in a previous post that he was very restless on Saturday night- same behavior continued Sunday night and last night it got much worse.

He was up and down all night, couldn't seem to get comfortable, not resting for more than a minute or two before getting up again, digging at the blankets and the mattress and all the while whimpering, moaning, sighing and even growling a little at one point.

Now, Joe has always been a rather vocal guy (he hardly ever barks but does make every other sound under the sun) but this was totally out of the ordinary. He often snuffles, grunts and sighs while he's getting settled in and while he's sleeping but nothing like this.

Needless to say, neither one of us got any sleep. I finally got up around 3 AM and took him out and walked around a little. He didn't seem to actually be in pain, wasn't limping or anything, just extremely restless and agitated. I even gave him a little canned food and he ate it right up. I finally just made a pot of coffee and stayed up with him the rest of the night. (the coffee was for me, by the way ).

I told all this to the vet this morning and he thought it might be a sign that Joe is slightly overloaded. He reminded me (as many here have also said) that the Lysodren continues to act in the body for 48 hours after the last dose is given, so he might still be on the downward curve of loading. (the 48 hour mark was this morning, so hopefully it is clearing out of his system now).

The vet is going to do a complete blood chemistry in addition to the stim test to make sure its not some new problem. He also said maybe he will try giving Joe a very small amount of prednisone and see if he improves. And we'll know the results tomorrow of the stim test and can take it from there.

Well, Joe is in good hands and I'm hoping this is just a bump in the road. Hoping the pred (or something) will make him more comfortable and we can both get a good night's sleep tonight.

Time to go make some more coffee.....

[Rusty's Mom]

Re: Kwiggles' Joe is starting lysodren

What's the news on Joe???? We are hoping for the best!

MJ

[LuvMyMunchie]

Re: Kwiggles' Joe is starting lysodren

Hi Karen,

Just checking in on Joe. Hope all went well with Joe's vet visit and tests today and that both of you can get a good night's sleep tonight.

Awaiting your update.

Louise

[Kwiggles]

Re: Kwiggles' Joe is starting lysodren

Hello All, Just checking in for Wednesday- When I went to pick Joe up at the vet's yesterday after his stim test, he looked much happier and perkier than he had when I dropped him off. The vet had given him 5 mg Pred and suggested i give him a half pill (2.5 mg) last night and same again this morning.

I think it did the trick as he slept much more soundly last night (a little restless but not too bad) and we both got caught up on our sleep

I asked the vet if this means that Joe was on the Lysodren too long and he said not necessarily but it does seem to indicate the Lysodren did its job. And that if he were to have had a really bad (life-threatening) response to being overloaded, we would have seen it by now. The residual Lysodren should be pretty much cleared out of his system by now and if his Cortisol does come back too low it can be managed by Pred until it comes back up. Whew.

Just waiting now for test results- some time this afternoon I think.

Thanks again everybody for your concern & support- I'll let you know when I get the numbers. Hope my boy aced his tests

[Squirt's Mom]

Re: Kwiggles' Joe is starting lysodren

Hi Karen,

Good to hear that Joe is feeling much better today and that ya'll got a better nite's rest! Pred can be such a wonder drug!

Hoping for great numbers today!
Hugs,
Leslie and the girls

[Rusty's Mom]

Re: Kwiggles' Joe is starting lysodren

Are you getting butt wiggles???? I surely hope so. Glad to hear the good news so far!!!

MJ

[Roxee'sDad]

Re: Kwiggles' Joe is starting lysodren

Hi Karen,
Very happy that Joe is feeling better. Looks like you are doing a really good job. Looking forward to some good grades on his test.

John (Roxee's Dad)

[LuvMyMunchie]

Re: Kwiggles' Joe is starting lysodren

Hi Karen,

I, too, hope Joe aced his test! Looking forward to your post with his results.

Louise

P.S. Hope you and Joe are getting some serious zzzzzzzzz's right now (which I need to do myself!!)

[Kwiggles]

Re: Kwiggles' Joe is starting lysodren

Hello All,
Checking in with a quick update on Joe- Just talked to the vet on the phone and he said Joe's response to the ACTH stimulation test was 6... That's pretty good, right? (Somebody remind me please- I think I remember hearing that 1-5 is considered ideal?) Before Lysodren treatment, it was in the 30's, so big improvement.

He wants me to wait one more day of observing Joe and making sure he's doing okay before starting Lysodren maintenance- I had not expected he would be starting Lysodren again so soon after the end of the loading- does this sound like the typical schedule? I'm wondering if maybe since Joe was on the high side of normal (at 6), the vet wants to make sure not to let the adrenal start regenerating again right away. (Does that make sense?)

Sorry to sound so clueless but this maintenance phase stuff is all new to me!

Anyway, feeling very happy & relieved for my boy And yes, MJ, Joe and I will now do the happy doggy dance, complete with wiggling butts (both of us )

[frijole]

Re: Kwiggles' Joe is starting lysodren

Hi Karen,

Since you never reached 5 or below I agree with the vet that starting soon on maintenance is a good idea. What were the instructions from the vet? Are you giving the dosage all in one day or splitting it in half and giving it 2 x a week?

The purpose of "maintenance" is to keep the cortisol levels where they are so they don't creep back up to 30 again. Keep a vigilent eye out in the event that you didn't get low enough to maintain your level of 6. If you creep up you will probably have to do another small load referred to as a miniload. You basically do the same daily thing (perhaps at a higher dosage) for a few days and retest.

My dog didn't make it below 5 and I had to do a miniload. I waited 2 mos to retest. You might do a test after 30 days (acth) just to be sure you are maintaining.

Congrats because the very hardest part is over! Pat on the back. Treats for the dog. Good luck! Kim

[ventilate]

Re: Kwiggles' Joe is starting lysodren

actually 6 is high, the normal range we want to see is between 1ug/dl and 5 ug.dl so you are correct 6 is high. What is the maintaince dose and sched he wants you do to? my concern is when dogs cortisol levels are higher then the theraputic range it crawls up higher on the maintaince then you have to reload. When did he want you do a stim again? Be sure not to go more than a month that is per protocol and time will tell if it will hold. Good job
Sharon
Now your vet seems like he knows what is going on,( not quite sure about the starting maintance when the level above the range) but I am sure the pred would have been given after the stim test was done, right? there is not way it was given before? what was the baseline stim there should be 2 numbers a pre blood draw or resting then the ACTH is administered and a hour or so later the second draw is done.
Sharon

[Lulusmom]

Re: Kwiggles' Joe is starting lysodren

Hi Karen,

I know that loading and maintenance is confusing so I'll try to explain it so that it makes more sense.

The little lesion on Joe's pituitary gland really messes with the communication signal between the pituitary and adrenal glands. The demon little lesion is kinda like the devil that sits on my shoulder sometimes that makes my mouth go into overdrive...so like me, the pituitary gland cannot shut up and keeps signaling the adrenals to keep pumping out them steroids. Oy vey.

The part of the adrenal glands that produces steroids and hormones is called the adrenal cortex which is the outer layer of the adrenals. Now this is perfect because the beauty of Lysodren is that it specifically targets the adrenal cortex without effecting the other parts of the adrenal glands. During the loading phase, you give heavy and frequent doses of lysodren that basically pound the adrenal cortex until it has eroded or shrunk it to a point where the excess flow of steroids is stimmed at which point you can say, tada cuz the dog is loaded.

In order for a dog with cushing's to be normal, meaning to see a resolution of all symptoms, you want the flow of post acth circulating cortisol to be no greater than 5 and optimally no less than 1.5. So any where between 1.5 and 5 is perfect. Unfortunately, the adrenal glands will regenerate so you need to maintain them in the same state they are in after loading. This is where the "maintenance" dose comes in. It doesn't take massive doses to maintain the adrenals in their current state and as a matter of fact if you give too much, the dog will get really sick from not enough cortisol being secreted. Soooo, usually a dose equal to the daily loading dose is split, preferrably into two or three doses and given on like Mon, Wed & Fri. For instance, if a dog loaded on 375mg a day, the maintenance dose would be 125mg given three times a week.

Your vet determines an appropriate maintenance dose and when to start maintenance based on the loading dose, how long it took to load and the post acth stim number. Sometimes its a crapshoot as to whether or not the maintenance dose will maintain the erosion which is why, as Sharon has stated, it is important to have another stim done no longer than 30 days into maintenance. It's alot better to know where you stand early so as to avoid having to reload.

I hope this helps.

Glynda

[Rusty's Mom]

Re: Kwiggles' Joe is starting lysodren

Hi Karen,

Love that you get to do the happy dance - wiggle away!!

MJ