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**stardeb55** · 05-11-2009, 03:42 PM

Re: Coolidge...

Excess production of the associated hormones, usually estradiol, progesterone, & 17-OH can cause the same sorts of liver damage that the excess cortisol will do. I almost sure that skin & coat issues are a common problem, too.

I'm not doubting your vet's word, but I think there may be a misinterpretation of what Dr. Oliver has said, this is why it's important to get a copy of that treatment recommendation sheet. The following link is the treatment recommendation straight from the UTK website, it might be good to review. I would also suggest you take a look at the enclosed link for Dr. O's article on steroid profiles.

http://www.vet.utk.edu/diagnostic/en.../treatment.php

Hope this helps.

Debbie

**Coolidge** · 05-11-2009, 03:59 PM

Re: Coolidge...

What I would give for a webpage that listed the complications of atypical cushings. Something that people can understand.

So basically she is in the same boat she was before, other than a final diagnosis.

I will still have to watch her closely, liver and other organs can still be affected.

I will have them fax me a copy tomorrow.

In the meantime, thank you thank you thank you. The expertise on this board is unsurpassed.

**gpgscott** · 05-11-2009, 04:38 PM

Re: Coolidge...

Sorry I have not posted to you earlier, it has been a crazy period.

Yes, get the treatment recommendation.

It will most likely be melatonin and lignans.

It is not a profound treatment like Lydosren or Trilo and that is because these other hormones although profound in their effect over time are not as immediately affected.

My Moria has been on melatonin and lignans now for almost 2 years. She is 15 years old. She is responding well to the treatment.

Scott

**Coolidge** · 05-12-2009, 03:20 PM

Re: Coolidge...

Results are in:

Cortisol:
Baseline: 24.2 ng/ml (Normal 2.1-58.8)
Post Acth: 83.1 ng/ml (Normal 65-174.6)
Androstendedione:
Baseline: 0.03 ng/ml (Normal 0.05-0.57)
Post Acth: 0.80 ng/ml (Normal 0.27-3.97)
Estradiol:
Baseline: 63.4 pg/ml (30.8-69.9)
Post Acth: 54.2 pg/ml (27.9-69.2)
Progesterone:
Baseline: 0.13 ng/ml (0.03-0.49)
Post Acth: 1.60 ng/ml (0.10-1.50)
17 OH Progesterone:
Baseline: 0.11 ng/ml (0.08-0.77)
Post Acth: 2.22 ng/ml (0.40-1.62)
Aldosterone***
Baseline: 76.1 pg/ml (11-139.9)
Post Acth: 141.4 pg/ml (72.9-398.5)

*** Normal range values for male and female dogs (N=72 baseline, N-23 post ACTH)

Dr. Oliver's Comments: Most hormone levels are normal, but both progestin's are modestly increased at stim. Consider items 2 or 3 or 5 on the treatment option sheet attached.

Feel free to comment. Thanks. (Am I the only one who thinks these "abnormal" findings are extremely mild, and that Cushing's really isn't the cause for her problems?")

Please note that I just realized his recommendation is different from what my vet told me he said. Have asked for clarification.

**stardeb55** · 05-12-2009, 04:19 PM

Re: Coolidge...

Could you post exactly what items 2,3,5 are? Yes, the elevations are mild compared to some that I've seen. The standard treatment of melatonin + lignans is pretty mild, so it might be the best thing to try. If it doesn't help, at least, it can't hurt.

Debbie

**AlisonandMia** · 05-12-2009, 04:30 PM

Re: Coolidge...

This is the UTK's treatment recommendation sheet: http://www.vet.utk.edu/diagnostic/en...ushing%27s.pdf

Alison

**Coolidge** · 05-13-2009, 05:19 AM

Re: Coolidge...

The treatment, according to Dr. Oliver would be:

2) Melatonin or
3) Melatonin implants or
5) Lysodren maintenance dose

I'm thinking (and waiting for it to be confirmed) that my vet pointed out that Coolidge is very sensitive to lysodren. So he probably recommended at that point to switch it to flaxseed or melatonin or Trilostane. However, reading up on the trilostane, we really don't want to go there because its not recommended for dogs with the higher progesterones. So I think the flaxseed and melatonin will be our course of action.

So she's mildly atypical cushings. Seeing what she is going through and being mild, I don't envy what you are all going through. Coolidge is experiencing a hiccup in her road of life. Others are experiencing tidal waves.
You all are tremendous in your love for your furkids.

ps. I'm having the vet check all of Coolidges records to find out if Coolidge was ever specifically tested for Diabetes.

**Coolidge** · 05-13-2009, 05:59 AM

Re: Coolidge...

I've probably asked this before, but what does one do with extra lysodren that they aren't going to use?

I have 15-20 500mg pills I halved for Coolidge. Before it expires, I'd like to find a home for it.

**Wylie's Mom** · 05-13-2009, 01:55 PM

Re: Coolidge...

Regarding the Lysodren - I would donate them to an animal rescue or shelter if they could use it or see if your vet could donate them to a client.

I'm thinking that the flaxseed lignans are not necessary... I believe it is primarily for the patients that have increased estradiol levels. But see what the others think about this or double check with Dr. O.

-Susy

**Wylie's Mom** · 05-13-2009, 02:26 PM

Re: Coolidge...

Becky,

I was trying to get more background information on Coolidge... here's the first page of your cc.net thread:

http://74.125.95.132/search?q=cache:...&ct=clnk&gl=us

You had posted on 01/02/2009:
"Results of the ACTH stim test following the loading phase was 0.9 and 0.6 ug/dl. (That was the 20th of October)...Latest are Sample 1 (5.5 ug/dl) and Sample 2 (8.8 ug/dl)."

This is from your first post on this thread:

Originally posted by Coolidge View Post

It's been since the middle of October since she was loaded, and only one dose of Lysodren on Jan 1st.

I'm confused - I just want to make sure - please confirm that we are sure Coolidge does not have regular Cushing's? The "within range" cortisol levels on the UTK panel are not due to the Lysodren?

-Susy

**AlisonandMia** · 05-13-2009, 06:54 PM

Re: Coolidge...

I'm thinking (and waiting for it to be confirmed) that my vet pointed out that Coolidge is very sensitive to lysodren. So he probably recommended at that point to switch it to flaxseed or melatonin or Trilostane. However, reading up on the trilostane, we really don't want to go there because its not recommended for dogs with the higher progesterones. So I think the flaxseed and melatonin will be our course of action.

If Coolidge is indeed particularly sensitive to Lysodren this does not mean that she can never take it - it could simply mean that she is best served by a much-lower-than-usual dose. Occasionally an individual dog does seem to be inordinately sensitive to Lysodren (or Trilostane for that matter) and in those cases unusually low doses are used - which is actually a good thing rather than a problem. If nothing else it saves money.

I believe that Trilo can lower progesterone but that it raises 17 OH Progesterone so would probably cause problems on that front. It also lowers cortisol and if her cortisol levels are so nice and normal then Trilostane could very well result in a low-cortisol situation much as you saw with the Lysodren overload.

When just a maintenance dosing of Lysodren (no loading) is used in Atypical Cushing's the aim is to give a dose that is sufficient to just gently damp down the adrenal overactivity but not to actively erode adrenal tissue which is what the aim is with a dog with Cushing's where the cortisol is elevated. When this is done a low-end maintenance dose is usually trialled at first, particularly with a larger dog. I believe Dr. O usually advocates 25mg/kg per week to start with and for a dog that could be sensitive to Lysodren starting considerably lower would probably be the way to go. Your vet could consult with Dr. O should it look like Lysodren treatment is in the offing and he could advise based on Coolidge's history and your concerns.

It is possible that Coolidge went very low after just one dose of Lysodren simply because she did not actually have elevated cortisol to begin with. Larger dogs often need a smaller mg/kg dose than do smaller dogs and will often load very fast on the regular 50mg/kg so that may have been a factor too.

I do share Susy's thought that the normal (very normal) cortisol levels on the UTK panel may be because the adrenals have not yet regenerated fully after the Lysodren overload. If that is the case then the production of other hormones may still be lower than it was pre-treatment too. How long adrenals take to regenerate is a real how-long-is-a-piece-of-string thing so time will tell if this is the case. Fingers crossed that what you have now is indeed a true picture though.

Alison

**Coolidge** · 05-14-2009, 03:00 PM

Re: Coolidge...

She underwent lysodren loading in Oct of 2008. She wound up with very, very low numbers on the ACTH test immediately following the loading.

Another followup ACTH test at the end of November showed the numbers till low.

Another followup ACTH test (Coolidges thirst had increased two fold) was done at the end of Dec. Numbers were rising, (don't have them but will get them), so my new vet thought we should begin maintenance. Gave her one pill on new year's day. Period. She immediately became very lethargic.

Mid Jan she had an ultrasound done at UW Madison Vet School. Adrenals were normal. (She was taken there because she had lost over 20 pounds between Oct and Jan 1st.)

While there, they discovered Coolidge had a UTI. Took three different antibiotics to get rid of it. Thirst decreased.

Never had a ACTH stim test done before Coolidge was loaded because the "specialist" said it wasn't necessary. She was basing her decision off of the Creatine Test and the LDDST. So I had no ACTH preloading numbers to reference.

So, it's now the middle of May. It's been over 4-1/2 months total since her last lysodren tablet. Can lysodren stay in the system that long?

added:

Crap. Can a dog have both atypical and pituitary based cushings at the same time? Just when I thought we had "the final answer"?
If things aren't bad, what is causing her symptoms? She was tested for Diabetes at the end of December.

All I know is this. I have spent $3000 on tests that have given me absolutely no answers.

**stardeb55** · 05-14-2009, 03:03 PM

Re: Coolidge...

Lyso normally peaks about 48 hours after the dose is given. Frankly, I don't think there's any way that Coolidge would even still have a trace amount of lysodren iin her system after this extended period of time, even if she is highly sensitive.

Debbie

**Wylie's Mom** · 05-15-2009, 02:59 PM

Re: Coolidge...

Originally posted by Coolidge View Post

Crap. Can a dog have both atypical and pituitary based cushings at the same time? Just when I thought we had "the final answer"?

Yes, it's possible (my pup is one of them

). I'm not a vet, but given the recent UTK panel & given how little Lysodren was used & how long it's been since Coolidge had any of it... I would think he does not have regular Cushing's...just a non-vet's opinion

.

-Susy

**stardeb55** · 05-15-2009, 03:04 PM

Re: Coolidge...

Yes, Harley is another Atypical + Pit Cushing's. I'm in total agreement with Susy that I, too, think that the problem for Coolidge from the beginning was Atypical, not Pit Cushing's, thus the bad reaction to the Lyso.

Debbie