INSTRUCTIONS FOR THE MEDICAL TREATMENT OF CUSHING'S DISEASE

Treatment of this form involves an initiating phase and a maintenance phase. The initiating phase arrests the disease and restores the dog to a more normal state. Some of the clinical signs, especially increased food and water intake, should stop within the first 1-3 weeks. Other signs, such as a poor hair coat or a bloated abdomen, may take several weeks or months to correct. The maintenance phase represents the phase of long-term therapy. This phase lasts the rest of the dog's life.

You must continually monitor your dog's food and water intake. We expect both to return to a normal level. Water intake should be less than 1 oz per pound (66 cc per kilogram) of body weight per day, but don't limit the water if your dog needs to drink more. For your dog this amounts to _________________. The food amount should be measured each day. At least two feedings per day are preferred.

Initiating Phase

1. Give ________ Lysodren tablet(s) one time per day beginning on _______________ for 9 days or until one of the following occurs:

a) Your dog's water intake drops to the 1 oz per pound (66 cc per kilogram) per day level or ___________ per day.

b) Your dog's appetite returns to normal or it takes 15-30 minutes to eat when it would normally eat in much less time.

c) Your dog does not eat a regular meal.

d) Your dog vomits.

e) Your dog has diarrhea.

e) Your dog becomes unusually listless.

2. Return in nine days or when one of the above occurs for another ACTH stimulation test. This test should be done early in the morning and will require your dog to be in the hospital for about 4-5 hours. If the test is abnormal, the initiating phase will continue. If the test is normal, the maintenance phase will begin.

3. If loss of appetite, vomiting, diarrhea, or listlessness occurs, give________ tablet(s) (_______ mg) of hydrocortisone twice daily for two days. DISCONTINUE THE LYSODREN TABLETS. If vomiting prevents oral administration, your dog must be seen by a veterinarian for administration of proper medication by injection. When you begin this treatment, please call us for consultation and instructions.

Following the first two days of treatment with ________ tablet(s) twice daily, give ________ tablet(s) twice daily for two more days, then ________ tablet(s) twice daily for three days, then ________ tablet(s) once every other day for one week. At the end of that time, make an appointment so we can assess the situation and give you further instructions on Lysodren administration.

4. Report any other changes in your dog's behavior that are out of the ordinary. This disease and this treatment can result in several abnormal behaviors. However, your dog can also have other diseases that occur concurrently but independently of Cushing's Disease. It is important that we differentiate between the two situations so that proper treatment can be taken.

5. Stay cautiously optimistic. This is a serious disease, but many dogs with Cushing's Disease enjoy a greatly improved quality of life for many years.

Maintenance Phase

When regulated, your dog will take Lysodren approximately once weekly. An ACTH stimulation test will be necessary about every 3-4 months to be sure that regulation is satisfactory. At the appropriate time, the specifics of the maintenance phase will be explained. Give _________ tablet(s) every ________ days.

Please contact us for more information.