hair and coat problems (13 y/o chow/shepherd mix)

[dogmom]

I'm new to this forum. I have a 13 yr old chow/shepherd mix, diagnosed with Cushings 3 years ago. She has been on Vetoryl for 2 1/2 yrs. Her coat is thinning significantly, and she has bare spots now on her chest and legs, as well as black calloused areas on the elbows and knees, etc. I'm afraid she is going to lose all of her coat. She has already lost most of the hair from her tail. Any suggestions would be most welcome! My vet says this is just part of the progression of Cushing's disease.

[StarDeb55]

Welcome to you & your pup! The first thing I need to ask you to do si to check your e-mail, especially your spam or junk e-mail for a note from k9cushings. com that you will need to answer so we can get your membership approved.

Now, your vet is kind of right, but not exactly. This sounds like your pup may be developing a problem called calcinosis cutis which is basically diagnostic for Cushing's. The following link will give you a little more information.

http://www.countryfriendsvetclinic.com/showpracfaq.cfm?FAQID=163&Private=0

It would also help us greatly, if you could post a picture of what these lesions or callouses look like. The other thing that will help us to give you the best feedback possible is to round up all the of the tests that were done to diagnose the Cushing's & post them for us. We are really numbers kinds of folks, & we love information.

Again, welcome!! We are here to help in any way we can.

Debbie

[Harley PoMMom]

Hi and welcome from me as well!

Skin abnormality and hair loss can be a symptom of a thyroid problem, has a thyroid issue been ruled out?

Like Debbie has mentioned, posting the results of all test/s that were done would help us to provide you with more meaningful feedback.

Please know we will help in any way we can so feel free to ask any and all questions.

Love and hugs,
Lori

[dogmom]

Thank you so much for your responses. I have felt so helpless as I watch my beautiful baby decline. I will gather up all of the info from the vet tests and get those posted. I have a huge file folder of lab work results. Besides the Vetoryl, Sophie is also on thyroid meds, Rimadyl, and Proin, and has been taking Dasuquin. I feed her Innova dry and wet. The vet suggested we decrease her Vetoryl to 3 X a week due to some vomiting she was having, so she has been on only 3 capsules a week for over 6 months now. She has had an ultrasound of the abdomen and I will also post those results when I post the lab work. Again, thank you so much for your input. I don't feel so alone anymore navigating these unknown waters. This has been a heart- breaking ordeal. I'll be back with test results....

[lulusmom]

Hi and welcome to the forum.

I'm sorry for the circumstances that brought you here but I'm glad you found us. You are not alone and we're going to do all we can to help you and Sophie.

If a cushdog's cortisol is properly controlled throughout the day and the usual symptoms associated with cushing's have improved, there should be no progression of the disease. The fact that your vet told you that is what is happening to your dog is concerning. Also surprising is the unorthodox dosing schedule, as well as prescribing a dosing change based on vomiting rather than appropriate bloodwork.

Coat and skin problems can take several months to resolve but a dog that has been treating for 2 1/2 years and is well controlled should not be losing their coat. The hair loss pattern in a cushingoid dog is usually symmetrical along the torso, including the tail, but sparing the head, legs and feet. I often wondered why that is and apparently the University of Utrecht did too. They did a study and determined that the reason cushdogs lose hair on their torso and tail is because these are the areas with the greatest concentration of sex hormones. Dog with cushing's always have elevations in sex hormones and why these hair follicles atrophy because of these elevations wasn't part of the study. I hate it when I only find a partial answer to things. :D

Did your vet do anything to rule out other causes for the hair loss, such as a skin scraping to rule out demodex mange? Cushdogs who are not well controlled have a compromised immune system which will leave a pup open to infection and mite infestation. Vomiting and hair loss are also side effects of Rimadyl. Is your vet positive this isn't causing some of Sophie's problems? Rimadyl is tough on the stomach and the liver and any dog taking it should have their liver enzymes tested routinely. Is this being done for Sophie? How long has Sophie been on Proin? If it was prescribed for incontinence after starting treatment with Vetoryl, did your vet make certain that cushing's was not the cause?

With respect to Calcinosis Cutis, I agree with Debbie that this could be a distinct possibility but again, the pattern doesn't fit, or at least it doesn't fit the pattern I've seen here. It can show up anywhere but the few members' dogs who have had this condition, I recall that it was primarily on the back of the neck and the back. I checked and the Merck Veterinary Manual and it does say that this is the usual pattern. I'm hoping that Angela, a member who is very familiar with this condition, will drop in and share her experience with you.

It will be very helpful if you inundate us with as much information as possible. In addition to the results of the tests done to diagnose your dog, please post the results of all acth stimulation tests done after starting treatment.

Looking forward to hearing more about your precious Sophie.

Glynda

[Squirt's Mom]

Hi and welcome to you and Sophie! :)

Debbie and Addy have gotten you started nicely with our usual 20 questions. :D But I have a couple more - what dose of Trilostane (Vetoryl) is Sophie taking? How much does she weigh? The test results will answer most of the others. ;)

No, honey, you and Sophie are no longer alone on this journey. You have found an amazing group of folks with an astounding array of experience and knowledge who are more than willing to share. And you cannot find a more caring, supportive bunch anywhere. We will be with you every step of the way. We will hold your hand when needed until it drips with sweat; we will laugh with you and cry with you. We are a family here and I am so glad you and Sophie are now a part of us.

Keep your chin up!
Hugs,
Leslie and the gang

[Sabre's Mum]

Welcome to you and Sophie!

I had a Hungarian Vizsla who had calcinosis cutis extensively. I would have to agree with my experience and what I have researched over nearly four years that generally the pattern that you will find with calcinosis cutis is that it forms in areas from the back of the neck down to the tail. Sabre also had spots under his ears - near the ear canals, in between his back legs, around his anus (where he had a bad case of pyoderma) and some on his sides. It can start in areas where there has been some form of foreign trauma - such as an injection site - which is actually where Sabre's first area developed after his vacination. What I saw initially was a thickened area of skin - waxy to white looking, eventually this thickened and hardened - in some spots there was a darkened blood look and some places these turned into pustles and weeped.

I find this picture to be the best at depicting calcinosis cutis in it's early stages-

http://en.wikipedia.org/wiki/File:Calcinosis_cutis_dog.jpg

The only real way of find out exactly what the lesions are - is to have a biopsy done.

I just type a long paragraph on Sabre's treatment and the progression of the hair loss and his calcinosis cutis but then I re-read your post and see that Sophie has been on Vetoryl for 2 1/2 years. Probably a good place to start is a history on her ACTH test numbers and dosages.

Take care
Angela

[dogmom]

Sophie weighs 58 lbs. Her dosage is: Rimadyl 100mg 1 x daily, Proin 50mg 1 x daily, soloxine 0.6 2 x daily, and Vetoryl 60 mg M/W/F. Re/ the hair loss: I have addressed this with the vet on numerous occasions. The vet has prescribed Clavamox. No biopsy has been done. This started with Sophie losing her hair from around her neck, under her collar, about a year ago. The vet suggested I take her collar off, that it was exacerbating the hair loss. At this time Sophie was just starting to get the black calloused places on her elbows and back of her back legs. She has since gotten much worse and now has bare places on her legs, chest, and at the base of her ears. She does lick the places she can get to. Some of the skin is very flaky in appearance and the fur will actually pull back. Her coat is thinning out too, and her tail is almost bare of fur. One side note: I used to give Sophie Frontline. I quit a year ago when I noticed that the hair on her shoulder blades where the Frontline was given was thinning out and changing texture. It is now almost bare. I mentioned this to the vet and suggested that this was a sign to me that this medicine was toxic to Sophie. Just a thought....

The ultrasound of the abdomen was done in January of this year. Results: degenerative renal disease, cystitis, liver enlarged, both adrenals enlarged. Her lab work shows ALT 153 GGT 28 Lipase 905, platelet 501, and T4 5.3. (I am only giving the ones that were high.)

Her last ACTH counts from Jan 2011 were: sample 1: 2.7, sample 2: 3.2. (Sophie was moved down to 60 mg of Vetoryl from 80 after this test was done in Jan of this year.) Prior to starting Vetoryl in 2009, her Cortisol Serial 2 (ACTH) counts were: Sample 1: 3.0, sample 2: 22.8. She also had a Urine Cortisol/Creatine Ratio test at that time and it was 45.2.

Sophie has become very weak in her back end but she is still able to go out the doggie door to go to the bathroom. She lays down to eat, and to drink water. She has weakened significantly in conjunction with her skin condition declining, so I do not know if this is Cushing's related, general aging, or if it med related.

I know this is alot to read....thank you for your time and for your suggestions. I had intended to call my vet tomorrow to again see if there is anything we can do about this skin problem. I will ask about a biopsy. Thank you so much!!

[dogmom]

I forgot to answer that Sophie has been on Proin for over 2 years. She was leaking and dripping urine and licking herself persistently. She has had numerous UTI's. Since being on the Proin the leaking has stopped. She has been on Rimadyl for over 2 years also. I addressed the high liver counts with the vet re/Rimadyl but she felt that the benefit of pain relief outweighed the side effects to the liver so I kept her on it. I am questioning whether changing the Vetoryl dosage to 3 x a week could be exacerbating the skin problem. I will ask that tomorrow also when I call the vet.

[lulusmom]

Thank you for the additional information. It looks like all testing and labwork was done at least 10 months ago. Is that correct? If not, when was the last blood chemistry and acth stimulation tests done?

I just noticed that Sophie is a Chow mix. Nordic/Spritz breeds, like Chow Chows, are predisposed to alopecia X so this is distinct possibility. I have a Pomeranian, also a nordic breed, who is as bald as can be and has black skin all over her body. If cushing's is well controlled and skin scraping and biopsy are negative, it is a possibility that this is what you are dealing with.

I think I understood correctly but can you confirm that your vet has not done a scraping or a biopsy to try to determine the cause of the problem and has prescribed clavamox in the hopes it might help whatever is going on? Have you considered a consult with a veterinary dermatologist? Most, if not all, dermatologists are well versed in cushing's and the coat and skin issues that come with it. One of the best cushing's vet I know is a veterinary dermatologist and she treats a lot of cushdogs.

Without the benefit of the normal reference ranges, it's difficult to tell how elevated the values are that you posted but the high T-4 caught my eye. When is the last time your vet checked Sophie's thyroid levels? Did your vet adjust the thryoid meds downward at that time?

[dogmom]

Thank you so much for your response. Yes you are correct that the T4 was high. The reference range was 1.0-4.0. The vet did not lower her dose at that time because Sophie was lethargic. And yes you are correct that the latest lab work was done 1/11/11, as well as the latest ACTH test. No skin biopsy has been done, but her coat and skin has worsened significantly since her last vet visit in Jan. In April of this year I did take pictures with my cell phone and show it to the vet re/skin and coat areas I was worried about. One place was on Sophie's neck area where the fur was flaky and where I could actually pull the fur away. She prescribed Clavamox at that time. (It is difficult now to try to get Sophie to the vet as she cannot get in and out of the car and I am unable to pick her up so the vet agreed to let me bring in the cell pics instead.) I have a call in to my vet this morning and plan to ask re/the Vetoryl dosage and the skin/coat issue. I will mention the alopecia possibility and I thank you for that advice. I will have to get Sophie in to the vet somehow for a skin biopsy. I will also ask if there is a dermatology specialist vet in the area. (I live in Houston Tx.) That would be wonderful to be able to see a specialist. I will post a reply when I hear back from my vet. THANK YOU!!!!!!

[lulusmom]

I am very concerned for Sophie and I am shocked that your vet has not done any bloodwork on her for almost a year. An ACTH stimulation test should have been done 14 days after starting treatment, again at 30 days and if levels are within range, again at 90 days. ACTH stimulation tests should be done routinely thereafter, preferrably every 3 months but no longer than six months. Given that she has had no monitoring for treatment of cushing's, I would recommend that you get her to an internal medicine specialist as soon as you can. I am also taken aback by your vet prescribing meds based on a picture taken on a cellphone. Any number of things can be wrong with Sophie and without appropriate testing, she can continue to decline. High cortisol can eventually shut down the immune system and leave a dog open to infection and most certainly mite infestation. Low cortisol can be extremely serious, even life threatening. Most specialists require a referral from your vet and I'm sure s/he will give you one. Here is a copy of a screen reflecting internal medicine specialists in or surrounding the Houston area.

http://www.acvim.org/websites/acvim/index.php?p=228

Texas A & M is great but I think that's a few hundred miles for you. I just checked out Bay Area Veterinary Specialists in Houston and I this might be a good place. They have internal medicine specialists as well as dermatology specialists. Do you have anybody that will help you get Sophie in and out of the car so you can get her to a vet?

http://www.bayareaveterinaryspecialists.com/

[Squirt's Mom]

I, too, am shocked at your vet's treatment of Sophie...all around! :eek: Bless her heart, and yours! :(

Has anything been said or done about the degenerative renal disease found on the U/S? When the kidneys are compromised, it is even more important to take care with the drugs used to treat Cushing's. This definitely needs to be looked into, soon. Do you have any test results for BUN, creatinine and/or the ratio for these two, phophorus/calcium levels? Would you mind posting all the lab results that are abnormal, both too low and too high? Please include normal ranges and units of measurement (ug/dl, nmol/l, etc.).

Her thyroid levels need to be checked asap, too. There is no telling what her levels are now...that last result was too high and her meds were not adjusted. :rolleyes: Thyroid issues can cause many of the same signs as Cushing's, including hair loss, so it is important to make sure this condition is under control at all times.

I agree with Glynda - get this baby to a specialist as soon as you can. I will also add - run, run very fast from the vet you have been using. It has been the misfortune of many of us to discover that our beloved long-time vets had no idea how to handle a cush pup...often with serious or disastrous results. Sophie deserves so much better care than she has gotten so far - and you deserve someone who will take the time and effort needed to work with you to help her regain her life. ;)

Hugs,
Leslie and the gang

[dogmom]

I was able to locate a dermatologist vet from the link you provided. Thank you very much! Re/ the latest lab work: (1/11/2011): bun was 17 (6-31 range), creatinine was 0.9 (0.5-1.6 range), and the bun/creatinine ratio was 19 (4-27 range). Phosphorus was 4.9 (2.5-6.0 range) and calcium was 10.0 (8.9-11.4 range). All of these were normal. There were no low counts for any of the lab work. The high counts I gave in the prior post but did not include the ranges: ALT 153, range 12-118; GGT 28, range 1-12; lipase 905, range 77-695; and platelets 501, range 170-400. Re/ the monitoring of vetoryl dosage, Sophie was diagnosed with Cushings 3/13/09 and started Vetoryl in June of 2009. (I was reluctant to begin medication until I researched all options.) After she started meds the vet did monitor her and do the necessary ACTH Response tests until we got the dosage correct....60 mg. seemed to work best. I did not include that info in my prior posts! You are correct however in that she has not been tested in 10 months now, and yes that the vet's recommendation to give her meds only 3 days a week due to the vomiting and diarrhea was done with out ACTH testing. I called my vet today and discussed my concerns and I will be taking Sophie in for lab work and ACTH testing and a skin biopsy. She wants to increase Sophie's meds to every other day to see if the skin issue will improve. I also discussed a referral to a specialist. You have been very helpful and I appreciate so much the support and the input. This is a wonderful forum and I am ever grateful! I feel like I am moving in the right direction to get Sophie the care she needs. Thank you!!

[Cyn719]

You are doing a great job for sure!!! Its alot to handle and take in -- A specialist is the best right now -- I learned the hard way and should of gone to a IMS a long time ago -- everyone on this forum is wonderful and I finally got Penny to a new vet -- hope all goes well - will check back -- Hugssss xo