Skin issues after treating w/ Trilostane - Simon has passed

[Simonsmomsays]

Hi my Simon & I are new to the site but not new to Cushing Simon strayed into our yard one day 6 years ago as an abused skinny unkept 8 month old chihuahua. Very timid & skittish. Simon on the other hand is very grateful & loves me like I have never been loved. It is mutual. Simon was diagnosed September 2013. I had researched his symptoms & cushings is what I came up w/ but our initial visit to the vet he suggested it was diabetes. Did very little as an examination took blood & I suggested it could also be cushings. The next day he called & said remember when we discussed Cushing well that's what it is. I said I remember when I discussed it. He then recommends an ACTH for $280, the initial panel was $195. I said okay thanks. Called my cousin a lg animal vet & ask if he would do the testing he said yes then called the vet & ask if he would use the tests from my cousin he said yes. However, I had researched this dreadful disease to know I didn't want to treat Simon w/ the poison drugs so we chose the alternative method of milk thistle, melatonin , lignin's.
. After 9 months of being untreated ( that's what they refer to the alternative method as being) his belly became more distended & he had trouble getting up & 1 night I notice his eye was closed @ he had trouble opening so I called the initial vet that I didn't return after the initial diagnosis, to for an appointment about his eye. Simon had lacerated the cornea deeply thrashing trying to get up at some point. The vet was treating the eye but would not address the cushings Simon didn't look good not was he acting right I called my cousin to schedule labs & the results were horrendous, infection pancreas, liver, kidneys... We were at vet for an eye check & he was giving a different med for the eye & I said pls look at these results & started to cry. He looked at them & we went on an antibiotic & vetoryl, mind you Simon had been in his office 3 times a week 2 weeks & he would address only the eye. After a few days on the vetoryl he also gave us denamarin after 4 weeks on both I had labs done again some levels were better some were worse. Simon has horrible sores under his arm pits that I can find nothing on. I think the Trilostane is causing the side effects he responded well at first but the 6 4th week was ravenous & drinking the water in excess again. The vet wants to do an ACTH test that my cousin can't do. Also treating the unknown skin issue w/ a topical steroid ointment? I don't think my vet is too familiar w/ cushings. Does anyone know what the skin disorder is & is it side effect of the meds or cushings.

[Renee]

Forgive me, but this sounds like a hot mess!

It sounds like cost may be a big factor for you (no judgement), so I encourage you to be very careful when you decide what you are going to do and how to allocate your funds. Treating incorrectly is worse than not treating at all, so please stop all meds (except the eye meds), and work on figuring out each issue at a time. Throwing all these different meds, without proper management, is very dangerous.

[Harley PoMMom]

Hi and welcome to you and Simon. Cushing's can be very difficult to diagnose, and unfortunately, it is often misdiagnosed. Since there isn't one test that is 100% accurate at diagnosing Cushing's a vet has to rely on multiple tests to confirm a Cushing's diangosis.

It would help a great deal if you would get copies of all tests that were done on Simon and post any abnormalities that are listed, we are especially interested in the results of any diagnostic and/or monitoring tests done for Cushing's. Were the tests for Cushing's performed while Simon was displaying signs of being ill? Was the pancreatitis confirmed with a spec cPL test?

Does Simon have diluted urine? How much does Simon weigh? What is the dose of Vetoryl he is taking and is it given once or twice a day? Some dogs with Cushing's can develop a skin issue known as Calcinosis cutis, which can be challenging to treat. Has the vet done a skin scraping or biopsy to try to identify Simon's skin problem?

Please know we are here to help in any way we can so do not hesitate to ask all the questions you want, ok?

Hugs, Lori

[molly muffin]

Hello and welcome, Lori has asked all the important questions that we need information on so that we can better help you to help Simon. Poor little guy, he is having a hard time.

Trilostane does not usually cause skin issues. Untreated high cortisol can cause skin problems, but it could be something else, such as a yeast infection on his skin and a skin scrapping should be able to tell you that. (maybe something your cousin can do and send off for you to find out)
We really need to see the test results, abnormal and range only, if it is all normal then you don't need to post it. And the date and unit of measurement too of course, something like this for example:

Nov- 2013
ALKP 550ug (range 50 - 150 ug)

That will get us started and hopefully help you to get this figured out.

Sharlene and molly muffin

[Meg_Elizabeth]

Welcome to the site! The women here are wonderful and so knowledgeable, they will help you tremendously! So glad you found the forum.

-Meg and Abby

[Simonsmomsays]

Thank u all but Lori to answer your ?'s Simon weighs 11lbs. His urine is diluted but it has never been tested, I can tell by quantity & he has accidents & it appears to be diluted. His initial panel in 9-13 ALP 579 ALT 803 phos elevated creatin 0.2- cholesterol 520+. Eye injury happened & I seen a rapid decline tested on June 12..ALT 959. Alk phos 8052,GGT 1102, chloride 99-,cholesterol 669, lipase 4253, WBC 23.4, RBC 4.6,MCV 80, platelets 995, nuetrophils 22932, lymphocytes 468-, eye healed , went on antibiotics , vetoryl, denamarin next panel July 22, AST 133/81 last test, ALT 1652/959, alk phos 4823/8052, GGT 1080/1102, creatinine 0.4/0.3, calcium up to 10.1, chloride 97-, cholesterol 786, amylase dropped to 294 still normal but was 1010, lipase 598/4253 WBC 14.8, RBC 5, MCV 82, platelets 773, neutrophil is 13774/22932. Everything is down except AST & ALT. ACTH was pituatary & I'm not sure of the values on that test but it was 10.8. I was under the impression the liver counts that are elevated now indicate liver damage. The vet has barely touched him, he said once the belly enlargement was due to ascites. And the test he wants to preform this weekend is the only thing other then the meds that he's suggested. I would like to start supplements & ween him off the Trilostane. When he had the eye injury he said it was lacerated thru 9 layers & he was amazingly tough. Not knowing what the first 8 months of his life was like I can assure u it wasn't too good, I took him to a vet for a scan when he showed up to see if he was chipped & he didn't have a tail. I wasn't sure why but the vet ask me to not seek owners because tail was mutilated & he has scars in random areas, i was told he may of been bait for pit fighting. To answer the question regarding $, it is definitely an issue as is my concern for my vet of 32 years and ha knowledge regarding cushings. Thank u all for responding & I pray the results may shine a new light on my little lover! He's usually perfect at the vets & this last visit he shook & didn't like getting his temp taken or nothing, truly he's like the best patient.

[Harley PoMMom]

Eye injury happened & I seen a rapid decline tested on June 12..ALT 959. Alk phos 8052,GGT 1102, chloride 99-,cholesterol 669, lipase 4253, WBC 23.4, RBC 4.6,MCV 80, platelets 995, nuetrophils 22932, lymphocytes 468-, eye healed , went on antibiotics , vetoryl, denamarin next panel July 22, AST 133/81 last test, ALT 1652/959, alk phos 4823/8052, GGT 1080/1102, creatinine 0.4/0.3, calcium up to 10.1, chloride 97-, cholesterol 786, amylase dropped to 294 still normal but was 1010, lipase 598/4253 WBC 14.8, RBC 5, MCV 82, platelets 773, neutrophil is 13774/22932.

With those liver enzyme values, specifically the ALT, GGT, AST, so elevated I also believe that this is a liver issue. If this were me, I would put the Cushing's on the back burner and focus on treating Simon's liver.

I am providing a link to an article from the DogAware site that has a wealth of information regarding treatment and diet for canine liver disease: Liver Disease in Dogs (http://www.dogaware.com/health/liver.html)

Also here is a link on how canine liver disease should be diagnosed: DIAGNOSING LIVER DISEASE A ROUNDTABLE DISCUSSION (http://www.idexx.it/pdf/it_it/smallanimal/vetlab/catalyst/diagnosing-liver-disease.pdf)

Hugs, Lori

[Simonsmomsays]

Cushings doesn't normally affect the liver in the manor it has Simons? I thought I had researched thoroughly & I did look into liver disease because he had symptoms that correlated w/ it. The vet wanted to do an ACTH Friday where i bring him in 4 hrs after vetoryl they draw blood give him some medicine & then draw it again. What does that test determine do u know? I was going to send a photo of the skin. It doesn't seem to be responding to the steroid but I had been using desitin & it was clearing up. Again I thank u Lori for all ur help & advice. I will check out the other links u provided for me & I am thankful for this site & the knowledge u all share...
Simonsmomsays

[Harley PoMMom]

Normally with canine Cushing's we do not see such high levels in the ALT, GGT, and AST. Regarding the liver enzymes in a dog with Cushing's we typically only see high elevations in the ALP and sometimes the ALT may be moderately elevated.

An ACTH stimulation test is performed to monitor a dog on treatment for Cushing's, and the stimulating agent used is generally Cortrosyn. An ACTH stimulation test measures how well the adrenal glands respond to the Cortrosyn injection. There are two blood draws, one taken before the Cortrosyn injection which is known as the "pre/baseline" number and second draw done 1 hour after the Cortrosyn injection, which is called the "post" number.

Hugs, Lori

[molly muffin]

Hi, just checking to see what the vet had to say on Friday and did they go ahead and do the ACTH test?

Lori is right, ALKP and ALT are the two main enzymes that rise with cushings. The others being raised in addition is like raising a red flag, saying this needs to be looked at.

Sharlene and molly muffin

[molly muffin]

I am very sorry to find out that your sweet Simon, your dearest friend has passed.
My sincerest condolences on your loss.

hugs
Sharlene and molly muffin

[Robert]

Praying for Simon and you. RIP SImon

[Dixie'sMom]

I'm so sorry to hear of your loss. It sounds like Simon had a pretty tough life before finding you and your family. I'm sorry he wasn't able to be with you longer. Hugs and Prayers. Rest in Peace, Sweet Simon.

[pansywags]

I am so very sorry for your loss. No matter how much time we have together, it's never enough. Treasure the happy memories.

[scoora]

I am so sorry to hear of the loss of your sweet boy Simon.
My thoughts and prayers are with you.
Hugs

[Harley PoMMom]

I am so sorry for the loss of your beloved Simon and my heart goes out to you at this painful time. Please know that we are here for you and do understand how you feel.

With Heartfelt Sympathy,
Lori

[doxiesrock912]

My sincere condolences on your loss of Simon.
I pray that someday soon they have a breakthrough for this horrible disease that claims so many.

Simon has many angels waiting to greet him.