Questions about Cushing Meds

[michaeljlynch]

Hello,

I have a Sheltie whose 8 years old who has a-typical cushings. This is on the adrenal gland and we have done all sorts of blood tests to confirm. The only test we haven't done is to send a blood sample to the Univeristy of Tennesee.

We know it's cushings because she is losing her fur and having multiple skin infections. Previously we tried all sorts of meds from kflex to many others.

Our vet wants to pur her on Lysodern but we know the dangers of it. We know that the Lysodern might kill her, and also we have to monitor with blood tests. Something honestly we can't afford right now. I was doing some reading through the FDA and they mentioned Vetroyl as a treatment option and is the only one that is approved to cure both kinds of cushings.

My Vet mentioned that the only reason why Vetroyl is used more is just because it's approved for animal use. Lysodern is an off the label medication that is normally given to humans and not animals. He told us as long as you watch her when she eats everything should be good. If she doesn't want to eat or she throws it up then we have to stop the meds.

When I talked to the vet about Vetroyl he said that Vetroyl is just as dangerous as Lysodern, the advantage with Lysodern is you can load it and then use a maintain dose later on. In terms of money, Vetroyl is about $100 US, whereas Lysodern is about $10. I don't mind paying more for medicine I just don't want to lose my Shelite due to a complicated medication.

I have trusted my vet for over 2 years, with my Shelite but I'm not really trusting him on this.

Since this is a cushings forum, is there any advice that someone can give me.

Thanks

[doxiesrock912]

Michael,
I would do the UPenn test to be sure that your dog has Atypical Cushings.
Lysodren and Vetoryl are not the only treatment options. Also, unfortunately too many vets are not as familiar with Cushings as we would hope. I had the same problem until I took Daisy to Cornell University Veterinary Specialist and met with an IMS (small animal specialist) vet. I would consult one in your area for a second opinion. When you have the tests results, please post the abnormal values here so that someone can help to review them for you.


It is important to determine which type she has before proceeding and Cushings progresses slowly so you don't have to decide on treatment right this minute.

This link is to a story about one particular Cushings case and has great information. http://www.sunshadethesuperdale.com/2013/03/cushings-disease-hyperadrenalcorticism.html

[michaeljlynch]

Hello Doxie,

Her levels I remember where at a 6.2. The test was done well over a year ago. Our dog has been like this for 3 years almost. Though it's progressively getting worse and that is why our doctor wants to put her on the medications.

We went to two IMS doctors already, one of them is our vet and another was out of the area. Our vet is actually considered one of the better IMS doctors in the county.

Both doctors have stated it's not normal cushings but the adrenal kind. We did a liver test too and that is also how we knew it was adrenal kind. Her problem is that she has sores all over her skin. We have had to shave her many times over the last couple years. Our doctor still thinks it might be pollen allergies, but we know that's just a wild guess. We have used just about everything in terms of meds, and even switched her food multiple times. Went with grain free bison, venison, and duck over the last couple years. Dog eats better than us.

I know our vet is very familiar with cushings. He treats a lot of animals with cushings. The thing is cushings is very expensive, and we know that the blood tests needed for the medications and stuff is going to make us go broke. We are not giving up on her, I'll go broke if I have to. But I just to make sure on the right treatment, because I don't want her to die. We lost one Shelite a few years ago for undergrown kidneys that our last vet never caught. She lived to 9, this one is 8. We have another Sheltie whose 2 right now, but she hasn't shown any issues yet of anything.

Also, not to complicate things, but our 8 year old also has staf infections in the form of MRSA.

[doxiesrock912]

Michael,
Has your vet ever done an ultrasound to see how her organs are doing?
The sores are most likely CC which happens when Cushings is not properly controlled.

http://www.vcahospitals.com/main/pet-health-information/article/animal-health/skin-calcinosis-circumscripta-and-cutis/590

Ok, I understand more now. Although your current IMS knows about Cushings, with her other illnesses obviously things are more complicated. There is a specialist who often consults on difficult cases and if you think that your IMS would be willing, I would still do the UPenn panel and an ultrasound and definitely reach out to Dr. David Bruyette (David.Bruyette@vcahospitals.com).

[hfurlotte]

Hi Michael,
We lost our beloved Zoe Claire in Jan this year she was diagnosed as Atypical pituitary dependant. In Canada there is no place that does the full adrenal panel and on researching myself I found this group and learned about the University of Tennessee they actually were doing studies about hormonal effects included atypical. Once we had it confirmed we treated Zoe with Ketokonazole( used as an anti fungal) however they proved it also helped with hormone imbalance seen in atypical pups. In conjunction we also gave her melatonin and flax linens. She was on that combination with absolutely no toxicity to her liver or other organs. We found her sores on her mouth and skin cleared up and her moods were much more stable. The cost per month was about 70 dollars and every three months we had her blood work done for liver kidney etc. when things started to back slide our vet called Dr Jack Oliver (RIP) at the university to discuss her and he suggested repeat after two weeks off her meds. I know it is so frustrating wanting answers and not getting them. I would definitely have the blood work done so you can have the best options on how to proceed.
Not sure if any of this helps you but we are thankful we had a definite diagnosis. We have a 10 1/2 year old black lab that is getting sick so we are in a similar situation here. Good luck a sending positive thoughts your way.

Heather (Zoe Claire atypical Cushings angel)

[michaeljlynch]

Doxie,

Over here in San Diego where we are at, no vet does ultrasounds unless you go the emergency hospital. And those are expensive. We know when we took our last Sheltie for her undergrown kidneys, the emergency hospital was the only one that found her kidneys in the issue that they were. It cost us nearly $2000 just for testing and for her to live 3 more days. We ended up putting her down, 7 days before her birthday in which she would have been 10.

This is why we are taking such good care of other dogs because we feel that while we were good to the one we lost, we knew we could do better.

I'll talk to my vet in the days about maybe doing some communication and correspondence with the vet you mentioned. I will email him as well this week to see what can be done.

As for CC - That's basically it. It's a rare form of the a-typical cushings, but the CC is common in the San Diego area thanks to the airborne diseases we have over here. As for control, that is something we have been working very hard on. Our vet is very good at this its just that the resources in our area are not available to treat conditions like this. We are lucky we have a vet who knows about it and his team of doctors know just as much as he does or more. Our vet has said many times that it's CC over the years. That is why we have given her so many antibiotics including cefalexin, cornenfincal, primeor and many others.

[doxiesrock912]

Michael,
Some on the forum have had success with this shampoo http://www.amazon.com/s/ref=nb_sb_noss_2?url=search-alias%3Daps&field-keywords=Keto+Chlor&rh=i%3Aaps%2Ck%3AKeto+Chlor

I believe that there are also wipes and a topical ointment. Worth asking the vet about.

[michaeljlynch]

Heather,

The melatonin and flax seed lignan is something we have been using for the last couple years. We read a blog about it and we tried. It actually worked for a little bit, we saw much more hair growth and more energy too. Though now just like everything else, it's not working anymore.

That's is where we are lost, we know she is doing fine because she eats, and her activity level is very high. She is always playing with us or with the little one. It's nice to hear their pitter patter all over the house. For nearly 2 years, the one who has Cushings never played around the house. It took the medications plus the flax seed lignans to really make her move around.

The University of Tennesse study is the right way to go, but the test alone is $400. Something that is difficult for us to afford. While $400 isn't a lot of money, for us its 2 weeks pay as my job is on pay cut mode right now until the company can get more money to pay their employees.

We are lucky that there are no sores near her organs. She does a blood test, usually, every few months. Probably should do another one soon. The newest ones are forming around her chest, and we found two cysts this week on her. One on her elbow and another one on her tail. Vet said that neither is cancerous, but this is something over the years we have discovered and that is the formation of these cysts. The only way to remove them is either through surgery to cut them off or they naturally just go away. I personally don't know if this is related to the cushings though.

The biggest issue right now is getting the right medications. I want to make sure she lives, she might be sick but she is in very good health otherwise. I know she can overcome this and that is why I'm asking the community for assistance.

[michaeljlynch]

Doxie,

Thank you for the link. I think we have something similar that the other vet in San Diego who was a dermatologist gave us.

If we don't have it, I'm going to order that. That might help her.

[doxiesrock912]

It's worth a try. Look for the ointment too. I know that several on here have had great results with it.
Have you applied for Care Credit? Many vets take it and you can pay monthly.

[michaeljlynch]

Our vets around here don't take anything but cash. No dog insurance or anything. I wish they would take this, but they don't. The place we go to is the most popular too in the area, and they just opened less than 3 years ago. I know I'm trying to get a deal with my company to become their payment processor so that we can offer things like this.

[doxiesrock912]

Cash only? That's crazy Michael!
How do they expect people to keep their pets healthy. Ridiculous.

[michaeljlynch]

Forgot to mention. Of course debit and credit cards too.

Most vets out here even the emergency vets don't accept anything else. Its just not a standard here.


Cash only? That's crazy Michael!
How do they expect people to keep their pets healthy. Ridiculous.

[Squirt's Mom]

Hi Michael and welcome to you and your baby girl! :)

First, if there is a tumor on the adrenal gland(s), it is NOT Atypical but conventional Cushing's - the form called ADH or Adrenal Dependent Hyperadrenocorticism. Another possibility with an adrenal tumor that is NOT related to Cushing's is a Pheochromocytoma, or Pheo. It is critical that you know which type of tumor is on the adrenal gland because you do not treat a Pheo with Cushing's meds, Lysodren nor Vetoryl (Trilostane).

Second, do not waste you money on the UTK panel since you already know there is a tumor on the gland. The UTK test looks at intermediate hormones along with cortisol and is used when all other cush tests are negative but signs still persist. You do not need the UTK. ;)

As for the meds, I personally prefer Lysodren and should I ever have another cush pup that will be what we choose. Lysodren has been around for a long time and is well established. Vetoryl is the new kid on the block in cush treatments and we are still learning how it works and the effects it has on the system. We know what Lyso does. Lsyo is easier to use in my mind and less expensive to use because it typically does not require dose tweaking like Vetoryl frequently does. And after ever dose change the testing schedule to monitor starts all over again...meaning more tests with Vetoryl than with Lyso typically. And your vet is absolutely correct - Vetoryl has the exact same risks as Lyso. The one thing that makes it SEEM safer is Vetoryl's short life in the body.

It would help us a great deal if you would get copies of all the testing done so far and post the actual results here. Please include all the little letters like mnol/l that follow the numbers and include the normal ranges for each.

Please tell us more about your babies general health. Does she have any other health issues that you know of?

Is she on any meds, supplements, herbs, etc?

What prompted the vet to check for Cushing's in the first place?

How much does she weigh?

Is she spayed?

Was her blood pressure checked?

Did they rule out hypothyroidism and diabetes?

I cannot recommend the ultrasound strongly enough. Without the US you will never know what is on the adrenal gland and you really need to know that. Plus the US will let them look at other organs to make sure they seem ok. This one test give the biggest bang for the buck and would be MUCH more beneficial to your baby and you than the UTK panel. ;)

I think someone is pulling your leg about payments in CA and the availability of US machines. Your vet may not accept anything but cash but that is not true for all of CA. We have had too many members out there using all sorts of payments, including, I believe, Credit Care. So I would do a bit of research on that on my own. Also you are in the town of one of the best vet schools around - UC Davis. I would be contacting them today and see about getting that ultrasound asap.

I'm glad you found us and look forward to learning more about your sweet girl.
Hugs,
Leslie and the gang

[labblab]

Hi Michael and welcome!

I just want to expand a bit on what Leslie has written. I agree that if your dog has been confirmed to suffer from high cortisol, then there is little value in proceeding with the UTenn adrenal panel testing. But this is the part I am not clear about: do you have test results that actually reflect high cortisol? Also, do you have any test results that actually confirm the presence of an adrenal tumor? This would typically require either an abdominal ultrasound or an endogenous ACTH test (this is a different test from an ACTH stimulation test).

Elevated cortisol can be caused by either a pituitary or adrenal tumor. By far, the most common cause is a pituitary tumor. So if you have evidence of an adrenal tumor, perhaps that is what your vet means by saying your dog is a less typical case. But as Leslie says, the formal diagnosis of "Atypical Cushing's" is reserved for dogs who suffer symptoms from other elevated adrenal hormones but the cortisol is normal. And just like for elevated cortisol, other adrenal hormone elevations can be caused by either a pituitary or adrenal tumor. So that's why I'm wondering exactly what the nature of the test results have been so far -- whether there is evidence of elevated cortisol, and whether there is evidence of an adrenal tumor (as opposed to a pituitary tumor). Your dog can, in fact, have an adrenal tumor that is associated with other elevated adrenal hormones but normal cortisol levels.


Adrenal steroid profiles reveal that adrenal tumors in dogs, cats and ferrets have a variety of secretory patterns, with serum cortisol levels often being normal.

Here's a really great article that helps make more sense of the symptoms and diagnostics associated with "Atypical Cushing's" (elevated adrenal hormones other than cortisol):

http://veterinarynews.dvm360.com/newer-tests-shed-light-causes-treatment-adrenal-disorders?id=&sk=&date=&&pageID=1

Before going further, I'll be anxious to hear back from you re: as many specifics as you can give us about your girl's diagnosis.

Marianne

[Renee]

There is so much misinformation in this thread, it is scary! The other resident experts have weighed in on the misinformation in regards to cushings (both typical and atypical), so I will just say my piece about the CC.

CC is generally diagnosed through biopsy, although I do believe some vets are comfortable diagnosing through examination only. Did your vet do a biopsy on the lesions? CC is NOT a 'rare form of the a-typical cushings' as you have stated. CC is a direct result of too much cortisol or steroid in the body (and other much less common causes). It happens to dogs with typical cushings, and although it is considered rare, it appears to be happening more frequently. It CANNOT be cured by abx either, so I am confused why your vet has frequently prescribed abx over the years, other than to clear the secondary infections that almost always set in when dealing with CC. The only way to 'cure' CC is to get the cortisol into the lower end of the therapeutic range, which is generally less than 5ug/dL.

I would also like to know how CC is more prevalent in your area due to increased airborne diseases? CC is not communicable and cannot be transferred; how do airborne diseases impact it's prevalence?

[michaeljlynch]

Hi all,
I'm Michael's fiance. I have more information on Ella than Michael does :D

Basics:
8 years old
25lbs.
Spayed
Sable and White Sheltie

My mom owns Ella's sister (from the same litter). Ella's sister suffers from heat spots, dry itchy skin, and hair loss in those areas. She also seems to be underweight.

All of Ella's problems seemed to have started when we lost our older Sheltie. Ella stopped eating. We at first thought is was solely due to depression. So we tried feeding her Beneful. She started eating again, but she started developing skin lesions.

So the foods she's been on (in order):
Neutral Natural Lamb and Rice
Beneful
Pure Vita Grain Free Bison
Limited Ingredient Diets: Potato & Duck Dry Dog Formula
Limited Ingredient Diets: Sweet Potato & Venison Dry Dog Formula Artisan Venison Freeze Dried Food
Hill’s Prescription Diet z/d

We’re back on Pure Vita Grain Free Bison and Artisan Venison Freeze Dried Food.

The vet says she has Hypothyroidism, Atypical Cushings, and MRSA. At one point she had a clogged(?) anal gland, Ringworm, Allergies(?), 3 cysts (don't remember what type but they're non-malignant), ear infections, eye gunk.

The Hypothyroidism is being controlled by Soloxine (blood test show we have her at the appropriate dosage). She lost weight (went from 37lbs to 25lbs...healthy weight now), gained energy, and at one point started growing back hair.

We were using antibiotics to try to cure the MRSA.

All medications we've tried (there's been too many for me to remember why we did each on):
Soloxine
Simplicef
Hydroxysine (Atarax)
Genesis Topical Spray
Metronidazole
Cephalexin
Vetericyn
Ciprofloxacin
Primor
Triz Chlor 4 Shampoo
Gentizol Ear Drops
Resicort Conditioner for the ears
Chloramphenicol
Clindamycin
Ampicillin
Melatonin
PetAlive Cushex Drops
Lignans For Life Flaxseed Lignans

The Only Test Results I Have In My Possession:
T4 Post Pill: 2.4000 (10-06-12)

She's had typical blood tests (including checking her kidneys since that's why our last dog passed away), Urine test, Urine Cort: Creat test, thyroid test, skin lesions test.

We did see a vet dermatologist who confirmed that it's most likely atypical cushings.

Her blood work is normal. Minus the skin problems, ear infections, growths, and eye gunk, she is healthy and happy.

The vet wants us to do the cushing's test. It will cost $400. Otherwise, he wants to treat the cushings with Lysodren. We wouldn't be able to afford the test to check on the adrenal levels, so we would have to do it blindly.

We do not have much money. We are trying are best to help Ella in whatever way we can.

And places down here do accept pet insurance. We just haven't looked into it yet.

I don't know if any of this helps.

We're pretty much left with doing the cushings test or simply treating for cushings blindly.

But I will say this: Ella is our baby. I suffer from depression and I NEED her to live...literally. While I know that she will pass away someday, she's only 8. She deserves a long full happy life free of whatever is plaguing her.

As an added note: we own a 1.5 year old sheltie who has no health issues (minus an over-bite).

[labblab]

All of Ella's problems seemed to have started when we lost our older Sheltie. Ella stopped eating. We at first thought is was solely due to depression. So we tried feeding her Beneful. She started eating again, but she started developing skin lesions...

...She's had typical blood tests (including checking her kidneys since that's why our last dog passed away), Urine test, Urine Cort: Creat test, thyroid test, skin lesions test.

We did see a vet dermatologist who confirmed that it's most likely atypical cushings.

Her blood work is normal. Minus the skin problems, ear infections, growths, and eye gunk, she is healthy and happy.

Thank you so much for joining in and adding all this additional info about Ella. It is very clear that you and Michael love Ella very much and want only the best for her. It is for that reason, though, that I am very, very worried about your vet's recommendation to start Lysodren treatment at this time. Thus far, there is nothing about Ella's profile that seems consistent with Cushing's other than skin problems and recurrent infections. These issues can be caused by factors other than Cushing's (I know this only too well, because my non-Cushpup has the very same problems :o). And there are other pieces of Ella's profile that are distinctly "non" Cushing's-like. As examples, Cushpups typically exhibit abnormally elevated liver enzymes and cholesterol level, the specific gravity of their urine is low due to excessive thirst and urination, they suffer from excessive hunger rather than reduced appetite, they can suffer from muscle weakness. As per the article I cited above, even for dogs who are diagnosed with "Atypical Cushing's" (elevated adrenal hormones other than cortisol), we can expect to see these types of lab abnormalities and an array of symptoms over and above skin and coat issues.

Lysodren is a very serous drug and it is simply not safely prescribed in the absence of tests that confirm Cushing's and monitor treatment. I do not want to make light of Ella's skin issues because I know what a chronic stressor they are for my own dog. But if Ella is otherwise a healthy and happy dog, I would not think you would want to risk the possibility of life-threatening side effects that are associated with using either Lysodren or trilostane in the absence of diagnostic/monitoring testing. Ella may simply be suffering from dietary or environmental allergies, for instance, since most of her issues are equally as consistent with allergies as they are with Cushing's. I know you said the dermatologist has suggested Cushing's as a possibility, but I have to believe that he/she would not think it either safe or wise to proceed with Cushing's treatment in the absence of a confirmed diagnosis and regular monitoring.

Cushing's treatment can be a quality-of-life-saver for dogs who suffer from debilitating or uncomfortable symptoms. But there is always a trade-off in terms of possible side effects and the rigors and cost of treatment and monitoring. So I truly urge you to reconsider launching into treatment without a confirmed diagnosis. If Ella is otherwise a healthy and happy dog, I just can't imagine that the risks could be worth it to Ella or to you at this time.

Marianne

[labblab]

Just wanted to return with a couple more questions. Sorry! :o

But I'm trying to get a better handle on exactly what the skin/coat issues are that are troubling Ella. I know you've mentioned MRSA infection and also Michael earlier talked about lesions. Can you describe the lesions for us, and did the dermatologist actually biopsy any of them? There is a particular type of skin disorder that is associated with conventional Cushing's called Calcinosis cutis. But this results from elevated cortisol so it would not be the result of "Atypical" Cushing's.

You mentioned fur loss prior to starting thyroid treatment. How about now? If there is current fur loss, on what part of the body?

Thanks again for any additional info to help sort out the puzzle pieces. I will add that trilostane is sometimes prescribed by dermatologists to treat certain issues with hair loss that are presumed to be secondary to endocrinological issues other than Cushing's. But I think monitoring testing would still be necessary even when using the drug in that context.

[lulusmom]

I completely agree with Marianne. There is nothing you have posted that makes me think Ella has cushing's. I don't have the benefit of any timelines, but it sounds to me that all of Ella's problems started with ear infections and skin problems. Your vet thought it may have been her diet so you've changed her diet, many, many times, yes? By the way Beneful is a horrible diet, especially if food allergies are suspected. The first six ingredients, in order, are ground yellow corn, chicken by-product meal, corn gluten meal, whole wheat flour, animal fat preserved with mixed-tocopherols, rice flour. Was your vet or the derm vet providing nutritional guidance or were you trying to find something that worked? How long did you give each diet a chance to work? When you switch to a single source protein, you have to give it several weeks so I'm curious how long did it take to go through all of those brands you've listed. Do you have Ella on probiotics? If not, I highly recommend that you consider doing so. Most vets have Forta Flora in their office but you can also buy it and other brands over the counter.

MRSA isn't so common in companion pets but if there was a perfect profile for a dog that has it, Ella would probably fit that profile. She most likely has antibotic resistance due to the many, many antiobiotics she's been on and she's most likely spent a good deal of time in the vet's office. The MRSA stars align with antibiotic resistance and the perfect invironment (vet's office) to pick up the bug. You mention that your vet said Ella has MRSA, as in present tense. What is the current status of MRSA? If that has not been resolved, the ear infections, eye gunk and skin problems will continue.

Was the dermatologist you consulted with a board certified vet dermatologist? Did s/he diagnose the MRSA? What kind of testing did this derm vet do? Did s/he direct any of Ella's treatment? Derm vets are usually pretty sharp because they deal with cushing's quite a bit, including atypical. As Marianne mentioned, symptoms and lab abnormalities associated with atypical are almost identical to those common in typical cushing's. Since Ella's labs seem to be normal, which I find odd because, with MRSA, you usually see some abnormalities on the CBC, I'm not sure why the derm vet has concluded that Ella probably has atypical cushing's. If the MRSA has not been resolved, even if you had the money for a UTK panel, the results may be a false positive as any active infection would cause elevations in one or more of the sex hormones. I've provided a link below to an atypical cushing's case report that will give you a really good idea as to clinical presentation of dogs with atypical cushing's as well as lab abnormalities. Perhaps if you read this, you might be able to identify some symptoms or lab abnormalities that you may have overlooked. As a matter of fact, it would be great if you could round up the actual lab results and make sure that everything is normal. If you find anything that isn't, please post it here.

http://www.vmsg.com/atypical-hyperadrenocorticism

I don't know if you've read up on MRSA or allergies and if not, I've provided links to some good reading material below.

http://healthypets.mercola.com/sites/healthypets/archive/2012/04/30/dangers-of-mrsa-for-pets.aspx

https://www.colorado.gov/pacific/sites/default/files/DC_CD_HAI-MRSA-Information-for-Veterinarians.pdf

http://www.whole-dog-journal.com/issues/10_5/features/Dog_Skin_Problem_15932-1.html

Sorry for the information overload but Ella does not fit the profile of a dog with atypical or typical cushing's and I believe your vet is suggesting a UTK adrenal panel as a last ditch effort to figure out what is causing Ella's chronic skin, ear and weight issues. The problem with that train of thought is that atypical cushing's is controversial and not really grounded in science by way of credible, sanctioned clinical trials. The reason why it's controversial is that studies have actually shown that some dogs, particularly northern breeds, can have elevated sex hormones but never have any clinical problems. If you aren't already addled by all the citations I've provided, I'm going to provide one more for a very good paper entitled "Atypical Cushing's Syndrome in Dogs: Arguments For and Against". This will give you a really good idea as to why atypical is so confounding.

http://www.2ndchance.info/cushingsbehrend2010.pdf

I so want you to get to the bottom of Ella's problems but based on the information you've provided so far, my gut is telling me that atypical cushing's is not the answer.

Glynda

[michaeljlynch]

Thank you everybody for the thoughts and opinions.

Basically, her sores are so bad that hair won't grow back in that area. Once the sores heal up in one area they form up in another area. This shows mostly on her belly.

Even our vet has said MRSA seems to be one of the issues. Even he told us not to have her shaved at the salon because the MRSA and sores are so bad.

I have to look through the paperwork if they did a biopsy. I don't think they did though. They might of though.

As for fur loss, before it was just on her legs and belly. Now it's all over her body from her chest, belly, legs. Literally everywhere.


Just wanted to return with a couple more questions. Sorry! :o

But I'm trying to get a better handle on exactly what the skin/coat issues are that are troubling Ella. I know you've mentioned MRSA infection and also Michael earlier talked about lesions. Can you describe the lesions for us, and did the dermatologist actually biopsy any of them? There is a particular type of skin disorder that is associated with conventional Cushing's called Calcinosis cutis. But this results from elevated cortisol so it would not be the result of "Atypical" Cushing's.

You mentioned fur loss prior to starting thyroid treatment. How about now? If there is current fur loss, on what part of the body?

Thanks again for any additional info to help sort out the puzzle pieces. I will add that trilostane is sometimes prescribed by dermatologists to treat certain issues with hair loss that are presumed to be secondary to endocrinological issues other than Cushing's. But I think monitoring testing would still be necessary even when using the drug in that context.

[Renee]

Basically, her sores are so bad that hair won't grow back in that area. Once the sores heal up in one area they form up in another area. This shows mostly on her belly.



Just a comment on this -- CC will NOT heal up on it's own. It takes months to heal, and the only way for them to clear up is to get the cortisol into the correct therapeutic range. If her sores are healing and popping up in other places, then I can say with certainty that it is not CC. Also, the belly is not a typical place for CC to form. It generally happens along the trunk, down the back and on the head.

[molly muffin]

I would definitely have a biopsy done so that the appropriate medication can be administered. Not all antibiotics work on every problem, and you'll find out if it is cc or not. It could even be that a couple areas should be done as Renee is right, belly isn't the normal spot for cc, but back, head, is

Sharlene and molly muffin