14 year old american staffy x with cushings

[brandysmum]

my poor dog has been diagnosed with cushings 2 months ago, originally we took her to the vet due to an awful hot spot on the back of her neck, it turned out it was the beginning of calcinosis cutis and is now covering her all along her back, we have already spent over $2500 in diagnosis and treatment, she is currently having 120 mg vetoryl twice daily, her pot belly has shrunk and her water consumption has decreased, however she now doesnt want to eat much and after the skin biopsy her skin condition is worsening again, she also suffers from arthritis in her leg which is causing her grief, is there hope for her or are we being selfish by putting her through all of this?

[molly muffin]

I only have a moment as heading out the door to,work but want to welcome you to the forum.

How much does your furbaby weigh? Have you had a follow up ACTH to check levels? If so what was the results?

Cc is the hardest to get rid of and usually takes the longest amount of time to clear up.

This is a link to another member who has had good results with her dogs cc.

http://www.k9cushings.com/forum/showthread.php?t=5908

We see best results with a post under 5.0 ug on the ACTH when it comes to cc.

All those calcium deposits need to push up through the skin before it totally goes away. So worse before it gets better. But it can get better.

Ikeep those areas dry and clean. Maybe get an antibiotic spray like trichlor as they can become infected with bacterial yeast infections.

If she vomits. Gets diarrhea or becomes lethargic and wobbly stop the vetroyl and get an ACTH immediately as the cortisol can also go too low. Is it 120 mg total or 120mg given twice a day? 240 mg would way to high to start is why I ask. New guidelines suggest starting at 1 mg per 1 lb.

Again welcome to the forum.

[labblab]

Hello and welcome from me, too! Sharlene has gotten you off to a great start, and I just want to "second" her concern about the high dose of trilostane that your dog is taking. Unless she has had interim monitoring ACTH testing that indicated she needed a dose that high, 240 mg. total daily is much higher than would be recommended depending upon her weight. An overdose of the drug would definitely account for loss of appetite and aggravation of mobility issues associated with arthritis.

So please do let us know about her weight and her testing history, OK?

Marianne

[brandysmum]

hi, thanks for the replys, we originally started on 120mgs once a day, then went to 60mgs twice a day but her condition kept getting worse, at that point we had another test done, im not sure what the results were but the vet consulted with the pathologist and they decided it would be best to double the dose, i did drop her nightly dosr to 60mgs for a few days as i was concerned that she was a bit lethargic but then she came right and her skin started deteriorating as well as her thirst increased, the good news is her appetite seems to be improving over the past day, shes still fussy with what she'l eat but at least shes eating, her weight has been sitting around 35 kgs, a few years ago her weight was 28kgs but it has steadily increased since, im sorry to say i put all her issues down to old age right up until the skin issues cropped up

[brandysmum]

hi, thanks for the replys, we originally started on 120mgs once a day,as well as a long course of antibiotics that we have since stopped, then went to 60mgs twice a day, the vet was happy with the test result to continue on that dose but her condition kept getting worse over the space of a week her cc had spread down her back and new lesions were bursting around the nape of her neck, at that point we had another test done as well as a skin biopsy just to make sure there was nothing else going on, im not sure what the results were except that it confirmed it was indeed cc, but the vet consulted with the pathologist and they decided it would be best to double the dose, i did drop her nightly dosr to 60mgs for a few days as i was concerned that she was a bit lethargic but then she came right and her skin started deteriorating as well as her thirst increased, the good news is her appetite seems to be improving over the past day, shes still fussy with what she'l eat but at least shes eating, her weight has been sitting around 35 kgs, a few years ago her weight was 28kgs but it has steadily increased since, im sorry to say i put all her issues down to old age right up until the skin issues cropped up

[labblab]

I am very worried about the high dose of trilostane. I surely do understand that you want to try the best you can to get the CC under control, but it is not safe to drive the cortisol level too low in the process. If the initial monitoring testing showed that 60 mg. twice daily was putting the cortisol in a good and safe therapeutic level, it is very, very dangerous to double the dose. At the very least, the cortisol needs to be retested again very shortly after the increase.

The monitoring testing needs to include both an ACTH stimulation test (this involves two blood draws over a period of 1-2 hours) and also a test of the basic blood chemistries including potassium and sodium levels. This is because trilostane can lower the level of aldosterone as well as cortisol, and the aldosterone controls the balance of those two chemicals in the body. If they get out if whack, life-threatening issues may arise.

I am so sorry about the spreading if the CC. I know what a horrible affliction that is. But the cortisol level can only be lowered so far without risking extremely dangerous consequences. How long has Brandy been taking the double dose? She really must be tested within 10-14 days of starting the higher dose or even sooner given a loss of appetite, lethargy, vomiting, diarrhea, etc.

Marianne

[Squirt's Mom]

Hi and welcome to you and your baby!

The CC will not clear up overnight and it is risky to try to rush the process with large doses - which seems to be what your vets are trying to do. All that calcium that has been deposited in the skin has to come out, leaving sores behind - often CC gets worse before it gets better as a result of that. But it is better to take it slow and easy with this drug (it is NOT as "safe" as some think, including vets ;) ), keeping the skin clean and dry meantime.

The new recommendations from the manufacturer of Vetoryl (Trilostane) are 1 mg per pound which is 2 mg per kilogram so your baby should start no higher than 70 mg a day, not twice a day, ONCE a day based on her current weight of 35kg. Then move up slowly if needed based on the ACTH results and signs.

This is one of the hardest things for many of us to accept, myself included when I began this journey - WE are in control of what happens to our babies, not the vets. We have not only the right but the obligation to our babies to learn as much as we can about this disease and its treatments so we can speak up for them when the vets take off on a path that may well harm them. We must be our babies voice and to do that, we must educate ourselves. And you already know enough to recognize something was wrong when she got lethargic and off her feed - you did good there, Mom, and you will learn even more in no time.

We are here to help with that and to be by your side the whole time. You and your sweet girl are not alone. A great many of us thought our babies were simply getting old, some way before their time. That is very common with this disease - you have nothing to feel guilty over, honey. I know, and I'm sure your baby knows, that you are a special mom...otherwise you would NOT be here. You would not have gone searching for help for your baby girl. But you did and that tells me you are a special mom.

So take a deep breath and hang on! You and your baby are starting an adventure like no other and there is a whole host of folks on that adventure with you, ready to help and share our experiences.
Hugs,
Leslie and the gang

[lulusmom]

Hi and a belated welcome to you and Brandy.

As others have mentioned, calcinosis cutis (cc) is very difficult to resolve and usually takes a very long time to resolve. I also agree with the others that it is extremely inappropriate for your vet to use the progression of cc as a basis for a dosing increase or decrease. There are documented cases of cc that never resolve with effective treatment treatment of cushing's. It used to be that if a dog showed up in the vet's office with a severe skin problem that was ultimately diagnosed as cc, it was a slam dunk that the dog has cushing's. That is not the case any longer. The latest veterinary textbook, entitled Canine and Feline Endocrinology, authored by Edward C Feldman, Richard W. Nelson, Claudia E. Reusch, J. Catherine Scott-Moncrieff and Ellen N. Behrend, reads; "Although previously stated to be pathognomonic of spontaneous or iatrogenic HAC, calcinocis cutis has also been reported as a consequence of fungal infection, treatment of hypoparathyroidism and renal failure, or as idiopathic. In one study Rottweilers, Rottweiler/Labrador Retriever mixed breeds, Staffordshire Terriers, Boxers and Boxer mixes, Akitas and Pomeranians were significantly overrepresented, but the number of dogs in each breed was low."

The fact that Brandy is a Staffy mix and you mentioned no other symptoms or tests, I am very interested in how your vet confirmed the cushing's diagnosis. Did your vet do the usual blood chemistry, cbc, urinalysis and/or acth stimulation test, ldds and an abdominal ultrasound to make absolutely certain he is dealing with cushings? Can you please post the results of any tests that were done? You need only post the highs and lows on the blood chemistry and cbc. Does Brandy have pituitary dependent cushing's or an adrenal tumor?

I've read many published papers and listened to lectures given by well known endocrine experts and the two most important things I've learned is that calcinosis cutis is very difficult to gain the upper hand on; it does not always resolve with treatment and if it does, it take quite some time. Dr. David Bruyette, who prefers Vetoryl to treat his patients, admitted that he has not had good results with Vetoryl in resolving calcinosis cutis. Regardless of that statement, we have seen dogs on trilostane see much improvement in calcinosis cutis. I believe most endocrine specialist would agree that if treating with Trilostane, it is imperative that adequate control of cortisol be maintained throughout the day with twice daily dosing and that the pre and post acth stimulation test results should be within the same therapeutic range used for Mitotane, which is between 1.5 ug/dl and 5 ug/dl. Again, even if the aforementioned protocol is followed to the letter, there is no guaranty that you will see resolution of calcinosis cutis. It's very difficult to watch cc worsen and it usually does before it gets better so we can't stress patience, patience, patience enough.

Looking forward to hearing a lot more about Brandy's diagnosis.

Glynda