Diet and skin help

[froggeez]

Hi,
First: I am really sorry for the long post! I have 2 dogs, an 11 yo toy rat terrier named Penny and she has addison's disease and a 11 yo boxer named Fawn that has cushings. My vet says she can not tell me the odds of having 2 dogs and them having basically the opposite diseases! Fawn is on trilostane for cushings and phenobarbital for seizures and we get her regularly tested to make sure she is on correct amount of trilostane. Her skin lately is getting really bad and her hair just keep falling out. She did 2 round of antibiotics and they cleared it up in the past but only helped a little now. Does anyone have any suggestions to make her skin better?
We feed Fawn science diet and now a little wet food(Purina Proplan savor), since we have to crush up her medicine. Sometimes we add low sodium chicken broth or no sodium chicken stock to her hard food. She goes back and forth from her food to the water bowl over and over, so I have been trying to find info online on what would be best to feed her. I would like something that would help her physically and also have better water content to maybe lower her drinking a little. She has a back leg that does not work well and toes under(we now wrap it to give her traction), but I was hoping changing her food might also help and give her a little more strength.

Any help would be greatly appreciated!!!!-Tina

[labblab]

Dear Tina,

Welcome to you and Fawn and Penny. Good gracious, it certainly is some odd luck that you would have both an Addison's dog and a Cushing's dog! I have only a moment to post right now, but can you possibly get your hands on the actual numerical results for any recent ACTH monitoring tests? It seems as though we have had quite a few boxers who suffer from calcinosis cutis, which is a particular type of skin disorder that can accompany Cushing's. For dogs with that issue, lower levels of cortisol may be recommended in order to gain control of the problem. So first things first, let's find out where Fawn's cortisol level has been running. Also, has your vet discussed running any cultures or other testing in order to try to identify the exact nature of the skin issues and hair loss?

Marianne

[Squirt's Mom]

Also, a quick word of caution. Be absolutely sure the broth you are using does not have onion in any form. If the ingredients list "flavorings" or "seasonings" or anything else that is generic - do NOT give it to your dog. If there is anything other than meat and water listed, I would pass on it. It is better if you can simply boil the meat at home in plain water to make a broth for them.

[froggeez]

Hi Marianne,
Thank you for writing to me. I called for results, but am not sure if the vet tech gave me what I need. So here is what I have and you can tell me if you understand it at all.
Test April 21,15
Cortisol Sample 1: 1.0-5.0
Cortisol Sample 2: 8.0-17.0
ACTH: 1.5-9.1 with little to no increase, obtimal control
This is with her on 110mg of trilostane and she is around 65lbs.
Does any of that make sense? If it doesn't can you tell me what I should ask them for. She has been tested many times and when I talk to her vet and she tells me the numbers and then tells me in terms I understand, so I have never kept track of the exact numbers.

Thank you,
Tina

[labblab]

Hi Tina, thanks for getting right on this! Good job!

Unfortunately, it looks as though the tech did not give you Fawn's actual test results, but instead just the laboratory's "normal" ranges. When the ACTH is used diagnostically to test for Cushing's, a dog without the disease will have a baseline cortisol between 1-5, and a stimulated cortisol between 8-17.

However, different ranges are desired when the ACTH is used to monitor treatment. That last set of numbers (1.5 - 9.1), is the acceptable range for a dog being treated with trilostane, as long as all symptoms are well controlled. But that's the issue with Fawn -- her symptoms may not be well controlled if she is having skin and coat problems, and therefore her cortisol may need to be lower within that range rather than higher. Unfortunately, though, it looks as though the tech did not not give you Fawn's actual test numbers at all. :( Perhaps it would work better if you ask them to make actual copies of her recent test results to give you, most definitely including the ACTH? If you prefer to call back, tell them you need Fawn's actual test numbers, not the laboratory's normal range which you now already have.

How long has Fawn been taking the 110 mg.? Has her dose changed over time?

[froggeez]

Hi again,
So they faxed me some paperwork and the sample 1: her results were 2.6 (range 1-5). I do not have a number for sample 2, sorry. She was diagnosed and started taking trilostane July 2014 and it was 100mg. We switched her to 110mg at the beginning of November 2014.
Unfortunately we are worried that she is not going to last very much longer, so I am tempted to take her off of it in hopes that it will giver her more energy and make her feel better. Between the pheno and the trilostane I am afraid they are both making it harder for her to have energy and get around.

[Squirt's Mom]

Hopefully that is the post, or second number. If not, I would call and ask again. The post number is the one that counts so that is the one you want if they can only give you one number. ;)

[labblab]

Darn! The second number is the really important one. :o

Do you mean it is somehow not on the sheet, or did the vet not even perform the second blood draw at all? The reason I am harping on this is because Fawn's stimulated cortisol could be key to several of her problems. It may be the case that simply changing her trilostane dose might make a big difference in how she feels. But you need to have that stimulated ACTH number to guide you before making any changes, either up or down.

I have an 11-year-old non-Cushpup Lab girl who has been taking phenobarb for four years now, and I am fearing that it may finally be taking somewhat of a toll in terms of her energy and mobility. So I do understand that the combo of the two drugs may be making you scratch your head a bit, especially because the two drugs may interact, resulting in the need for dosage adjustment in one or the other. But this is why routinely checking both the phenobarb level and post-ACTH cortisol level in her bloodstream is so important.

So that brings us back to that second, post-ACTH number. When was that most recent test performed, and why is the number missing? Your vet cannot safely make trilostane dosing decisions based solely on baseline cortisol levels alone. So if you do wish to continue with the trilostane, that complete test needs to be done now if it was not done previously.

Marianne

[molly muffin]

Hello and welcome to the forum from me too.

Yep, that second number is very important and here is why, calicinois cutis is while not exactly common, we do see it quite frequently on the forum here (all things cushings of course) and most of the time to get the skin under control, the post number is going to need to be under 5.0 ug. Of course you would need to know if it is cc that you are dealing with. A good antibacterial spray for the sores though might be helpful to help prevent them from becoming infected.

How long has she been having seizures? Do they think the back leg is knuckling? as in a neurological problem?

So sorry that you are having to deal with both extremes of the adrenal gland spectrum. I can't imagine how crazy that must make you sometimes. :) It would me anyhow.

A good glucosomine supplement for joints would probably help her if you aren't already giving her that. I use glyco-Flex III which is their strongest by vetri-science (available amazon)
Also if liver enzymes are elevated, then sam-e, milk thistle supplement would help with that.

i think the most important thing is to feed a good quality of dog food. I like Fromm's personally, but their are others, moderate protein, lower on the fat content side.

You can always add water to dry food, you can also as Leslie suggested boil chicken yourself and make your own broth, that is usually better for them than anything bought in the store.

The water, probably won't decrease though if the control of the cortisol is not good. They drink because their kidneys work over time and they need the water.

Lots of stuff to get you started. And how is your little Penny doing with her Addisons?