Jinx - Newly diagnosed with Cushing's

[jinxwrigs]

My 12+ year old cattle dog mix, Jinx, was recently diagnosed with Cushing's. Symptoms started with excessive water drinking about 7 months ago and she started having accidents in the house. Progressed to getting in the trash every day, eating everything outside, hind leg weakness, and losing a total of about 10 lbs (going from 44 to 33lbs). Did blood work and liver values were through the roof. Vet did an ultrasound and said adrenals were not enlarged, but her liver and gallbladder were very inflamed so she suspected it was a brain tumor or cancer. She didn't think Cushing's because Jinx had lost so much weight and even though I've upped her food intake many times, she can't seem to gain any.

Vet put her on tramadol, gabapentin, a motility pill (she had undigested food in her stomach at ultrasound which led vet to other diagnoses besides Cushing's, but could be a result of the tramadol which was prescribed a week earlier), and ursodiol.

About a week later, oozing and crusty lesions start popping up on Jinx's back underneath her fur and while the vet had no idea what they were, I did some online research. Calcinosis cutis popped up on some images and prompted me to request the Cushing's test from my vet. It was positive.

I'm now trying to decide on medication options and want to do what's best for Jinx's quality of life. She's a rescue that's been with me for 11 years so I'm unsure of her exact age, but she's been very active and healthy up until about last summer when I noticed her starting to slow down and I foolishly chalked it up to old age and the summer heat.

Her ALT is 217, with the normal range being 10-100 and her ALKP is 1781, with normal being 23-212. All other values are within normal range. Her ACTH test was 4.9 pre-test and 21.6 post-test.

Vet wants to put her on 30mg of Vetoryl a day. Is that a normal dose for her size? She also prescribed prednisone in case she has adverse side effects. Is Vetoryl better than Lysodren? My vet said it tends to work more quickly and has fewer side effects. Has anyone found that to be true?

Does the calcinosis ever clear up? She's wearing doggie tank tops now to keep her from scratching and making them bleed, but I know they make her uncomfortable.

Thanks for any advice!

[Harley PoMMom]

Hi and welcome to you and Jinx!

Cushing's is one of the most difficult canine diseases to diagnose, and unfortunately it is often misdiagnosed. If any underlying illness is present when the tests for Cushing's are performed the chances of false positive results are more likely to happen. Could you get copies of the results of all tests that were done on Jinx and post those abnormal values here along with the reference ranges and reporting units..e.g...ALT 100 U/L (5-50)...thanks. Also what test was performed to diagnose Jinx's Cushing's, what were those results, and was this the only test done? Since there is not a test that can accurately identify Cushing's, multiple tests need to be done to validate the diagnosis for Cushing's. Is Jinx taking or was taking any other medications?

Although Jinx does show some symptoms of Cushing's losing weight is not usually one of them, however we have seen this happen on the forum. There is a illness, known as Exocrine Pancreatic Insufficiency (EPI), where loss of weight does happen even when the dog's appetite has increased and is eating more food. Has Jinx had any diarrhea episodes, are her stools light yellow or clay-colored, with the consistency of mashed potatoes?

As for deciding which medication to use, it depends on the vets knowledge, experience and familiarity with the drug they use, how comfortable the pet owner is with the treatment plan, and the dog's general health. Vetoryl/Trilostane is no safer than Lysodren/Mitotane, and vice versa. Adverse effects usually only happen when the proper protocols are not followed. Cushing's is a treatable disease, however for the treatment to work safely and successfully it requires an educated pet owner along with an experienced vet.

We do have members that are experiencing success with their dog's treatment for calcinosis cutis. Improvement with calcinosis cutis is slow and it usually gets worse before getting better, the treatment that works for one dog might not work for another dog.

I am providing you with links to other members threads that are dealing with CC:

http://www.k9cushings.com/forum/showthread.php?t=5850

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

Renee is our resident CC expert, and in her photo album she has pics of her sweet Tobey with varying stages of CC, could you take a look and see if this is what Jinx's bumps look like, here's a link to Renee's album: http://www.k9cushings.com/forum/album.php?albumid=805

The best advice I can give you is to do your research on Cushing's, the treatment protocols, and how it is diagnosed. I am providing a link to our Resource forum which has a wealth of information regarding Cushing's and also includes articles written by some of the most renown veterinarians that specialize in endocrinology http://www.k9cushings.com/forum/forumdisplay.php?f=10

Please ask all the questions you want and know that we will help in any way we can. ;)

Hugs, Lori

[Renee]

Just popping in with some info and encouragement about the dreaded CC. My Tobey is in 'remission' as I like to say with her CC.

First - Do NOT get discouraged. It can be managed.

CC will generally get worse before it gets better. Keep in mind that what you see on the outside is only half of what's going on. There are CC lesions still under the skin that need to work their way out.

The ONLY true cure for CC is getting the cortisol into the proper therapeutic range and KEEPING it there for an extended amount of time. The general consensus here, and my own personal experience, is that the proper range is a post cortisol of 5 ug/dl or lower (but not below 1.5). You'll want to keep the cortisol in tight control for months to heal the CC.

As for treating what is there while you work on the cortisol, there are many different approaches you can take. My own personal experience has been that DMSO does not work in a significant way, nor does constant bathing. But, some people find the medicated baths (weekly) to be helpful. I feel that moisture encourages bacterial growth, so I kept Tobey's lesions dry at all times. And, some people swear DMSO works, I just never felt it helped.

The lesions themselves are prone to secondary infection. I chose to address this with abx. I highly suggest you start some abx just to check any infection that could be brewing. You may need a round of abx a few times throughout the process. We did twice.

Clip the hair around the lesions, if your dog has long hair. You want these lesions exposed to air, to help them dry out. I used tea bag compresses on the lesions that were especially raw and oozy. If there was an especially large scab that was ready to come off, I gently removed it, so the skin underneath could be exposed to air. Do not force or rip off a scab, just remove it if it's ready.

The first sign that they are healing is when they begin to dry up and flake more. The scabs won't be as raw and oozing, nor will the skin appear as angry.

I know how you feel. At the worst of the CC, when more were popping up every day, I wondered if my girl would make it through this. I felt terrible guilt. But, we persevered and she recovered well. It took about 6 months in total.

[jinxwrigs]

Thanks for your replies! Her 10-panel bloodwork is below. As for the tests, they did an ultrasound as well as the ACTH test. The ultrasound did not show adrenal gland issues, but she does have heavy liver and gallbladder inflammation, which is why they put her on Denamarin and Ursodiol.

GLU 97 (range 70-143)
BUN 15 (range 7-27)
CREA 0.4 (range 0.5-1.8)
BUN/CREA 38
TP 5.7 (5.2-8.2)
ALB 3.2 (2.2-3.9)
GLOB 2.5 (2.5-4.5)
ALB/GLOB 1.3
ALT 217 (10-100)
ALKP 1781 (23-212)

Jinx was not taking any medications prior to being diagnosed besides daily fish oil and glucosamine. She is now on Tramadol 2x a day, Ursodiol 2x a day, Denamarin 1x a day, B12 injections once a week, Immunoregulin injections once a week, and Metoclopramide 2x a day. She just finished a round of antibiotics for the CC. I am still a little unsure as to all the medications and what good they are doing besides the Tramadol which seems to be giving her a little more spunk with the back leg arthritis. Do those medications sound like too much? Am I completely overloading her system?

And Renee, as for the CC, yes, your pics are very similar to what's on Jinx's back and she's got them all down her spine. She's been on one round of abx as the vet did find signs of an infection when she went in initially and they thought it was some kind of random skin thing on her back. They also gave me some SSD burn cream to put on it, but from your experience, that sounds like it might not be the best thing as it does keep the spots moist. So the key is to keep them dry and exposed to air? My poor girl will need shaving as the vet only shaved the biggest spot. She doesn't have super long hair, but it's long enough that scabs are gunking up her hair in the other areas where new spots are cropping up.

What is DMSO? Forgive me if you mentioned it in your post. Do you have any recommendation for the itching? She's constantly trying to scratch the spots or rub her back on furniture and Benadryl doesn't seem to help.

[Harley PoMMom]

Before you start treating her lesions I really recommend having a biopsy done on those sores to see if it truly is calcinosis cutis.

Those elevations in the ALT and ALKP can be attributed to the inflamed gallbladder/liver issue.

Does the vet know what is causing the inflammation of the gallbladder?

Hugs, Lori

[molly muffin]

We have also had members use TrizCHLOR spray on the cc to prevent bacterial infections in the lesions. Cut the hair around it. Keep it dry spray some antibacterial spray such as I mentioned. If this is caused by Cushing's the only real help is bringing cortisol levels down. Just make sure it is Cushing's as Lori mentioned.

[jinxwrigs]

She had an ACTH test and the vet confirmed it was Cushing's. 4.9 pre-test and 21.6 post-test. Any ideas of what else could be causing the lesions? It seems to be systemic as new areas are cropping up with no provocation and hair is coming out with the scabs so she's getting more bare spots. Do new CC lesions appear pretty quickly? Her lesions have progressed rapidly in about a 2-week time span to where they start almost at the back of her head and go down her spine and are starting on the sides. I can take some photos tomorrow after the vet, but not sure how I put them into an album.

We have an appointment with the vet in the morning again regarding the lesions and Cushing's medication.

Vet does not know what is causing the gallbadder inflammation.

[labblab]

The lesions may simply be the result of a blossoming bacterial or yeast infection as your vet originally suspected. Since Cushing's causes systemic immunosuppression, patients are more vulnerable to infections of all kinds, including skin infections. But there can be other causes of skin infections, as well. Right now I am battling a spreading staph infection in my non-Cushpup Labrador retriever. We are currently unaware of any underlying illness, but she is in the midst of sprouting smelly, sticky lesions all over her back. Her hair comes out in plugs, leaving inflamed red skin underneath and crusty borders. We just had some lesions cultured and staph has been confirmed. But as to the cause, we do not know. Perhaps allergies, perhaps some other underlying deficiency. But it had worsened rapidly and dramatically for her, too, within a two-week time period. We are in the midst trying to figure out a reasonable diagnostic/treatment plan, as well. I think a skin biopsy may be the next step for us, too, in order to try to get a handle on some possible underlying issues.

Anyway, the point is just that Jinx's lesions may or may not be CC, regardless of the Cushing's diagnosis. Without a biopsy of a lesion, it is impossible to know for certain. If it is instead an unresolved infection, then performing a culture and sensitivity (if that has not already been done) could hopefully point you towards an antibiotic that will combat the lesions more effectively. Apparently skin infections can sometimes require extended courses of antibiotics (multiple weeks) to totally control/eradicate the symptoms.

Also, can you give us the normal range for Jinx's diagnostic ACTH test? For many labs, a result lower than 22 ug/dL would be considered an equivocal or borderline result. Apparently the lab used by your vet has a lower cut-off since 21.6 is being deemed "positive," but it would be helpful for us to know the actual range. Also, do bear in mind that both the ACTH and the LDDS can return false positives in the face of other, nonadrenal illness. I do agree that Jinx's overt symptom constellation certainly does seem consistent with Cushing's. But loss of 25% of her weight and the normal appearance of her adrenal glands are not characteristic of the disease. Given the extreme inflammation of her liver and gallbladder, like Lori, I must wonder whether there is something else -- or something in addition to Cushing's -- going on with her.

In answer to an earlier question, though, if you do decide to start Cushing's treatment at this time, 30 mg. would be a reasonable trilostane dose given her weight. The initial dosing formula that is most widely recommended at this time equals 1 mg. per each pound of weight.

Marianne