Cushing and Calsinosis Cutis

[fosboyd]

My 11 year old dachshund, Ruby will be getting the test for Cushing's on Monday. I'm sure it will be positive because for the last few weeks she has developed calsinosis cutis. We did the biopsy to confirm this. Once I read about Cushing's I knew this was the culprit. The big belly, the extreme hunger, muscle atrophy in her head, and frequent urination. It all makes sense. And now the CC. And within 2 weeks it had spread all across the back and sides of her neck. The doctor had her on antibiotics when the rash first started which did nothing but make it mad. Undoubtedly my vet had never seen CC before. Yesterday I found a new lesion in her armpit. The rash is so aggressive. And it has begun to itch. And the scratching has started it bleeding. I cut the sleeves of a couple of old t-shirts to make a cover on her neck so maybe she can't scratch it as much. This is all so frustrating. They kept telling me she needed to lose weight and now I realize it might have been the Cushing's all along. And I'm afraid the big belly is going to cause back issues. Any ideas which meds would be the best for her? I like hearing from people who might have been through this.

[Harley PoMMom]

Hi and welcome to you and Ruby!

I have manually approved your membership so now all your posts will be seen right away. Also, please just disregard the validation email that was sent to you from k9cushings.

Gosh I am sorry dear Ruby is going through so much right now. :( We do have members that are experiencing success with their dog's treatment for calcinosis cutis. Improvement with calcinosis cutis is slow, and unfortunately, it does get worse before it gets better.

The two medications generally prescribed for Cushing's are Lysodren (Mitotane) and Vetoryl (Trilostane) and they both can be used in a cushdog that has CC, 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, here's a link to Renee's album: http://www.k9cushings.com/forum/album.php?albumid=805

One question that I have, was Ruby taking any steroids; orally, topically, drops, at anytime? Oh, does she have any other health issues that she is taking medication for?

I'm sorry this post is short, I'm at work so I have only a moment to post. I'm sure the others will be by soon to welcome you both. Glad you found us and we will help in any way we can.

Hugs, Lori

[fosboyd]

Ruby has never taken any steroids. She's never had any skin issues. That was the first thing my veterinarian commented about. She has occasionally had a hotspot which I treat and that was what I originally thought she had in the beginning. But after a couple of days I realized it was something else. She doesn't take any meds other than a fish oil or glucosamine. I worry about her back. She weighs about 21 lbs. she is technically a mini but really more of a tweenie. A good weight for her would be about 17 lbs.

[fosboyd]

Last week, following the results of the biopsy, the doctor gave her some ketaconazole thinking it might help with the CC. That was on Tues. It starting itching her on Friday so I've kept the area wrapped. Still she manages to scratch it some. We had to take her off the keta yesterday so it wouldn't affect her bloodwork tomorrow. With it bleeding now I've cleaned it with hydrogen peroxide and applied neosporin, mainly to keep the area from sticking to the cloth. This morning one area looks really nasty and infected. Is there anything I can do until she sees the doctor in the morning that might help? I was going to post a picture of it, but cannot figure out how to do it.

Thanks, Sandra

http://i24.photobucket.com/albums/c3/fosboyd/Mobile%20Uploads/image_zpsc2ecqdgk.jpg (http://s24.photobucket.com/user/fosboyd/media/Mobile%20Uploads/image_zpsc2ecqdgk.jpg.html)

Since posting the picture I cleaned the area with peroxide and put some gold bond powder on it to try and dry up this lesion. She will be at the doctor in the morning.

[deannah]

So sorry to hear your pup is having those awful sores. I'm a newbie to this forum and to cushings disease as well. My pup, Puckie also has the cushings and also the cc. I have read and tried the shampoos that contain Chlorhexidine as well as the spray and wipes. I saw that ingredients mentioned by a vet as well as other sites for treating the sores so they did not become infected. So far it seems to be working for her, though she does have a new sore that has erupted on her back. Good luck and hope she does well.

Deanna and Puckie

[fosboyd]

Ruby's results came in this morning and they are positive. We were expecting this. He wants to put her on 20 mgs of Vetoryl and follow up with blood work periodically. I don't know what to expect once we start or how soon her symptoms may improve but I understand they may be slow. When I get a copy of the test results I will post them.

[fosboyd]

Please, if anyone can tell me what this is on my baby, I would appreciate it. She has Cushing's and was supposed to start her medication today but the compound for her dosage did not come in and won't be here until Monday. She is a 11 year old 21 lb red female dachshund, Ruby, and she also has a bad case of CC, as maybe you've seen in my other thread. Just a little while ago out on the porch where the light is a lot better I noticed this bruise type thing under her neck. I sent a picture to the vet and they say don't worry, as long as it's not swelling. (They were closing in about 45 mins. I'm a half hour away.) They say it doesn't hurt to wait till Monday to start the meds. In the meantime, I'm going to go crazy. It doesn't appear to hurt her. And she acts about the same. She doesn't have a lot of energy but hasn't for a while. Any ideas, anyone?

Thanks, Sandra

http://i24.photobucket.com/albums/c3/fosboyd/Mobile%20Uploads/image_zpsce6nfcpg.jpg (http://s24.photobucket.com/user/fosboyd/media/Mobile%20Uploads/image_zpsce6nfcpg.jpg.html)

[fosboyd]

Okay, maybe I freaked out a little. I just found out this is the area where they drew blood this week to run her Cushing's test. I've had my son and grandson and 2 dogs (besides my own) here this week and maybe the bruise had already started and just not noticed. I did not know they drew blood from the neck. Why they didn't tell me when I first called is beyond me. I so wish there was a doctor in my area that was more familiar with Cushing's.

Thanks, Sandra

[My sweet Ginger]

Any blood drawn from the jugular vein or around her neck recently?

Oh, ok and that's good to know. We had the similar experience.

[fosboyd]

Thanks to My Sweet Ginger, for the reply. I am learning, maybe a little slower than I'd like. And also, I keep her necked wrapped with a portion of a t-shirt sleeve to keep her from scratching her CC, which is on the back of her neck. And of course , that was hiding the bruise also.

[My sweet Ginger]

Yea, they do look awfully scary and make you feel terrible for what they have to go through so often with this disease whether or not you know why it's there. Maybe gentle massages will make it go away sooner.?
Good luck to you and Ruby on her treatment with Vetoryl for a smooth progress. Song

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about the neck bruising into Ruby’s original thread. We like to keep all posts about each pup in a single thread as it makes it easier for members, and parents, to refer back to the pup's history when needed. Thanks!

[Squirt's Mom]

I'm glad Song was able to help. They used to pull blood from Squirt's neck and it scared the crap outta me the first time I saw that bruising there so I understand how frightening that is, especially just after learning Cushing's in on the scene.

[molly muffin]

Whew, glad that was figured out.

That bruising can look pretty scary. Molly has had them show up a couple times, not very big, but from the area where the blood was taken and I called to find out where they took it from to make sure that is what it was. (it was) but nothing wrong with being sure either. So good you called to make sure.

Now you've experienced it, if it happens again you'll know what to look for. Molly doesn't get bruising every time and almost never now.

[fosboyd]

Ruby got her tests results 7/30 that verified that she had Cushings.She had the Cortisol Serial 2 (ACTH). The first sample was 7.2 and the second sample was 48.4. That was the only test they ran. I asked them when she comes back for her next test that they do a complete blood workup so we can tell if anything else is going on with her. She weighs 21 lbs and they put her on 20mgs of Trilostane and she took her first dose 8/4. Her doctor ordered a compound for us so that the price would be better, rather than having to take 2-10mgs. Up until she started the Trilostane the doctor had her on ketaconzole and cipro. The were helping dry up the CC. Since starting the Trilostane she has gotten a few new eruptions, but not nearly as bad as what she had. One on the tail, one under the arm, and one on her head. Also some new ones further down her back. We will follow up with a new blood test in 2 weeks. Other than that I haven't noticed any change, I am aware it can be very slow. This is how she looks today.http://i24.photobucket.com/albums/c3/fosboyd/A0E759C8-3AAC-46E7-88AF-58EE9ADCA661_zpsuycsj5jh.jpg (http://s24.photobucket.com/user/fosboyd/media/A0E759C8-3AAC-46E7-88AF-58EE9ADCA661_zpsuycsj5jh.jpg.html)

[molly muffin]

With cc, any calcium deposits that are there, have to come up through the skin and go away. It's a long process. That she has only gotten a couple new ones is good news indeed.

We'll really be looking forward to seeing what her next ACTH test results are.

[fosboyd]

Thank you Molly Muffin! The first CC she got all happened in about a 3 week period. They may have been there earlier but by the time I saw them, they were already erupting. They were well hidden in that thick patch of hair on the back of her neck. Now that I know what I'm looking for I try to be more observant. So I do feel pretty good about the smaller and fewer break outs. Do you think her hair will grow back? Not that it's the most important thing. I also want to ask how long before maybe her pot belly shrinks? Or will it? I am so worried about her back. With the loss of muscle she looks like she's had a dozen litters. Also, does anyone have any idea what might have caused her to get Cushings? Since she's never taken predisone, is it something she was just predisposed to get?

Thank you, Sandra.

[labblab]

Hi Sandra, I wish I could tell you more about the hair regrowth, but I will leave that to some of our other folks who have also been treating CC. I just don't know about the time frame for that.

As far as the pot belly, yes, you can expect that to improve over time as muscle mass and muscle strength rejuvenate. It can take a while though, too, so patience becomes a real virtue. :o

Boy, I wish we knew the cause for Cushing's, but I think it is still a huge question mark for humans as well as dogs. Over the years that we have been hosting this forum, we have seen dogs of all breeds and all ages, with all kinds of health histories and diets and lifestyles. There simply is nothing definite to which to point a finger in terms of causation. When parents take the time to research and find their way to us, that usually means that they have also taken excellent care of their dogs all through their lives. So it absolutely is not a lack of care or attention that results in the formation of these tumors that cause Cushing's. Maybe one day there will be a research milestone that can tell us more!

Marianne

[Renee]

Hi there - I don't get in here as often as I'd like to, but the most recent picture of that CC is looking good. That drying out process is a good sign. It means things are healing. You may continue to see new lesions come up over the next 2-4 months, but none of the new ones should be as angry, oozing, or red as the initial ones.

You can see some documentation of the lesions in my album.

It takes a solid 6-10 months (in my experience) to resolve CC. You also need that cortisol to get down to 5 ug/dl or lower, and keep it in range.

[fosboyd]

Thank you Marianne and Renee! Wow, 6-10 mos. And I'm glad you mentioned that she might get new ones for a while. I was concerned because after my earlier post I found some new ones on her chest. Totally different spot. They are only red, right now, but I'm sure that's what's happening. Hopefully they will stay small. Also, bathing as usual? I have used Malaseb in the past mainly because my male dachshund gets yeast under his armpits.

Thanks, Sandra

[Renee]

This is probably where I differ from others - I never bathed Tobey while her lesions were active. I waited until they were good and dried out. I did not want to add any more moisture to the skin while the lesions were open as I felt that just increased their risk of developing secondary infection.

Once her lesions were mostly dried up, then I took her to a groomer and bathed her.

Once I got her cortisol into range, she still got lesions coming though, but none of them ever got as bad as those first ones.

[fosboyd]

Thanks Renee. I actually feel the same. In fact, when I thought I was dealing with just a regular skin infection I bathed her gently massaging the crusty areas, and then it was right after that when the break out tripled in size. I haven't bathed her since.

Sandra

[molly muffin]

I can say my molly still has her belly. Her liver is still enlarged (shown on ultrasound) so it isn't surprising that her belly is still there. Course she has also had that belly since she was about 4 years old, so it may partly just be her thing too.
I think too, it's hard sometimes because we see them every day and don't catch necessarily those minute changes. It is when someone comes over and says, gosh has molly lost weight or wow, she looks like a puppy, how old is she, that I think, hmm, meds must be working for her. LOL

[fosboyd]

Finally we have some good news for Ruby! She had her blood tested yesterday, 24 days since the first one. Her cortisol levels were 4.3 at resting and 14.5 two hours later. We did a regular blood work up also and everything was within range except for her ALT which came in at 380, suggesting some liver damage. Her CC is slowly, and I mean slowly, is getting better. Still an occasional new eruption, but smaller and fewer. Thank you to everyone for all your support. It so helps to be informed when you take your baby to the doctor and be able to discuss all the issues with some amount of understanding.

Thanks, Sandra and Ruby

[molly muffin]

You are going to want to bring that post number down a bit more so that you don't end up with more eruptions of the cc. At a guess you will need to increase the dose a bit, but see how much she continues to come down.

:)

[Renee]

You'll want to come down farther than 14.5. Ideally, below 5 ug/dl, but you may see good improvement just getting under 10.

[fosboyd]

Thank you Renee and Sharlene for the response! I thought those numbers were really good after 3 weeks. But I will hope they are better when she gets her next tests. They said 90 days for the next tests. They did not suggest increasing the dosage at this point and I never even thought about it. I was so afraid there wouldn't be any progress. I have not seen any new eruptions in about a week except for a small one on her belly. Looked more like a few pimples. She acts like she's feeling better, even a little playful at times. She's never been into toys like our male is, so even a little playful seems good for her. Her appetite is still ferocious, but then it always has been. She'll go all night without urinating. But that wasn't her worst symptom. I'm just so happy to see any progress. It's all been so overwhelming!

[Renee]

At only 3 weeks, to come down to 14.5 is good progress. However, your vet is wrong if they think you are done. You are making progress, but have not hit the goal yet.

Cushings is not in range, unless you are below 9 ug/dl, and all symptoms are controlled. If you don't get control at 9, then you need to go lower. With CC, usually you need to get to 5 or lower.

I would suggest you run a stim again in 2 weeks, then increase your dose, if your range is not below 9.

[fosboyd]

Thanks Renee. When you say stim test, you mean the ACTH test, right? Which runs about $200 each time. If the eruptions continue, I will do the test sooner, for sure. I'll keep an eye on her. Also, where the eruptions have healed her skin in lumpy, scarred sorta, and darker. I assume she'll keep these forever.

Thanks Sandra

[molly muffin]

Hi Sandra, yes the stim test is the ACTH, so if you notice any new skin problems then she isn't likely coming down any further.
Normally 30 - 35 days is about as long as they drop on a given dose.

[fosboyd]

Sorry for not keeping in touch. Have had a lot going on and just finally was able to get another stem test. My veterinarian used a different company to do the blood work so it was a little difficult to compare from her last test. But this is what they told me. Her level at resting was 8 (range 2-6) and 2 hours later 12.3 (range 6-18). Previously her tests had her at resting 4.3 (range 1-5) and 2 hours later 14.5 (range 8-17). There was 3 months between tests. I was a little disappointed with the numbers even though the doctor wasn't. She hasn't had any new breakouts in about 3 months. She doesn't urinate as much nor is she as thirsty, but her appetite is still huge. But it was long before Cushings. I asked the assistant that called to ask the Dr if he would consider raising the dosage a couple of mgs. She weighs 21.5 lbs. and is currently taking 20 mgs of trilostane once daily. Opinions??

[fosboyd]

http://http://i24.photobucket.com/albums/c3/fosboyd/D1A602EE-858D-4752-AFD4-96670C67B5DA_zps4rz8byk3.jpg (http://s24.photobucket.com/user/fosboyd/media/D1A602EE-858D-4752-AFD4-96670C67B5DA_zps4rz8byk3.jpg.html)

Recent picture of Ruby

[fosboyd]

Sorry for not keeping in touch. Have had a lot going on and just finally was able to get another stem test. My veterinarian used a different company to do the blood work so it was a little difficult to compare from her last test. But this is what they told me. Her level at resting was 8 (range 2-6) and 2 hours later 12.3 (range 6-18). Previously her tests had her at resting 4.3 (range 1-5) and 2 hours later 14.5 (range 8-17). There was 3 months between tests. I was a little disappointed with the numbers even though the doctor wasn't. She hasn't had any new breakouts in about 3 months. She doesn't urinate as much nor is she as thirsty, but her appetite is still huge. But it was long before Cushings. I asked the assistant that called to ask the Dr if he would consider raising the dosage a couple of mgs. She weighs 21.5 lbs. and is currently taking 20 mgs of trilostane once daily. Opinions??

[judymaggie]

Hi, Sandra! As Renee and Sharlene have said, with calcinosis cutis present, it would be best if the post number was lower to keep it under control. Dechra now manufactures a 5 mg. capsule. A 5 mg. increase would be very conservative. Dechra recommends an ACTH at 10-14 days after an increase and then again at 30 days but many vets prefer to test just at the 30 day mark, especially if there are no signs to indicate otherwise. You might also see Ruby's appetite decreasing with an increase.

[Harley PoMMom]

The (reference) ranges for a dog taking Vetoryl are 1.5 ug/dl - 5.4 ug/dl, and if all clinical symptoms are controlled that post number can go as high as 9.1 ug/dl.

We have found on the forum that when a dog has CC that it seems to be easier to get that CC under control and stay under control if that post number is 5 ug/dl or lower. Is her drinking/urinating of a normal amount? If not, along with her ravenous appetite I too would contemplate raising the Vetoryl dose a bit.

Hugs, Lori

[fosboyd]

Thank you the quick reply. My vet just called me and said from everything he knows about Cushing he thinks that as long as Ruby is not having any more breakouts that we should continue what we are giving her. He thinks that if we give her more there is the chance of her going too low. And that is more dangerous. I am going to get an opinion from my son in law who's a veterinarian out of town. I think 5 mgs could be too much of an increase. Maybe when it is time to reorder her medicine they can add just a couple of mgs. I will find out.

Thanks, Sandra and Ruby

[fosboyd]

Also, Lori, she sleeps all night without urinating. And doesn't seem to drink in excess. The water bowl is never empty.
Thanks

[molly muffin]

Okay so isn't overly drinking and peeing and no new break outs of cc. So only the appetite is large but it always has been. So how is her mobility? It could be that she will be fine for now on the dose she is on, but it also might be that the cortisol will go up and you'll end up having to increase the dosage too.

She might do well on 22 or 23 mgs of trilostane.