Cushings Boston terrier girl. Might be time for treatment now, but scared !/ CC

[DominicYUL]

Hey all,

My story is almost the same as the recent "New cushings mom" thread started a few days ago.

My Boston Terrier girl, who is 8 y.o, was diagnosed with pituitary cushings back in summer of 2015. She was drinking a lot, had that pot belly, was craving food all the time... Had blood tests, MRI and urine tests done, then the devastating results came back! She has had skin allergies problems for years, with some red flacky patches, so this can explain a lot.

I consulted an internal médicine vet, who felt my girl was doing quite good considering the results. I had already changed the food to a low temperature dehydrated raw food, which helped A LOT for the pot belly. I also started, like "cushing mom" a mix of melatonim/HMR lignangs and it seemed to work very very well for a while. Less drinking, happier dog, less food cravings, no need to Wake up 3 times every night to let the dog go outside for her pee, etc. Despite a case of ear infection tha got into partial paralysis and her being our of balance and falling, all was relatively Under control and good.

I was a happy dad until January of this year. Coming back from vacation, I noticed she had suddenly started drinking a lot, and was looking for food even after having finished her bowl. For the last week or so, it seems that her back legs are losing their strenght, as she is having a hard time jumping on the bed or climbing the stairs... she even missed a step while coming on the first floor and withing second she fell all the way down. Hopefully she did not get hurt.

In the recent days, I started seeing bad CC patches. 1 on her neck, one on her side. I have dealt with MANY skin issues with her and the best results were obtained with probiotics and enzymes. She still gets these suppléments every morning.

Now I am starting to realize it might be time for more "drastic" measures, i.e. putting her on meds like Vetoryl. I am a bit worried. Having read a lot of things, including here, i am afraid she might get worse and I might lose her faster than just waiting and continuing with the lignans/melatonin mix. Costs are frightening too, especially here in Canada (was told prices for Vetoryl are around 4-5$ a pill every day) but hopefully I can somewhat afford them. But really, my biggest concern is "what if she does not react well to it, will it get even worse" ?

A confused dad here...

[Harley PoMMom]

Hi and welcome to you and your girl!

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.

This Cushing's disease sure can be frustrating and confusing but we are here to help you and trust me, once you understand more about this disease you'll be less afraid.

We love details so the more share about your girl's medical history the better our feedback can be, and the way we find this information is with a lot of questions, ok? So here go some of mine!

Could you get copies of all tests that were done on your furbaby and post any abnormalities that are listed? With respect to the blood chemistry and complete blood count (CBC), you need only post the highs and lows and please include the normal reference ranges. Does your furbaby have any underlying illness that she is taking medication for? And if so, what is it and what is the medication? Were other non-adrenal illnesses ruled out such as diabetes, UTI, or a thyroid problem? How much does your girl weigh? What tests were performed that diagnosed her Cushing's, and could you post those results too? Has an urinalysis been done to rule out an UTI?

I am assuming that the CC you are referring to is calcinosis cutis, right? And if so, than yes, it can be difficult to get under control and it seems that it gets worse before it gets better. We do have a couple members dealing with CC and are having success with their treatment for it, we have found that the main goal with getting a handle on that CC is having the dog's cortisol at 5 ug/dl or lower.

Vetoryl does have some pretty scary side effects, however, adverse effects are usually not seen unless the proper treatment protocols are not followed. We have many members that are treating their cushdog with Vetoryl and are experiencing success. The key to facilitating safe and effective treatment is an experienced vet and an educated pet owner, so the best advice I can give you is to do your research on Cushing's, the treatment protocols, and how it is diagnosed. With treatment dogs with Cushing's can have a good quality of life and there is every reason to believe that they can live out their normal life span.

If you have any questions please do not hesitate to ask them. ;) I sure am sorry for the reason that brought you here but so glad you found us.

Hugs, Lori

PS: You can save money on those ACTH stimulation tests if your vet is open to cooperating. There is no reason why s/he shouldn't so make sure you talk to him/her about splitting the vial of cortrosyn, which is the stimulating agent used in the ACTH stim test. It is the cost of this agent that makes the stim test so darned expensive. Those members with small dogs can capitalize on this savings. You and your vet can read about this on Dr. Mark Peterson's blog for veterinarians, found here: http://endocrinevet.blogspot.com/2011/03/how-to-extend-your-supply-of-cortrosyn.html You can also get the Trilostane compounded which will save money too.

One of the ways that helped me with the expense was applying for Care Credit. It's a revolving credit line that allows you to pay large bills same as cash for a year. This information and other financial resources can be found here: http://www.k9cushings.com/forum/showthread.php?t=212

[DominicYUL]

Thanks for the reply. I need to call the vet for an appointment so I will ask for blood tests results as well. I think (my memory fails) that the tests were ACTH and low-dex, as well as ultra sound which showed an enlarged liver. The urine did not show any infection, but showed something that pointed us to the possible cushings (not sure what it was).

Mi girl is approx. 25 lbs, no other known illness, so no medication. Only thing is suppléments like probiotic and digestive enzymes to help with her skin allergies, as well as HMR lignans (20mg) and Melatonin (3mg). Unfortunately, due to her sever skin allergies, my vet used to give her steroids shots as she did not believe it was recurrent and thought it would solve the problem. I asked her to stop at one point, as I believed i needed to find the root cause of the problem instead of always relting on médications. She has not received steroid shots for over 2 yrs now, but I believe this might be the cause of the cushings, or at least might have acceleraed the process.

And yes, by CC i mean calcinosis cutis. As previously stated, she has had severe allergies for years now (most likely 5 years or so, but was prone to ear infections in the past). Hopefully this is now Under control thanks to the supplements and food. She has had naughty skin rashes in the past that looked like CC, but it is the first time she has 2 patches of that type, with a very bumpy feel. Looks like the skin is very thick and dry.

I'll get back with more results on the blood tests as soon as i can.

Thanks a lot !

[Renee]

I'm so sorry your girl has the dreaded CC. How was it diagnosed?

My Tobey (pug) has had CC since Oct 2013. We started vetoryl treatment in Dec 2013, and the CC mostly went into 'remission' over the following year. It took quite a while to go through all the stages and heal. It has rebounded a few times over the past few years, and she currently has one active lesion.

The thing about CC is that left untreated, it can become a quality of life issue. Some dogs never develop it at all, and some develop it mildly. No idea why. However, if your pup does have true CC, and it is progressing, then I strongly encourage you to safely begin treatment.

There are a number of things you can try in order to reduce discomfort and prevent infection -- but, the most important factor in healing CC is to get her post cortisol levels to below 5 ug/dl and keep it in lower range long-term. Do not ever forget that cortisol is your enemy. If you ask around, many people will tell you to try this, try that, etc, etc. Cortisol is the enemy. Treat the symptoms as best you can and work on getting that cortisol down.

The lesions are prone to secondary infection, especially once they bust open. If they look at all infected, run a course of abx.

[onlyg]

Hi Dominic. This is "New Cushings Mom". :) I just wanted to let you know you came to the right place. Everyone here is so knowledgeable and really caring. I may be new to the forum but the response and reassurance I have received is priceless!!! I cannot believe how much our situations are the same. Except for the fact that Maggie is 12 and weighs 2 lbs less than your baby, their situations are almost identical. She had bad skin allergies all her life, used lots of steroids in the past which I too believe has now played a role in all this. Other than that, she too has been healthy. The advice they give you here is the best. Take a breath, read everything you can, ask a lot of questions here and then make a decision based on the knowledge you gain. That's how I found this forum. I stressed myself to death when I made the decision to put her on Vetoryl but she started to deteriorate so fast and then the CC started and I had no choice. After reading the stories on this forum, I came to the conclusion that I could live with trying Vetoryl. Everyone is different so you have to be comfortable with the decision you make. So far, I am so glad I did. In this small amount of time she is much less stressed than she had been in months. I know the road is long but at least I feel like I'm helping her. Time will tell and lots of decisions and changes will be made, but I know I speak for everyone here that the ultimate goal is keeping our babies as happy and comfortable as possible. The rest is out of our hands. Please know you have many people here that really care and will help you through this so you don't have to go it alone. I don't know how I would go forward if I didn't find them! Big hugs to you and your sweet girl!!!

[tank&kat]

Welcome

I'm sorry your girl is not doing well. It sounds like the vet did all the necessary testing for an accurate diagnosis. I will be interested in seeing those results as soon as you get them. It is common for vets to not treat an asymptomatic dog even though test results are positive for Cushing's. It takes time before hypercortisolism starts to wreak havoc within the body and once it does, it's best to treat.

The medications to treat Cushing's have a bad rep. Vetoryl and Lysodren can both be very effective at lowering cortisol and controlling symptoms. The key is to have an experienced vet that has full knowledge of the dosing and monitoring protocols. Lysodren is cheaper than vetoryl but it all depends on which drug the vet has more experience using.

~Katherine

[Harley PoMMom]

I am so glad to see that our resident CC expert, Renee, has posted to you. I've also taken the liberty and added CC (calcinosis cutis) to the title of your thread that way it will make it easier for members that are dealing with this to see your thread and respond sooner.

[DominicYUL]

Thanks everyone for the kind words. I have been coming on the forum since I started looking for info on Cushings. I must admit I have read tons I posts on here but never posted. Now is my time I guess ;)

CC was never diagnosed since she never had it in the past. My internal medicine vet is very knowledgeable from what I saw and also cares that my dog feels good all the time, and never pushed for meds before as my girl was doing relatively well without medication. I have an appointment with the vet on March 1 and will explore all options with her, as I feel her condition has deteriorated over the last month or so. In the meantime I'll make sure to clean the skin patches with a chlorhexidine solution, as it looks to me like the best thing to keep the lesions clean and dry, and to keep infection away. Any advice on this ? Should I use something else ? I know that I need to keep lesions dry and nt to put any greasy stuff.

I'll call back tomorrow to get the full tests results.

I'll keep you all posted !

[DominicYUL]

Ok. Got a hold of the vet and jut received a copy of the tests. God there are so many numbers on there lol.

What exactly would help you ? I have something like 4 pages of results.

[Harley PoMMom]

With respect to the blood chemistry and complete blood count (CBC), you need only post the highs and lows and please include the normal reference ranges. As for the diagnostic test/s for Cushing's please post those results too, the two tests usually performed to diagnose Cushing's are the LDDS (low-dose dexamethasone test) and the ACTH stimulation test: the LDDS test will have 3 numbers, a baseline/resting, 4 hour and an 8 hour; the ACTH stim test will have 2 numbers, one is the pre and the other is known as the post.

I'm including a link to Renee's thread where you will find answers to some of your questions: http://www.k9cushings.com/forum/showthread.php?t=5908

Hugs, Lori

[DominicYUL]

Morning all.
I must admit: I am lost with all the numbers and can't seem to find the reference data. Sorry about my ignorance on this, but it is the first time I see these results and I can't seem to be able to locate what's important from what it not.

I have just created an album with the results I got from the vet. Can someone help me read them and identify the important information ?

Much much appreciated:o

[Renee]

LDDS (converted from nmol)

Baseline 3.52
4 hr 3.01
8 hr 3.77

[DominicYUL]

Thanks a lot, Renee ! Am I right to say that these numbers would be considered as normal ???

[Renee]

Thanks a lot, Renee ! Am I right to say that these numbers would be considered as normal ???

These numbers indicate a positive diagnosis of cushings, but they do not tell us if she has PDH or ADH. Based on that, I would suggest you consider some kind of high-quality imaging, like an ultra-sound or CT, to determine if there is an adrenal tumor.

[DominicYUL]

Ok so I definitely am confused with these numbers :) Thanks for clarifying.

However, I can confirm an ultra sound/MRI was done back in that time, which confirmed that there is no adrenal tumor. It was confirmed it is pituitary, with a slightly enlarged liver.

[tank&kat]

Are you more comfortable with the medications to treat this? Let me know your concerns. I'll find you a couple good sources that could help.

~Katherine

[DominicYUL]

Are you more comfortable with the medications to treat this? Let me know your concerns. I'll find you a couple good sources that could help.

~Katherine


Hi Katherine,
My discomfort comes from the fact that I am afraid of some of the possible side-effects, but most importantly afraid that it speeds up the deterioration process.... I know it is a silly thing, but you want to consider all aspect before going with harsh meds on your little fur baby. However, I see that many here have had positive results with Vetoryl, so I guess that starting with a lower dose and closely monitoring is the best solution.

I am meeting with my internal médicine vet on March 1 so I will ask as many questions as possible :)

[Renee]

Ooops, she did have an MRI! Sorry about missing that from the first post.

You are doing good Dominic. I completely understand your fears ... but, CC changes the game quite a bit. Seeing an IMS is a great start. Just note all your questions between now and the appointment and be ready with them.

Low and slow is best, no more than 1mg per pound.

Hang in there!

[molly muffin]

Not treating can also have an adverse effect as high cortisol running rampant thoughout the body affects the internal organs like kidney and liver. So that too is something to consider when discussing with your vet.

The problem once you have calicinois cutis is that calicum deposits are forming in the body and just as you see them come through the skin, they also can calcify inside the body, on the organs. So, again, something to consider.

It's a whole picture thing. Protocols for dosing and for testing (monitoring) are the most important to reduce possibility of side effects. Most side effects are in fact due to not starting at the right level for your dog or not following proper protocols to monitor the effects on the adrenal glands.
Not discounting that there are always the dog who doesn't read the book but I think that what I wrote is a fair generalization.

Hopefully this will help you to have a frank discussion with your internist and come up with a game plan.

[tank&kat]

Hi Katherine,
My discomfort comes from the fact that I am afraid of some of the possible side-effects, but most importantly afraid that it speeds up the deterioration process.... I know it is a silly thing, but you want to consider all aspect before going with harsh meds on your little fur baby. However, I see that many here have had positive results with Vetoryl, so I guess that starting with a lower dose and closely monitoring is the best solution.

I am meeting with my internal médicine vet on March 1 so I will ask as many questions as possible :)

It's not silly at all. I can recall having the same thought about the drug speeding up the whole process in a negative way. Once I saw my dog change and get all of his energy back, that negativity went away. Many people have the same fear of the adverse reactions or over suppression. That's why one of the first things we are concerned about is the dog's weight and how much med is prescribed. Anytime a drug is started at a lower dose and split throughout the day there will always be a lower chance of ill effects.

[DominicYUL]

Hi everyone,

Been busy a lot lately and could not keep you up to date on Lucie's conditions.

Went to the vet early March and we started her on Vetoryl. Vet started with very low dose (10mg - she weighs 23 lbs) to see how it would affect her. She tolerates the meds very well, with no side effects what so ever. Drinking has reduced quite a bit, and I even think her hair grows back a little (just a little, but hey, that's positive). Skin on her belly does not look as thin. Waiting for the new blood tests results, that should come in tomorrow (tests were performed this morning).

However, CC has spread a lot!!! Vet said it should be "Under control" (meaning, should stop spreading) once we find the right dosage, and that it might take up to 4-6 months before it completely heals. Up until yesterday, they were Ok considering what it is (thick patches, flacky,, no hair). However, it started bleeding yesterday... Pretty nasty :( I clean almost every day with a Chlorexidine solution to keep infections away, but we are starting an antibiotics treatment today, for 4 weeks, as the vet thought it was a bit infected. Hope it helps. It breaks my heart to see her like that, as I know there is little i can do for CC....

And of course... Since bas news never come alone, vet also diagnosed a possible cancerous tumour on her right hip. Tumor is attached to her leg muscle. Bad daddy I am, I have decided not to move forward with any surgery or chemo treatments, as it would put her into too much stress and pain, and I don't want that for her. I have decided to focus on treating the cushings to give her a quality of life. Thankfully (!?), the vet will see her every 3 months so we'll keep a close eye on the tumor and advise in due case should it gets too big or if we feel it is invading too much. I feel this part was even harder to digest than learning about cushings last year....

That's about it for now. Not all good news, but let's keep faith that she'll be doing fine for a while !

[Joan2517]

Oh, I'm so sorry about all this bad news on Lucie...hopefully the medication will help.

Joan

[Renee]

Hi Dominic,

Thank you for updating. One of the admins will be along soon to merge your thread.

Take a deep breath and stay calm. CC goes through many stages, often getting worse before it gets better. Those lesions need to work through the various stages and come out. I am very glad you've started a course of abx. I did that myself when dealing with CC. And, your vet is correct that it may take 4-6 months. But, don't worry, as soon as her cortisol is in the proper range, those lesions will begin drying up and healing. It won't be raw and oozing forever.

Please post those results for the monitoring test as soon as you get them!

[Squirt's Mom]

MODERATOR NOTE: I have merged your update into Lucie’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!

[molly muffin]

Hmm, couldn't they do a fine needle aspiration to find out if it is actually a cancerous tumor? Maybe it is a lipoma or something benign?

Definitely want to hear what the test results are too.

Renee is right and she has been through it, so quite the expert. They do break open and bleed sometimes and they get really nasty, but they have to do that so it can heal. :( And yes, 6 months is not unheard of. Once you get the right dose, though, no new ones should form.

[Harley PoMMom]

Bad daddy I am, I have decided not to move forward with any surgery or chemo treatments, as it would put her into too much stress and pain, and I don't want that for her. I have decided to focus on treating the cushings to give her a quality of life.
That's about it for now. Not all good news, but let's keep faith that she'll be doing fine for a while !

In no way are you a bad daddy, and I too, believe that quality of life is paramount. Your deep love and devotion to Lucie is evident to us all and she is a lucky girl to have you as her daddy.

Hugs, Lori

[onlyg]

This is new cushings mom again. If I didn't know better, I'd think your baby and mine were twins! :)I posted the latest pics of Maggie's CC in her album. It may help you to see the pics from before the vetoryl, 10 mg- she is also 23lbs, to now after one month of treatment. You can see it actually looks a little better already. Fortunately for me, it has never really split open or bled. Just started looking red and angry for a while. But as you can see, it started along her spine and very quickly spread over her entire back and shoulders. I keep a tshirt on her to reduce the risk of infection and keep her from possibly scratching it on anything. It seems to bother me much more than her. She also has one hard growth and one soft one on her leg that we are also just watching for now. My vet and I also do not feel comfortable having her endure a surgery right now. l just thought it might help to know you are not alone and have something similar to compare it to. Hoping things get better for you and your baby!!

[DominicYUL]

Thanks to all for the replies ! It helps to see we are not all alone in this.

Hopefully the set of abx will help reduce inflammation and infection on the skin patches. In the meantime, she would be the perfect extra in a zombie/apocalyptic movie :p

Results are in:
Pre: 138 nmol/l
Post: 132 nmol/l

The vet is very happy with these results and said they show that Vetoryl is working well and dosed correctly. Is that right? Lucie is on 10mg now for 23 lbs, and vet wants to continue with same dosage.

My question: with a dog that shows signs of CC, I have read from the "CC Master" (Renee) in here that we need to keep the figures below a certain amount... Can't recall the treshold... are these results ok ?

Thanks all for your support !

[Renee]

Dominic! That's so funny you say she could be an extra in a zombie movie. That is exactly what we said about my girl too. We called her zombie-pug, lol!

Your results converted to ug/dl are
Baseline 5.0
Post 4.8


These figures are PERFECT. Do not increase the dose. Stay at this dose and let it work it's magic. You'll want Lucie to be in this range long-term. If you can keep her cortisol around this range for the next few months, you should see things start to dry up and heal. It takes a while, but you are on the right path!

You'll want to run another stim test in about 4 weeks to see if her cortisol is staying in range.

[Harley PoMMom]

I agree with Renee, and Dominic, you are doing a great job!!

[molly muffin]

yay for good news that the dosage she is on is working.

I'm with the others, quality of life is paramount. :)

[DominicYUL]

Hi everyone,

It's been quite a while I have not been here. And it's been quite a hectic ride for my pooch and me.

So.... last time we "talked", I had started Vetoryl at a 10mg dosage. Everything went pretty well. Results in June showed an increase of her cortisol level, but nothing dramatic, so we kept the same dosage. At that time, the CC was getting Under control, with a much improved skin, yet no hair regrowth. Skin started to crust again, with infections, severe patches, hair loss, etc etc. Increased Vetoryl to 20 mg a day (10 in the am and 10 in the pm, since a 20mg pill does not exist) + 6 weeks of antibiotics. The vet even opened the door to the eventuality of putting her to sleep if we can't control the symptoms, as she feared her quality of life might suffer.

Came back from 2-weeks vacation on August 20 and dog looks great, much happier, improved muscle strength, gained weight.... Looks like she had fun at grandma's :)

However, did some new blood tests yesterday and results are too high again ! Here they are (sorry, don't know how to convert...)

Pré: 94 nmol/L
Post: 224 nmol/L

Post range should be between 50-150 nmol/L, especially if we want to control her CC and improve the skin...

Now the vet is suggesting another increase. BUT, that means 2 x 10mg in the morning + 1 x 10mg in the evening. For those who use Vetoryl, you know how painful that is on the wallet ($325 CDN a month). The vet is afraid that going for a 30mg dosage in the morning might be too rough. Lucie weighs approx. 20 lbs.

I am very surprised to see the manufacturer does not have any dosage between 10mg and the next step, which is 30mg. Giving 3 pills a day looks to me like a lot, but it seems that there is no other alternative. Compound is not really available here....

Any thoughts ? Similar experiences ?

[DominicYUL]

Me again. Started Lucie on 20mg this morning and 10mg tonight. Now her left ear is all flappy. She is a Boston and therefore should have both ears straight. She is still happy, does not seem to be sleepy or anything. Did not vomit either and stools are ok.

Should I worry that it is related to the new dosage ??

[Harley PoMMom]

Sorry to hear that Lucie is having trouble with her ear :( I really don't think that the increase in her dose would have caused that. Does her ear feel warmer that the other one? Is there any kind of swelling, discharge, or odor?

Hugs, Lori

[labblab]

I'm also sorry to hear about Lucie's ear problem. But like Lori, I don't know any reason why the Vetoryl would have caused it. In that vein, I also would think that it would be OK to shift to giving her the 30 mg. once daily in the morning. Given her weight, this still only works out to a formula of 1.5 mg. per pound, which is not an exceptionally large dose at all. Plus I'm guessing that, worldwide, the majority of dogs taking the medication are dosed once daily and that remains the recommendation of Dechra unless symptom rebound indicates that the drug's effect is wearing off too quickly within a 24-hour cycle. So given the big financial difference, I'd certainly be inclined to give the once daily dosing a try.

Marianne

[DominicYUL]

Thanks for the replies. The vet who checked her was not the usual one, as my regular intern vet was on vacation. I'll talk to the usual vet once she is back. Not that Lucie is complaining about taking three doses though, as this means three times the treats ;))

Will keep you posted !!