Daisy - 6yo labrador diagnosed with Cushings (Daisy has passed )

[arentspowell]

Hello, I hope this is the right section to post!

Daisy our sweet 6yo lab was recently diagnosed with Cushings. My mother in law first brought the increased water drinking to our attention. After two pee accidents inside, I knew something wasn't right and we made a vet appointment right away. The blood panel and urinalysis results showed elevated levels and very dilute urine. (I will post more specific results later.) The vet suspected Cushing's and scheduled us for an ATCH stim test. The result of that test also strongly suggested Cushings and we were referred to a specialist for an ultrasound. The ultrasound should two enlarged adrenal glands so she was diagnosed with pituitary Cushings. Daisy has all the symptoms - increased water intake, ravenous appetite, rear end weakness, more panting than usual, and an enlarged belly. The specialist vet says she's a textbook case of Cushings.

We have decided to go with the Trilostane for treatment and are just waiting for it to come in to start.

My husband and I have taken the diagnosis pretty hard. It's become so apparent to us just how much Daisy has slowed down in just the last two months. She just doesn't have the energy or stamina to swim or do agility anymore. She has always been lean and muscular but now her spine is started to show even though she weighs more than she ever has (64lbs vs 55-60lbs). She has eaten 1 1/3 cups twice a day for most of her adult life (currently Earthborn kibble). My mother in law thinks we should feed her more but I'm just not sure. She eats grass constantly whenever she's outside and has started to snatch food off of the coffee table.

She can't jump onto the bed anymore and almost fell off trying to do it this morning. I just can't believe this has happened so quickly and it makes me worried considering she is only 6 years old which is relatively young for a Labrador. Will her energy and muscle tone improve after starting treatment?

Thanks for listening :)

[dsbailey]

Welcome,

I'll just make a few comments and suggestions to give you a head start and let the other more experienced take over. Gather all of your test results blood work, urine, ACTH, ultrasound, etc., they love numbers here. What I can contribute here is to start out on the lowest dosage possible for your girl, my guess is your vet / IMS is starting her out on 60 mg once a day in the morning with a full breakfast. It sounds like you're doing exactly what needs to be done so far. The next step will be to slow down and get the dosage right which can be frustrating and may take a few months. The point of the exercise is to not over-medicate which isn't good for your girl, your sanity, and it will slow the process because you will have to pause and start over on a lower dosage.

My girl is a 10 year old Aussie Shepard mix and weighs in at 57 lbs. All dogs react differently to Trilostane, my girl is sensitive and her initial dose of 60 mg was too much and is now taking 35 mg. Please read the short thread titled "Lolita" to get an idea of how we got from 60 mg to 35 mg. I think we will be bumping her up to 40 mg which should be just about perfect. It's very important that you schedule an ACTH Stim Test no later than 14 days after you start the meds and during that time look for ANY major side effects.

I'm not going to go any further because by the end of the day today you will be inundated with replies and information from people that have years of experience compared to my few months.

There are a couple of positives you may be overlooking in all of the negatives. You caught it early, you took the proper steps, and it's pituitary and not adrenal so the disease should be easier to control.

Darrell and Lolita

[lulusmom]

He and welcome to you and Daisy,

Darrell has done an excellent job of reading my mind and saying exactly what I would have had he not beat me to the punch. We do love to see test results so when you have chance, please post them. It's actually a a great idea to keep all of Daisy's test results in a folder. The reason for that is not just because we keep asking you to share results but because cushdogs are more likely than completely healthy dogs to require an after hours trip to an ER. ER vets love it when they have their patients latest up to date medical history in front them. That folder also helps when we pet owners forget some things during the emotional turmoil of our dog's sickness. When you are ready to share the results, we need only see the highs and lows on the blood chemistry and cbc, and please include the normal reference ranges.

My second cushdog was a shelter rescue with very advanced disease. He was one big infection with bleeding eyes, black stuff oozing from his ears and he had severe muscle wasting due to the catabolic effects of excess cortisol. His hind quarters tremored constantly for the weakness and he would fall over if he attempted to lift his leg to pee. My first cushdog was also diagnosed late but she was much younger, only three years old so her muscle wasting was not so severe. I remember the first time Jojo actually started to skip across the yard. I started to cry because I never thought I would see him do anything but plod along. Muscle wasting is a symptom that does not resolve quickly so patience really is a virtue, especially for a pet owner like you whose dog have been remarkably active and agile. I promise that with effective treatment, this will get much better in time.

As for the physical changes due to cushing's, muscle wasting and redistribution of fat makes a dog look thin and fragile and it doesn't mean a dog is emaciated and needs more food. I would keep Daisy on her same healthy portions of good feed that is higher in good quality protein and lower in fat. Earthborn is a bit higher in fat than some people are comfortable with but if she's done well on that brand, I personally would not change it. It's actually rated as one of the better kibble. It's actually more important that you remember to give her the Vetoryl with or directly following a full meal. Daisy's appearance will improve but it may not be restored to her former glory. We have seen more than a few cushdogs who returned to agility and did quite well, so hang in there.

It is in Daisy's best interest that you be an active participant in her care. My best advice, based on my own experience and those of a multitude of members, is never place blind faith in your vet to act in the best interest of your dog. You seem to be a lucky one who has an pretty good vet but many people have not been so lucky. I am including a url below to Dechra's Continuing Education (CE) page for petowners and veterinarians, that will help you understand a great deal more about monitoring treatment. The flowchart is fairly easy to follow so quiz yourself when your vet does the first acth stimulation test at no more than 14 days after starting treatment. See how well you can assess the results. This will help you greatly in being a proactive participant in Daisy's care. The more you learn, the more relaxed you will become. There are a lot worse things that can happen to our dogs and as long as you and your vet do your part, your precious Daisy can live out her life expectancy with a very good quality of life.

http://www.dechrace.com/pdfs/vetoryl/VETORYLTreatmentMonitoringBrochure.pdf

I'm sorry for the circumstances that brought you here but I'm glad you found us. We're here to help you in any way we can. Be sure to check out our Helpful Resources subforum. There is a whole bunch of reference material on many, many subjects that can help you learn. If you have any questions, don't hesitate to ask.

Glynda

[DoxieMama]

Welcome to you and Daisy! Looks like Darrell and Glynda have covered all the topics I can think of this morning, though I don't see your mention of the dosage of Trilostane you're going to start using. I hope it's no more than the current recommendation of 1mg/pound.

I'm so glad you found us, and am looking forward to learning more about Daisy!

Shana

[arentspowell]

Thanks for all the replies all. My husband has been the one to take her to all the appointments since his hours are a little more flexible but I do have all the paperwork so I'll post that info as soon as I get home.

The medication just came in and the dosage is 1mg per lb. We are making an appointment for a stim test for 14 days out.

[Harley PoMMom]

Hi and welcome from me as well!

I see that you have received a lot of very good information and the only thing I'd like to add is that some members give their cushdog frozen green beans to help with that ravenous hunger, carrots are also another option as long as diabetes is not involved.

Hugs, Lori

[arentspowell]

Here's everything that was outside the normal range, i put the reference range in parenthesis

ALP - 1707 (5-160 U/L)
ALT - 792 (18-121 U/L)
AST - 58 (16-55 U/L)
GGT - 101 (0-13 U/L)

Cholesterol - 347 (131-345 mg/dL)
Chloride - 106 (108-119 mmol/L)
Potassium - 3.9 (4.0-5.4 mmol/L)
NA/K - 38 (28-37)

Lymphocyte - 811 (1060-4950 uL)
Eosinophil - 7 (70-1490 uL)

T4 - .8 (1.0-4.0 ug/dL)

Pre-ACTH - 12.1 (2-6)
Post-ACTH - 34.9 (6-18 )

[judymaggie]

Hi to you and Daisy! You have already received outstanding guidance. I did want to mention a couple of things. There are many theories about why dogs eat grass. I personally have found that my dogs have eaten grass when they have an upset stomach. If the latter is the case with Daisy and because trilostane can cause indigestion in some dogs, you may consider giving her some Pepcid AC (original) about 15-20 minutes before the meal after which she will get the trilostane.

Others who have more experience than I with regard to lab test results will come along to discuss those. In light of all of the liver markers being high, I would be interested to know if the ultrasound report said anything about Daisy's liver.

[arentspowell]

Judy - I checked the ultrasound report and it doesn't mention anything about the liver. The ultrasound did reveal a gallstone that we weren't aware of that could possibly be pose a problem in the future but isn't cause for too much concern right now. Other than that it just says the bilateral enlargement of the adrenals rules an out adrenal tumor.

The specialist also noted a grade II systolic heart murmur which I didn't even know she had! Our regular vet may have told us this when she was a puppy but we must have forgotten.

[lulusmom]

Thank you for posting the abnormal labs. With few exceptions, those abnormalities are normally associated with cushing's. What does not fit is the very high ALT and elevation in AST. Mild elevation in ALT is not unusual but Daisy's ALT was anything but mild. Did the ultrasound findings mention anything about the gall bladder? I ask because any type of bile duct obstruction can cause these liver enzymes to rise. A hemolyzed blood specimen can also increase these two enzymes but I doubt it would have that significant of an impact on the ALT. Did your vet discuss any of the labs with you and/or mention keeping an eye on the ALT?

Glynda

[Aunt Jana]

I am a fairly new member, only my own experience to share. Read my thread, my young boxer got this out of the blue. A healthy, happy, sweetie pie. I give her a few things that have helped with her weight, it is maintaining, despite everything.
Good luck to you, go by your gut extinct. Listen to it and don't second guess yourself.
This forum has wonderful members who have a wealth of information about this disease.

[arentspowell]

Our regular vet was concerned about the liver values so the ultrasound orders to the specialist vet included instructions to check the liver.
My husband asked specifically about the liver at the ultrasound appointment and the specialist told him it looked normal but that she did have a gallstone.

The report says:
"A stone was noticed within the gallbladder incidentally during the ultrasound today. There is a future risk for biliary obstruction which could require surgical intervention. Please monitor Daisy Mae for vomiting, diarrhea, lethargy, inappetence, and yellowing of skin/eyes/gums, as they could all be signs that this stone has become a problem. No specific medical interventions are required at this time."

I wasn't aware until now that the elevate liver is not related to the Cushings. Thank you so much for bringing that to my attention. I will continue to press about the liver values with our vet.

[arentspowell]

I am a fairly new member, only my own experience to share. Read my thread, my young boxer got this out of the blue. A healthy, happy, sweetie pie. I give her a few things that have helped with her weight, it is maintaining, despite everything.
Good luck to you, go by your gut extinct. Listen to it and don't second guess yourself.
This forum has wonderful members who have a wealth of information about this disease.

I read through your thread and my heart is breaking for you and Bubbs. :( I'll keep your girl in my thoughts.

[lulusmom]

It sounds as though the radiologist didn't express much concern with the gallstone but I do know they can cause bile duct obstruction which is why I asked about the gall bladder. Anything that causes bile duct obstructions can cause some pretty high elevations in ALT as well as GGT. It is very rare that a dog with cushing's has a normal liver on imaging. The liver is usually enlarged and has distinct changes (hyperechoic) caused by the glycogen accumulation that occurs as a direct result of cushing's. Can you check the ultrasound comments to see if the liver truly is completely normal? If Daisy were my dog, I would want to have her liver values checked in three to four weeks to see if they have dropped. If they haven't, I'd ask the vet to do a bile acid test. I just can't help but wonder if there is more going on with Daisy because a more than six fold increase in ALT and a completely normal liver are definitely not common in a cushingoid dog.

[arentspowell]

My husband has been the one going to all the appointments since our vet is right across the street from where he works and he brings Daisy and our other dog Lily with him to work everyday. I think I'm starting to drive him crazy asking him all these questions! He said the paper I quoted above is the only one he got from the specialist and he believes thats all that was forwarded to our regular vet who is directing the treatment. He said he also specifically asked about the liver during the specialist consult and they told him it looked fine, that it wasn't "shriveled up" like a damaged liver would be.

The numbers are really high though so he understands why I keep asking about it over and over. The ATCH re-check is on a Friday and I get off early that day so he said we can go together and express all our concerns and get a new blood panel done to make sure everything is ok.

[arentspowell]

4 days into treatment. I was really hoping that the pee accidents would subside :( There was a huge pee spot on the bed when I went to go to sleep. Had to wash everything - duvet, sheets, and mattress cover. Didn't get any sleep until 2 am when the sheet and mattress cover were finally dry. We never saw her do it and we keep the door to the bedroom closed while we aren't home. Is it possible she peed while laying down on our bed?

[lulusmom]

Thank you for responding. With respect to my comments about the liver, I am aware that dogs with primary liver disease have smaller livers on imaging as the liver cells are dying. However, dogs with cushing's have enlarged livers and it is rare that a cushdog's liver on an ultrasound is normal in size or structure. I apologize if your husband was annoyed that you were asking so many questions. When I first arrived on the scene on this fabulous forum, I learned a great deal about the disease by answering questions from experienced members, some of whom I believe could teach gp vets a thing or two. I thought I was a great advocate for my dog but I discovered rather quickly that I was woefully inadequate. :D It is not my intention to second guess your vet or you. My intention is to put everything about Daisy's medical history on the table so we all can provide you with more meaningful feedback, appropriate reference material or simply share our own experiences that may mirror your own.

With respect to Daisy's pee accident on your bed, it is quite possible that she peed in her sleep. Dogs with cushing's whose symptoms include voluminous intake of water and peeing lakes aren't concentrating their urine so a once housebroken dog can start to have accidents, including peeing in their bed and yours. Can you remind me again how much Daisy weighs and what dose of Vetoryl (trilostane) is she getting and is it once a day or twice a day? Treatment can drop cortisol rather quickly and if Daisy is on an appropriate dose, you should start to see improvements in her drinking and peeing soon. However, a small number of dogs can take longer to see resolution of those issues depending on how long they've not been concentrating their urine. If you don't start to see improvements within a week to 10 days, the dose may be too low. The acth stimulation test done at 14 days will tell the tale.

Reminder: Always give Vetoryl with food, including the day of the acth stimulation test. Makes sure you have Daisy to the vet's office within 3 to 5 hours of the morning dose. Stick to the same routine with every acth stimulation test so that your vet will be comparing apples to apples.

[arentspowell]

It's very much appreciated! I was feeling overwhelmed and hopeless when we first got the diagnosis but the wealth of information and comments from members has been awesome and very helpful to me.

I think my vet was also concerned about the liver values but it hasn't been brought up again after the ultrasound. In fairness to him we haven't had another office visit with our regular vet since the ATCH test. After the ultrasound with the specialist we have spoken to our vet over the phone a few times to discuss treatment, it was then ordered and we picked it up. We go back in 10 days for the ATCH test. I feed the dogs at 7:30 and we will probably drop her off at the vet around 9:30. I will make sure to tell the the precise time the dose was administered for accuracy. I'll bring up the liver values when we meet with the vet. It's really easy for us to just pop over there to do another blood draw if they want her fasted for it.

At her last weigh in about a month ago Daisy weighed 65 lbs. This is the heaviest she's ever been but she looks very thin in the rear due to the muscle waste. From the front she looks ok, ribs are easily felt but not showing. We are giving her a 60mg dose of Vetoryl. It's only been four days and no side effects so far.

I'm not really sure how long she hasn't been concentrating her urine. The first ever accident she had was probably 6 months ago and never happened again. It was a one off thing so we didn't stress about. She's always peed 2x every outing since she was a puppy so we didn't think much of it when 2x turned into 3-4 times as if she was marking. We noticed the increased water drinking about a month ago. My in laws brought it to our attention. Around the same time she had two accidents in the house. Both times she panted heavily for a few minutes then squatted to pee on the rug. That's when we knew something just wasn't right. She's normally very good about letting us know. We have bells at the front door that she rings. Ever since the diagnosis we've been taking her out constantly. During the day she is very good at letting us know that's what made me think maybe she peed without realizing it. It happened the other day on an area rug and I never saw her squat. I suspect that it's probably been longer than we realize that she hasn't been concentrating.

[molly muffin]

Day 4 is still a army days. Sometimes it takes a bit longer than that to see results. I usually say around day 10 but that isn't a given, just a generalization I have noticed. Mao hang in there and hopefully the peeing accidents will get better.

[arentspowell]

I have the results back from our 14 day follow up
Pre - 6.5 ug/DL
Post - 6.6 ug/DL

The reference range from the lab says 2-6 for pre and 6-18 for post. We are right on the cusp for pre and the vet is pleased with how Daisy is responding to the Vetoryl so he doesn't want to change anything just yet. We are continuing on the 60mg dose for another 30 days and then we'll see where we are at when we retest. Just to clarify this is still the starting dose of 1mg per lb.

He also did an in-house blood panel. I am not super familiar with what all the things mean but here are the values that showed up outside of normal. Reference is in parenthesis.

GLU - 129 mg/dl (75-125)
TCHO - 403 mg/dl (120-310)
GGT - 121 u/l (0-14)
ALT - 467 u/l (0-120)
K - 3.7 (3.8-5.3)

[Harley PoMMom]

For dogs receiving treatment with Vetoryl/Trilostane the reference ranges are 1.5 ug/dl - 5.4 ug/dl and that post number can go as high as 9.1 ug/dl if symptoms are controlled. Those other reference ranges that you posted (2-6 for pre and 6-18 for post) are for a dog that is NOT on treatment with Vetoryl/Trilostane, I know it can get confusing.

Daisy's ACTH stim results are great and the vet's decision not to raise Daisy's Vetoryl/Trilostane dose at this time is in accordance with what many cush savvy vets are doing, which is also great!

Regarding her chemistry blood panel the GLU (glucose) can be transiently elevated from the Vetoryl but should normalize so you may want to keep an eye on that because diabetes is common in dogs with Cushing's. Another thing that concerns me is the increased GGT and ALT, both of these are liver enzymes and usually are only slightly elevated which warrants monitoring too. I'm not sure what TCHO is hopefully someone else will know. How are her symptoms?

You're doing a wonderful job!

Hugs, Lori

[arentspowell]

For dogs receiving treatment with Vetoryl/Trilostane the reference ranges are 1.5 ug/dl - 5.4 ug/dl and that post number can go as high as 9.1 ug/dl if symptoms are controlled. Those other reference ranges that you posted (2-6 for pre and 6-18 for post) are for a dog that is NOT on treatment with Vetoryl/Trilostane, I know it can get confusing. Daisy's ACTH stim results are great and the vet's decision not to raise Daisy's Vetoryl/Trilostane dose at this time is in accordance with what many cush savvy vets are doing, which is also great! Regarding her chemistry blood panel the GLU (glucose) can be transiently elevated from the Vetoryl but should normalize so you may want to keep an eye on that because diabetes is common in dogs with Cushing's. Another thing that concerns me is the increased GGT and ALT, both of these are liver enzymes and usually are only slightly elevated which warrants monitoring too. I'm not sure what TCHO is hopefully someone else will know. How are her symptoms? You're doing a wonderful job! Hugs, Lori

Thanks Lori. I looked it up, TCHO is cholesterol. My vets in-house blood panel results were harder to follow than the original one from the lab. Liver enzymes are still high but they are down significantly from our first blood test about a month ago so we will continue to monitor that.

The symptoms have mostly resolved, ya'll were right day 10 was the magic number. She is drinking normally and appetite level has mostly gone back to normal, for a lab lol! No more pee accidents. The biggest improvement has been in her overall mood, she is back to her happy playful self and has more energy to fetch. Agility is still on the back burner for now but we are hoping to get her into the pool for some swimming.

As soon as I got the results for the ATCH test I checked the Dechra insert and noticed the reference ranges are different. The vet told us she was very close to where we want her at so he didn't want to increase and I think that's the right call based on the progress we've made in a short time.

[molly muffin]

That is excellent that you are seeing really good results on the 10mg. Sometimes you just have to tweak it a little bit and Wa La. :)

So good to hear to this report

[arentspowell]

I apologize in advance for the long update!

Daisy had a strange episode on Thursday night. Around 2 AM she hopped on our bed and started panting heavily and digging the sheets like she does during a thunderstorm. There was no storm but we thought maybe she was trying to tell us she needed to go out. We walked her downstairs but she refused to go out the door. Came back upstairs and she stood in the corner and wouldn't move or respond to her name being called. I got down on the floor with her and she became responsive again. She laid down and calmed down. A few minutes later I walked her down again, this time she went out like normal, peed and ate a treat. First available at the vet was the last appointment on Saturday.

The vet was concerned about an Addisonian Crisis so he did another blood test and sodium/potassium levels were perfect so that was ruled out. The test also showed that the elevated liver enzymes have dropped a little further. So that was a good thing. I forgot to get a copy but I'll post those values this week.

My husband has been complaining that Daisy still pants a lot and breathes loudly (like snorting sounds). So we are doing a chest x-ray on Tuesday.

Daisy also had a little patch on her leg where the hair literally got ripped out. We pointed that out to the vet and he said the thin skin is common with Cushings and gave us an ointment for it.

Lastly, while we were in the waiting room we noticed a ridge going down Daisy's back where the hair won't lay flat. When we lifted the hair we noticed red irritation. The vet said it could be CC but he wasn't exactly sure because he's only seen it in the later stages when its really bad and more crusty than what he was seeing on Daisy's back. He gave us a hypoallergenic shampoo to bathe her with twice a week and we're just going to keep monitoring it. Also, no topical flea and tick medications for the time being. We normally bathe Daisy about four times a year so this should be fun! :roll eyes:

[lulusmom]

Daisy's odd behavior could have been caused by a partial complex seizure. There are a lot of different seizures but this type is a bit different as symptoms can look just like a dog who suffers from anxiety from loud noises. Hopefully it's a one off episode and you'll never see it again but you may want to mention it to your vet. One of my cushdogs had infrequent petit mal seizures that were hard to watch.

The results of Daisy's first stim test were very good and I suspect those numbers will drift downward before the next stim test is scheduled. That is a very good thing because if Daisy does have calcinosis cutis, you want to get the pre and post stimulated cortisol below 5 ug/dL. I've seen calcinosis cutis on side view xrays in veterinary textbooks so if your vet is doing chest xrays, it may show up on imaging, but not sure as Daisy will be on her back.

Until I adopted my current furkid who weighs 55 pounds, I've always had tiny dogs who I could bath in a sink. I'm praying that I never have to give frequent baths for skin issues. I sincerely feel for you.

Glynda

[arentspowell]

Seizure instantly came to mind during the episode but I guess the vet didn't think it was. I'll ask about it when we go back.

If the skin irritation turns out to be calcinosis will the baths even help? I did the first bath last night and will probably give her another one on Wednesday or Thursday.

[lulusmom]

If the skin irritation turns out to be calcinosis will the baths even help? I did the first bath last night and will probably give her another one on Wednesday or Thursday.

If Daisy has calcinosis cutis (CC), the baths may ease any discomfort and will keep the areas clean but it will not heal it. It will likely continue to break through the skin and get a lot worse before it gets better. It is a rare symptom of cushing's that is very difficult to resolve. Getting cortisol down is the only thing that will help and even that is not a 100% guarantee that it will resolve completely. However, most members have seen much improvement with treatment. I think your vet gave you the shampoo in the hopes that the problem is an allergic irritation and I'm keeping fingers crossed that he's right.

I am hoping that Renee, our resident CC expert, will drop by and share her extensive experience with you. She knows what the onset of CC looks like. I'll send her message with a link to your thread. In the meantime, I've provided a link to one member's thread whose dog had CC. There are a links to other threads and pictures, including Renee's that may help you identify CC.

http://www.k9cushings.com/forum/showthread.php?t=6093

Glynda

[Renee]

Hi there!

Popping in to talk about the dreaded CC.

Without seeing pictures, I cannot say if your girl does or does not have CC, but your description sounds about right, and the area you describe is also consistent with where it usually occurs.

The good thing is that you've already brought Daisy's cortisol down, so any new formations of CC should get nipped in the bud.

If your vet has a high resolution x-ray machine, it may pick up imaging of the CC along her spine, depending. My girl has had a CT and x-rays, and in all of them, the CC can be visualized.

As far as how bad your girl's CC may get, I just don't know. We've had other members here that seemed to 'catch it early' and get just a mild case, while other cases get a lot worse. I would like to think that if you have just one lesion and you've already brought her cortisol down, you shouldn't get the worst of it. But, it does get worse before getting better. The CC has to work it's way out, then the new skin underneath can come through.

Are you able to take pictures and post them?

[arentspowell]

It's a little tough to see but it's all along this back ridge where the hair won't sit flat and it looks like her undercoat has actually fallen out in this area.

http://img.photobucket.com/albums/v204/madeofrealcheese/LF%20pics/1BC8A0D6-F5D6-43E9-902F-E3410C7486D7_zpso0xfi2xi.jpg (http://smg.photobucket.com/user/madeofrealcheese/media/LF%20pics/1BC8A0D6-F5D6-43E9-902F-E3410C7486D7_zpso0xfi2xi.jpg.html)

http://img.photobucket.com/albums/v204/madeofrealcheese/LF%20pics/065CA750-EC55-4DAD-842B-A5C218D7928E_zpszkghgsbt.jpg (http://smg.photobucket.com/user/madeofrealcheese/media/LF%20pics/065CA750-EC55-4DAD-842B-A5C218D7928E_zpszkghgsbt.jpg.html)



http://img.photobucket.com/albums/v204/madeofrealcheese/LF%20pics/4AA34AEB-ED77-46BF-AEC6-E568EDFBD34A_zpswtwagfxf.jpg (http://smg.photobucket.com/user/madeofrealcheese/media/LF%20pics/4AA34AEB-ED77-46BF-AEC6-E568EDFBD34A_zpswtwagfxf.jpg.html)

It's worse in some areas, particularly near her butt. There were some small white lumps in that area too :( You can't really see them in the picture though

[molly muffin]

Hmm, it looks sort of like the very beginning of what could be cc, before they turn red or crusty or anything like that but I'm certainly no expert on it. I'll leave that to Renee who has seen it Way too often.

Did they do any kind of scraping to send to dermatology or anything?

[arentspowell]

Nope, no skin scraping. Would he be able to diagnose it for sure that way? And if we are able to confirm its CC, is there anything to treat with other than continue the Vetoryl?

[lulusmom]

A punch biopsy must be done to diagnose calcinosis cutis (cc). I believe Sharlene may have mentioned a skin scraping to rule out mites instead of diagnosing cc. As far as treatments, I've never gotten the impression that there are any drugs or topicals that are that effective but some may help Daisy. I've included a link below to a short article that mentions all of the treatments I've been exposed to through our members.

http://www.nevetdermatology.com/calcinosis-cutis-in-dogs/

[arentspowell]

Thanks for the link, that was very helpful. I guess for now we'll keep with the 2x week bathing and see how it goes.

Chest X-ray is today at 4:30. Will post the result as soon as I have them.

[dsbailey]

That's a lot of baths. Maybe throw on some "Mane and Tail" during the rinse cycle. ;) You can buy it at Walmart but purchase it in the pet section and not the human section because the cost is way more for way less.

Darrell and Lo

[molly muffin]

Yes, mites, mange, different thing but for definitive cc you need the punch biopsy.

See how things go with the bathing and if it isn't working then you may want to consider the other tests to find out exactly what it is.

[labblab]

Skin scraping or skin cell collection can also be used to diagnose infections, as well. So even though it cannot diagnose CC, it is a simple procedure that can rule out other issues.

Marianne

[arentspowell]

Good to know that a skin scraping can confirm it. It hasn't reached the point where it's worrying us too much so we are going to hold off on any testing and just wait and see what happens as the cortisol levels get under control with the Vetoryl.

Between the medication, ATCH testing, ultrasound, x-Ray, and office visits every time something doesn't seem right we've spent a small fortune already. We had pet insurance on Daisy through Petplan but my stubborn husband cancelled it when the premium rose. Back then all we were worried about were orthopedic issues and he thought we were in the clear. I still have pet insurance on our mini dachshund and I'll never cancel it after this experience with Daisy.

[arentspowell]

Well looks like we're going back to the vet today. Irritation on the back has gotten worse and is starting to look more and more like CC. Ugh I was hoping it would not rear its ugly head on us.

The chest X-ray last week came back clear. The vet told us she was the easy dog he's ever x-rated. My sweet girl, seems like we can't catch a break around here. I really hope we don't have to shave her down :(

[arentspowell]

http://img.photobucket.com/albums/v204/madeofrealcheese/LF%20pics/AE8902F5-4E36-4B5B-AC6D-5E78A952C4B0_zpshuajslg4.jpg (http://smg.photobucket.com/user/madeofrealcheese/media/LF%20pics/AE8902F5-4E36-4B5B-AC6D-5E78A952C4B0_zpshuajslg4.jpg.html)

Vet had to shave her down. He's saying he doesn't think it's CC and that its most likely a bad bacterial infection because she's immuno-compromised due to the Cushing's. He gave us antibiotics, an antibacterial spray, and a different shampoo to bathe her with 3x a week. He's not sure if it's contagious at this point so he wants us to be careful about our other dog.

Thoughts?

[Budsters Mom]

Did the vet do any kind of testing, such as a biopsy or skin scraping to figure out exactly what kind of infection (or ?)you are dealing with? Certain antibiotics tend to work better on specific types of infections. There is a large area affected. Seeing a veterinary dematologist would probably be my next step. Shaving down is not a bad thing. It helps to keep the wound cleaner and makes it easier to monitor progress in either direction.

Kathy


Vet had to shave her down. He's saying he doesn't think it's CC and that its most likely a bad bacterial infection because she's immuno-compromised due to the Cushing's. He gave us antibiotics, an antibacterial spray, and a different shampoo to bathe her with 3x a week. He's not sure if it's contagious at this point so he wants us to be careful about our other dog.

[arentspowell]

He did a skin scrape and consulted with a derm vet over the phone for the appropriate medications.

My husband called me while I was at work to let me know he was taking her in because the skin was starting to smell really bad. He was there for two hours and left feeling overwhelmed and depressed. Hopefully I'll get a better idea of what went on when I look at the paperwork.

[Harley PoMMom]

Oh poor girl, that looks sore. Keep us updated.

[Whiskey's Mom]

Oh the poor sweetie. That breaks my heart. Really hope she gets some relief soon.

[arentspowell]

I'm starting to get nervous that the irritation on her back is a dermatological reaction to the trilostane. The vet confirmed its a bacterial infection from the skin scrape. Can't recall what kind but thankfully it's not MRSA.

We treated for antibiotics for a week and though it appeared to us to be making progress, when we went into the vet to pick up more antibiotics, the vet was disappointed that the infection really hadn't shrunk down as much as he had hoped.

Now it appears that it's spreading onto the base of her tail and her butt. It's very irritated looking and the hair is starting to peel off in strips like it already has on her legs.

This whole skin thing has me so stressed out. I feel like we're on an emotional roller coaster where just when we think it's getting better we find out its getting worse. Could this be a reaction to the Trilostane? The vet mentioned it could be a possibility but he didn't mention it again when he called with the culture results.

[arentspowell]

Here's a photo of the progress

http://img.photobucket.com/albums/v204/madeofrealcheese/LF%20pics/751D0FD9-D694-49DB-BF29-2303883788EF_zpslhsoucao.jpg (http://smg.photobucket.com/user/madeofrealcheese/media/LF%20pics/751D0FD9-D694-49DB-BF29-2303883788EF_zpslhsoucao.jpg.html)

Left - day 1, Tuesday July 19
Middle - day 4, Friday July 21
Right - day 8, Monday July 25

[Joan2517]

Oh, the poor girl! I hope they can find something that helps her. I would be stressed to the max as well. Dealing with Cushing's is the worst...the ups and downs are nerve-wracking. Hang in there, we are all feeling for you~

[DoxieMama]

Oh my that does look painful. :( I sure hope those antibiotics help.

[Harley PoMMom]

To me this looks more like calcinous cutis (CC) than just a bacteria infection. And if it is CC, unfortunately it gets worse before it gets better. :(

Our resident expert on CC is Renee, her sweet girl is battling CC for the second time and Renee has pictures in her album with CC in various stages. Here's a link to Renee's album, check it out and see if you think this looks like what Daisy has. http://www.k9cushings.com/forum/album.php?albumid=805

[arentspowell]

It looks very similar to Renee's photos to me, especially the ones from 2013 that she notes are about a week old. Daisy's fur seems to be pulling off her skin like that too.

Our vet originally suspected CC but when he shaved off the hair he changed his diagnosis. Even though he has experience treating Cushing's, I don't think he's treated much CC and when he has it's been more crusty and scaly, like in some of Renee's later photos. He admitted he hasn't seen it in the earlier stages so he didn't want to entirely rule it out.

We will continue to treat with antibiotics because there is a bacterial infection there but the fact that it appears to be spreading really worries me. Our next ATCH test is coming up soon, I plan to ask for a biopsy at that time.

[Renee]

Oh dear. That does look very, very painful.

It looks somewhat like CC -- but, it also looks like a very bad bacterial infection. Did she have any hard, flaky, crusty plates of skin peal away? CC and infection seem to go hand in hand, so you are probably dealing with both.

Stay the course with the abx long term. I would suggest doing a culture & sensitivity, rather than a skin scrape. Identify the exact bacteria and have them tell you the appropriate abx to address it. I would do no less than 4 weeks of abx.

If you are up to it, a biopsy may be in order, especially if CC is suspected.

If it's CC, then you'll just have to get through this tough part, which admittedly gets worse before getting better. The goal will be to get her post cortisol below 5.0 ug/dl.

It can take months. Six months or more to see significant resolution of CC.

[molly muffin]

I think I would ask for a biopsy too and if it is bacterial you need an antibiotic geared to that bacteria. Also you can get antibacterial sprays to help keep it clean topically.

[arentspowell]

30 day ATCH test was today, will post the results when I have them on Tuesday.

After treating aggressively with antibiotics for 4 weeks the vet finally thinks it's CC and not just bacteria. It looks a lot better but the margins haven't really shrunk at all. I posted a picture in the albums section. The vet said we could do the biopsy but it won't really change how we are treating it so we are opting out of the biopsy and will continue the course of antibiotics, topical spray, and now DMSO gel and of course just continuing to get cortisol levels down.

[Aunt Jana]

I'm so sorry your dealing with this and your poor Daisy is too. My boxer has a very bad case also, it's so difficult to deal with. Did her skin harden and peel off? That's what is going on with my poor pup. We are treating with antibiotics only. It is devastating. I have pictures posted if you want to compare. I sure hope your Daisy heals. Best of luck :)

[arentspowell]

ATCH results came back and the post was 9. Our vet consulted with an internal specialist and has bumped Daisy's Vetoryl to 60mg in the morning and 30mg in the evening. We had the new medication overnighted to us so D's been on it for two days now and we will test again at the 14 day mark. Keeping my fingers crossed we have the dose right this time.

[Harley PoMMom]

Although a post of 9 ug/dl is acceptable if clinical signs are controlled, but since Daisy is battling what looks like CC that post will need to drop to 5 ug/dl and stay there to get some control over that CC and I so hope the extra 30 mg in the evening will get you there...keeping fingers crossed!

Hugs, Lori

[arentspowell]

She's right there on the high end of the controlled range but the huge CC breakout on her back has the vet concerned. Also we aren't entirely sure that the clinical signs are controlled. She had a pee accident a few weeks ago and I think she's been drinking more but it's hard to be certain. Vet was hesitant to automatically want to raise the medication when that happened about two weeks ago because a lot was going on at the time with the bad infection on her back and she was taking a lot of antibiotics but now that the ATCH test is showing elevated cortisol levels and we are sure we are dealing with CC it seems like the right call.

I would like to start measuring her water intake the only issue is she spends the weekdays with two wiener dogs and another lab. The weens are about 10 lbs each so their water intake is relatively small in comparison but the other lab drinks a lot and they are used to all drinking from the same bowl so it would be impossible to tell who drank what and when.

[arentspowell]

I'm so sorry your dealing with this and your poor Daisy is too. My boxer has a very bad case also, it's so difficult to deal with. Did her skin harden and peel off? That's what is going on with my poor pup. We are treating with antibiotics only. It is devastating. I have pictures posted if you want to compare. I sure hope your Daisy heals. Best of luck :)

When we first noticed it it was just appeared to be redness under the hair. Then it started to pus and smell so the vet shaved all the hair off from the based of her head to the base of her tail and uncovered a huge raised red patch spanning that entire area that was very infected. It did scab over and it's looking so much better! It's still raised and harder than the rest of her skin but no more open sores.

[arentspowell]

Yesterday was the 14 day ATCH test after starting the new dose of 60mg in the morning and 30mg at night. Daisy's pre-value was 2 and the post value was 8. We are still dealing with the big patch of CC on Daisy's back. I am a little disappointed by the results. I was REALLY hoping that the post value would come back under 5 with the new dose. The vet wants to bump Daisy us to 60 mg in the morning and 60 mg at night per the recommendation of an IMS he is consulting with. He said we can check her Na/K levels at 14 days but do an ATCH test at 30 days to keep costs down. Thoughts on this?

[labblab]

I think this is a reasonable approach to things, and I will certainly be hoping that this additional dosing increase will finally get Daisy's cortisol down within the lower range that you're shooting for.

Aside from the patch of CC, how is Daisy doing these days in terms of symptoms?

Marianne

[arentspowell]

She's doing really well! She's happy and is back to her old energy levels. Ever since Daisy was a puppy, if you stomped or shuffled your feet near her as if you were going to lunge at her she would get really excited and start zooming around. It had been several months since she had done that. My husband was overjoyed the other day when he stomped his foot and she zoomed and zigzagged around him. He kept saying she passed "the test". :)

[molly muffin]

Aww that is so great that she is once again zooming!

[Allison]

That's fabulous news! Enjoy these revitalized times.


She's doing really well! She's happy and is back to her old energy levels.

[arentspowell]

Hi all, itÂ’s been a while. I posted originally when Daisy diagnosed with PDH Cushings about 2 years ago. SheÂ’s now almost 9 and weÂ’ve beeen treating with vetoryl since the diagnosis. Originally Daisy started with the dose of 1 mg per pound of body weight. SheÂ’s a 60 lb yellow lab so 60 mg. At some point, the dose was not keeping her level under control, she got calcinosis cutis and lost all the hair on her back, and we needed up (after a few adjustments) at 120 mg (1 60 mg in the morning and 1 at night) That dose kept the cortisol levels at the low end of normal for over a year and a half. Then the dose became to high, we dropped down to one 60 mg in the morning one 30 mg at night but the cortisol levers were still pretty low around 1.2 until we were down to just one 30 mg in the morning. She was on the 30 mg does for a about a month.

All was fine until January 3 when she had a strange episode of Horners syndrome with her eyes and would freeze up and not respond to her name. My husband rushed her to the vet where the vet did blood work and they looked pretty normal for a dog with Cushings and on vetoryl (slightly high liver values but otherwise everything else looked good). The vet referred us the urgent care so that we could get a quick turn around on a baseline cortisol test because he was still unable to rule out an addisionian crisis but he also suspected that the issue could be neurological. By the time we left the vet and arrived at urgent care she was also extremely lethargic.Daisy was admitted to veterinary urgent care where they kept her for three days, on the second day she was transferred to ICU. Over the course of three days we did a cortisol test, chest X-ray, abdominal ultrasound and X-ray, and a neurological consultation. The tests gave us really little answers and the vets best guesses where that this was either 1. Addisons, 2. A bad reaction to vetoryl, 3. Or something new which may or may not be related to the cushings. She was being treated as an addision crisis dog but she wasn’t really improving. Finally the vet gave her mannitol to relieve brain swelling. Because of how quickly the mannitol worked, the vets have ruled out addisons and suspect that it’s something “in her head” so to speak. It could be the pituitary tumor that grew, a new brain tumor, a stroke, something bacterial or tick Bourne. Without an MRI of her skull, there is no way to know for sure.

The only way we were able to bring her home is to start her on prednisone to keep the brain swelling down. She was also given clavamox and doxycycline just in case the cause was bacterial. The first week was rough because she would not eat but by the second week she was eating normally. In fact, she was eating better than she was while taking vetoryl. We were given a month supply of prednisone but because she was doing so well we were instructed to start tapering this week.

However, this week sheÂ’s looking pretty rough again. It almost seems like the cushings symptoms are back in full force. Her back looks boney, her belly looks distended, sheÂ’s panting more and more (sheÂ’s been breathing quick since the initial episode and the vet said she was having trouble oxygenating but itÂ’s definite getting more frequent with the panting) We canÂ’t do the ACTH test because sheÂ’s on prednisone and IÂ’m worried that if we pull her off the steroids that she may relapse. We are very afraid to lose her.

Has anyone been through anything like this?

[Harley PoMMom]

Hi Ashley and welcome back!

You will see that I have merged your post into Daisy’s original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thank you so much for the update although I am sorry that Daisy is having some difficulty right now.

Dexamethasone is another steroid replacement medication that can be given when cortisol is too low and it won't interfere with the ACTH stimulation test, I'd ask the vet about giving her this instead of the prednisone.

With the prednisone or any other steroid replacement medication, the body reacts the same way as it would with cortisol so those Cushing's symptoms could be from the prednisone. What is the dose of prednsione she is taking?

Lori

[Squirt's Mom]

Good to hear from you again tho I wish the update was more uplifting and I KNOW you wish that as well. Did you see any other odd behaviors around the first of Jan - head pressing, circling, staring off into space, acting as if she did know how to go out the door or into her crate etc, or anything else? Studies have shown that in rare cases Vetoryl can cause the microscopic pituitary tumor involved in Cushing's to start to grow and become a macroadenoma but signs are typically seen like those I mentioned above tho each pup is different. One of our members started a thread about her pup who developed a macro and other members have added their experiences to that thread to help others who come after them who's dog may also have a macro. You can read thru their stories and see if anything seems to fit Daisy's case which may help you and your vet determine what may be going on. Here is the link to that thread - https://www.k9cushings.com/forum/showthread.php?3567-Macroadenomas

Please know we are here for you all the way regardless of what is going on, Cushing's related or not.
Hugs,
Leslie

[Larinda]

we are going through a similar situation with blue. 6 year old lab. two weeks ago we thought possibly sards but the opthomologist said his eyes are healthy. we did another acth test three days ago awaiting results to see if he is in addisions, or overdosing on the vetryol, but he just had a test done dec 6th that was fine. strange behavior indeed, he no longer wants to hold his prized blankey, wont engage, distant, detached, lays staring at wall, doesn't want to go outside or follow us around really, picking at his kibble, not begging for dinner or snacks, little strange behaviors for sure. vet said it could possibly be something in his brain, with how hes processing things, like sight, etc. not sure what we are going to do either, other than await test results, and go from there. maybe take a wait and see approach, as to continue more tests to confirm a possible brain tumor or something will only put us more in debt and confirm the inevitable anyhow, we cant seem to win I fear. i'll be anxious to see how you make out. and I will let you know what we find.

[arentspowell]

Sorry all, life has been very busy and I never came back to post. Daisy is still with us. She celebrated her 9th birthday in April. The neurological episode in January aged her about 3 years overnight. She is no longer taking any medication what so ever. She was taken off the prednisone due to extremely high liver enzymes. While her cortisol levels have risen she started to respond atypically to the ATCH test. My understanding is that there is no rise in the numbers after ATCH is administered if that makes sense. So even though the Cushing's symptoms have returned, we can't give her vetoryl. The vets are stumped.

At this point her quality of life is poor. All her hair is about to fall out because the calcinosis has returned with a vengeance. She has zero muscle mass and is basically a walking skeleton but he still eats, pees, and poops normally and can hold her bladder. She occasionally wags her tail. We tried CBD oil for little bit but it didn't seem to make much of a difference and she would leave some of her kibble when we added it to her food so we decided to prioritize eating all the food vs trying to force her to take the CBD.

We don't feel like its time to say goodbye yet but are at a loss of what to do at this point. We seem to be be past any further medical interventions. Is there anything we can give her at this point. At least to relieve the calcinosis. It looks painful.

[labblab]

Sorry all, life has been very busy and I never came back to post. Daisy is still with us. She celebrated her 9th birthday in April. The neurological episode in January aged her about 3 years overnight. She is no longer taking any medication what so ever. She was taken off the prednisone due to extremely high liver enzymes. While her cortisol levels have risen she started to respond atypically to the ATCH test. My understanding is that there is no rise in the numbers after ATCH is administered if that makes sense. So even though the Cushing's symptoms have returned, we can't give her vetoryl. The vets are stumped.
I’m so sorry to hear that Daisy is doing so poorly right now! In order to try to help, I have an important request for you. Can you please try to get us the exact dates and numbers for Daisy’s recent ACTH tests? Also, how recently did she stop the prednisone? Was she tapered off over time? Once we have all this additional information, we can discuss possible treatment options much more knowledgeably.

In looking back back through your thread, I see that you’ve consulted with a specialist at times. Is that who’s directing Daisy’s care now? If not, before giving up on medical intervention, I’m thinking this would be an important time to get some expert feedback about her condition. But in the meantime, filling in some of these informational “holes” for us will be a big help.

Marianne

[arentspowell]

The prednisone was tapered off towards the end of January over the course of several weeks. She hasn’t been on any medications since January. We saw the specialist when Daisy was first diagnosed and from there on out our vet consulted with the specialist when the vetoryl needed adjustment. Our vet consulted with the specialist when the ACTH readings started to come back atypically but the specialist was not particularly helpful. We also consulted with a neurologist in January. We did not do an MRI because she was on prednisone at the time and our vet does not think she is well enough to be able to do it now. Based on many of the threads I’ve read on here, I think she has a macroadenoma.

I will try to get copies of the last two ATCH results tomorrow. It’s been several months since we’ve done one. Last we spoke to him about Daisy’s care, he did not think it was a good idea to continue to do ATCH because he felt they were really stressful on her body.

[labblab]

Sadly, a macroadenoma is indeed a possibility. However, if it has been quite some time since her adrenal function was checked, it’s also possible that her cortisol production has spiked once again. Especially in view of the worsening calcinosis cutis, I would think that the benefit of one more ACTH would outweigh the stress. But let’s first see what the past numbers look like, and we can go from there.

Marianne

[arentspowell]

2/27/19 - pre 7.5, post 7.8

3/20/19 - pre 7.3, post 7.3

We did another blood panel today and are going to do a baseline cortisol test to determine whether we should do another ACTH

[labblab]

Thanks so much for this information, and we’ll be anxious to see how the results from yesterday turn out.

In order to refresh my memory, I’ve just now gone back to review Daisy’s entire history, and interestingly enough, her very first ACTH after beginning trilostane back in the summer 2016 was also “flat.”


I have the results back from our 14 day follow up
Pre - 6.5 ug/DL
Post - 6.6 ug/DL

At that time, your vet wasn’t concerned, and left her trilostane dose unchanged. A couple of subsequent ACTH tests did show an expected increase in post-ACTH readings. So what might account for these odd readings? One simple explanation might simply be that the stimulating agent that your vet is using is inconsistently compromised in some way. If he’s also treating other Cushing’s dogs and all their tests come out as expected, that would blow that theory. But I just mention it as a possibility.

You say that your vet consulted a specialist about these test results, but the specialist was not very helpful. Can you tell us what the specialist actually said? I’d be very interested in his/her take on all this. Baseline cortisol levels as high as 7.0 in a Cushing’s dog would typically prompt a full ACTH with the expectation of an even higher post-ACTH result and the need to restart medication. But if Daisy truly and genuinely doesn’t exhibit any stimulated increase, then I’m afraid I’m stumped, as well. As severely compromised and uncomfortable as she seems to be right now, before giving up, I’d really try to let a specialist directly examine her and offer you an opinion face-to-face so that you ask any and all questions that you may have. Her situation is certainly puzzling, and it might give you greater confidence, or at least some peace, about the best path forward.

Marianne

[arentspowell]

Thanks so much for this information, and we’ll be anxious to see how the results from yesterday turn out.

In order to refresh my memory, I’ve just now gone back to review Daisy’s entire history, and interestingly enough, her very first ACTH after beginning trilostane back in the summer 2016 was also “flat.”



At that time, your vet wasn’t concerned, and left her trilostane dose unchanged. A couple of subsequent ACTH tests did show an expected increase in post-ACTH readings. So what might account for these odd readings? One simple explanation might simply be that the stimulating agent that your vet is using is inconsistently compromised in some way. If he’s also treating other Cushing’s dogs and all their tests come out as expected, that would blow that theory. But I just mention it as a possibility.

You say that your vet consulted a specialist about these test results, but the specialist was not very helpful. Can you tell us what the specialist actually said? I’d be very interested in his/her take on all this. Baseline cortisol levels as high as 7.0 in a Cushing’s dog would typically prompt a full ACTH with the expectation of an even higher post-ACTH result and the need to restart medication. But if Daisy truly and genuinely doesn’t exhibit any stimulated increase, then I’m afraid I’m stumped, as well. As severely compromised and uncomfortable as she seems to be right now, before giving up, I’d really try to let a specialist directly examine her and offer you an opinion face-to-face so that you ask any and all questions that you may have. Her situation is certainly puzzling, and it might give you greater confidence, or at least some peace, about the best path forward.

Marianne


Baseline cortisol from yesterday was 8.6. I’ve requested all the ATCH test results do I can go back and compare. I think some of the ones we did when we had found out groove for a little bit were not flat. Now that you’ve pointed that out I want to see them all side by side. Initially we had the issue where cortisol was not dropping and late last year, aroundNovember we started to have the opposite problem where the levels were borderline Addisons and not rising despite a big decrease in the medication. Then she had the mysterious neurological episode in January. We ran every test short of an MRI and the only thing that helped was mannitol to reduce brain swelling followed by a course of prednisone at home. From there the cortisol levels did start to rise again but the ATCH tests kept coming back flat.

The vet is going to look into starting Daisy on vetoryl again. Possibly with prednisone if necessary. He’s going to consult with the specialist.

The specialist that saw her and that our vet consults with is at blue pearl. This is the same practice that treated her in January. To be honest, it’s a little frustrating to deal with them. Over the years our vet has consulted with the specialist regarding dose changes. Not sure if there is anyone else we can see in the area. We have a vet school 2 hours away at UF.

[arentspowell]

We said goodbye to Daisy today. It was her time. The calcinosis took over her entire body and turned into painful open sores. Ironically, we had called Dechra yesterday to discuss the flat ATCH results and what options we had. They spoke to our vet and we felt optimistic about starting Vetoryl again to hopefully get some relief from the calcinosis. Shortly after that call, Daisy's front leg swelled up with fluid and she could barely stand. The vet did X-rays and her spleen and liver were so enlarged, squeezing her lungs and stomach. The leg had some calcifications below the skin as well which is why it swelled up. This morning she could barely open her eyes and we knew it was time. The hospice vet came around 5 pm today and we said our goodbyes. We miss our sweet girl like crazy but she is finally pain free.

[Joan2517]

I'm so sorry for the loss of your sweet girl...

[labblab]

Oh I am so sorry, too. My heart goes out to you, knowing how dearly you loved Daisy and how much she’ll be missed. But I totally understand your decision, and I hope you’ll continue to find peace in knowing that she is at long last pain-free. We hope it may also bring you a bit of comfort to know that Daisy will always be honored and remembered here, amongst all of our brave angels who now surround her at The Bridge:

https://www.k9cushings.com/forum/showthread.php?9161-Remembering-All-Who-Have-Left-Us-(2019)

If it would please you to have us add a photo link to her memorial line, you can send a picture to us at any time: k9cushings@gmail.com. We’ll take care of everything once we receive the photo.

In the meantime, please know that we’ll always welcome you back should you wish to talk about anything more, or just to share memories of your sweet girl and your lives together. You’ll both always remain members of our family here.

Sending you my warmest thoughts in loving memory of your sweet girl and her brave battle,
Marianne

[Squirt's Mom]

Dear Ashley,

I am so so sorry to hear about sweet Daisy. :( I know your heart is shattered - I've been there too many times so I know what you are feeling today. Please know your precious girl knows you did all you could for her to make her life the very best possible. And when the day came that the options ran out you gave her the greatest gift...freedom from a failing vessel. Her spirit is now whole once again as she was in her youth and she is running wild and free in the Rainbow Fields with so many of the babies from here. I firmly believe we will be with our babies when that day comes that our jobs here on Earth are done. We will cross that Bridge and they will fly into our arms to cover our faces with kisses. And we will never be parted again. Until then she will be by your side always. You may not always see her or hear her or feel her presence but she is there, always.

My deepest sympathies,
Leslie



I'm Sill Here

I was near you, by your bed last night; I came to have a peek. I could see
that you were crying, you found it hard to sleep.

I chattered to you softly as you brushed away a tear, “It’s me, I haven’t
left you. I’m well. I’m fine. I’m here.”

I was close to you at breakfast. I watched you pour the tea. You were
thinking of the many times your hands reached out to me.

I was with you at my grave today. You tend it with such care. I want to
reassure you, that I am not lying there.

I flew with you back towards the house. As you fumbled for your key, I
gently touched you with a feather, I smiled and said, “It’s me.”

You looked so very tired, and sank into a chair. I tried so hard to let
you know that I was perching there.

It’s possible for me to be so near you everyday To say to you with
certainty, “I never went away.”

You sat there very quietly, and then smiled. I think you knew In the
stillness of that evening, I was very close to you.

The day is over – I smile and watch you yawning And say, “Good night, God
bless, I’ll see you in the morning.”

And when the time is right for you to cross the brief divide, I’ll fly
across to greet you and we’ll enter side by side.

I have many things to show you. There is so much for you to see. Be
patient, live your journey out… then come home to be with me.

– Author Unknown

[joalgopa]

I'm so sorry for your loss and thank you for sharing. I feel like talking about our experiences help us to be prepared for the harder times, I know we cannot be completely ready to say goodbye to a loved one but at least there's a sense of community that help us cope.

[Lori C]

Thank you for sharing Daisy's story. I'm so very sorry for your loss. Run free, Daisy Mae.

[WeLoveAthena]

We are SO very sorry For your loss we just lost our oldest boy in December he did not have Cushing’s but we are dealing with our beautiful silver labrador who has Cushing’s and Diabetes. There is no doubt reading through your posts that you loved/love Daisy with all your heart. You will never have to look far when you miss her the most because she lives in your heart forever

If it should be that I grow frail and weak
And pain should keep me from my sleep,
Then will you do what must be done,
For this -- the last battle -- can't be won.
You will be sad I understand,
But don't let grief then stay your hand,
For on this day, more than the rest,
Your love and friendship must stand the test.
We have had so many happy years,
You wouldn't want me to suffer so.
When the time comes, please, let me go.
Take me to where to my needs they'll tend,
Only, stay with me till the end
And hold me firm and speak to me
Until my eyes no longer see.
I know in time you will agree
It is a kindness you do to me.
Although my tail its last has waved,
From pain and suffering I have been saved.
Don't grieve that it must be you
Who has to decide this thing to do;
We've been so close -- we two -- these years,
Don't let your heart hold any tears.