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View Full Version : New Cushings and Calcinosis Cutis



KathyB
07-30-2016, 03:46 PM
Hi, thanks for accepting me. Our lovely boy Herbie, a 10 year old Border Terrier has just been diagnosed with cushing's and calcinosis cutis. It took a while to get the right diagnosis, initially we just thought he was slowing down as he was getting older, he has always been very laid back and easy going. Then he stopped eating (he has always been very fussy to the point where if he decided he was bored with a particular food he would just refuse to eat for days until he would eat just enough to stop himself from falling over!)
When we took him to the vet he was not eating, turning back on walks(literally just having left the house) and very lethargic and sleeping on the bed all day not spending time with us.
Initial blood results were all normal apart from a slightly white cell count which the vet felt was due to stress(Herbie hates the vets). The vet then did ultrasound scans and xrays, all organs appeared normal except the gallbladder was sludgy so he was started on antibiotics and pain killers. There was no improvement on the abs so he was started on Ursodeoxycholic acid, at this point the 1st lesions appeared on either side of his groin, pale pink round patches just smaller than a 10p piece. The vet felt it was heat rash and prescribed him a steroid cream.
There was a slight improvement in his condition but nothing significant, although he was starting to eat more, the rash got worse started spreading, became more raised and red. This made the vet suspect cushing's or thyroid problems (due to the hair loss, I forgot to mention that). He did ACTH and sent bloods for thyroid problems. Although he said he would expect Herbie to be ravenously hungry not continuing to not eat and losing weight. All tests came back normal.
By this point I was convinced we were going to lose him. Since the ACTH was normal our vet started him on a trial of prednisolone. No improvement. The vet felt our only option left would be to take Herbie in for exploratory surgery but we felt he would be too weak for this and at his age would not be the kindest thing for him.
By this time the lesions had got worse again so he kept him in for skin biopsies, more bloods and repeat the abdo ultrasound. The vet said he had never seen anything like the lesions before!
The biopsies came back positive for calcinosis cutis which the vet said pointed back to cushing's so he booked him in for LDDS test which came back positive for cushings(Herbie had been off the pred for at least 8 days).
That was about just over a week ago, he was started on 30mg Vetoryl daily, I questioned the dose ats Herbie is now only 8kg and that was almost 4mgs per kg instead of the recommended 2mg per kg but was told it was right. By this time his lesions were very sore, he had been wearing a collar since the biopies were done about 3 weeks ago.
We went back to the vet as Herbie was very unhappy, even more lethargic and not eating again.He had been on antibiotics for 5 days as there had been a clear ooze from where the biopsies had been done. Although the vet(a different one, didn't like her!!) insisted the vetoryl dose was correct she reduced it to 20mgs instead and gave us some chlorhexidene wash for his lesions.
2 days later wound ooze is brown, starting to bleed and Herbie is still very unhappy, so back to the vets. We managed to catch a urine, which showed the poor boy now has a uti on top of everything! We have changed the antibiotics and are waiting for swab results to show what the wound infection is.
Since dropping the vetoryl dose and starting the new antibiotics, Herbie is a little happier and is coming out of the bedroom to see us and eating a little more. We have also been putting Manuka honey on his lesions which is making them look better. The vet feel s that if we can get the uti and wound infection under control we will hopefully see the vetoryl start to work and then a good improvement in his condition.
If you have read this far, thank you so much, it wasn't meant to be this long:)
How long, normally did it take for you to see an improvement in your dog's health? I still can't shake the feeling that we are going to lose our boy, it really scares me .

DoxieMama
07-30-2016, 08:22 PM
Welcome to you and Herbie. I'm sorry I don't have any answers for you, but I'm glad you insisted on the reduced dose of Vetoryl. How long as he been on the new reduced dose? Do you have copies of the tests that were done, so you can share the abnormal bloodwork as well as the results of the LDDS with us?

Hugs,
Shana

Harley PoMMom
07-31-2016, 05:22 AM
Hi and welcome to you and Herbie!

You need not apologize for the length of your post we love, love details. ;) In fact the more information you tell us about your sweet boy the better our feedback will be. Like Shana, I am so glad that Herbie's Vetoryl dose was reduced, and you are correct, 2 mg/kg is what is recommended.

I am sorry you and Herbie are dealing with calcinosis cutis (CC), and unfortunately CC gets worse before it gets better :( In our experience on the forum it seems that you need to get that post cortisol number down to least 5 ug/dl to get control of that CC. Our resident CC expert, Renee, is treating her sweet cushgirl, Tobey, for CC a second time around and Renee is also using Vetoryl to control the Cushing's. I am including a link to Renee's thread where you can read about their ongoing journey and gather information pertaining to CC. My girl pug (confirmed Cushings & confirmed calcinosis cutis) / Introduction (http://www.k9cushings.com/forum/showthread.php?t=5908)

Although a ravenous appetite is a common response from Cushing's we have seen a small number of cases here that not all cushdogs share this symptom.

Has an ACTH stimulation test been scheduled to check his cortisol level? In case this wasn't mentioned by the vet, with Vetoryl it is very important to give it with a meal and those ACTH stimulation monitoring test have to be performed 4-6 hours post pill. Are these protocols being followed?

I am sorry for the reasons that brought you to us but so glad you found your way here and we will help in any way we can.

Hugs, Lori

KathyB
07-31-2016, 11:52 AM
Thank you for your replies. I don't have any copies of Herbie's results, I should be getting the swab results tomorrow so I will ask for them when I speak to the vet.
Herbie has a ACTH booked on the 10th August which is 3weeks after starting the vetoryl.
Thank you so much for posting the link I will have a look at that. :)

KathyB
07-31-2016, 12:09 PM
I forgot to say we were told to give it with food, unfortunately Herbie's appetite is so poor these days that he won't eat anything when he gets up. If we are lucky we can get him to eat a little bit of chicken or ham a couple of hours after taking the meds. This really worries me.
The problem is we don't know if the poor appetite is related to feeling rotten with the uti and infected sores or whether it's due to the vetoryl.
Herbie is booked to go into the vets for a check up with the vet at 9am and then stay for the ACTH, they have said it will be 4 hours after his vetoryl is given.
He has been on the reduced dose for 6 days now, do you think it should be reduced to 10mg due to poor appetite and still being lethargic(although not as lethargic) or give the antibiotics a bit longer to work?
Thanks Kathy

judymaggie
07-31-2016, 03:35 PM
Hi -- a belated welcome to you and Herbie! Couple of thoughts -- one, if Herbie is not eating, then I would suggest you stop the Vetoryl. Not giving the Vetoryl with food will greatly reduce its absorption and, therefore, its effectiveness. It also may be upsetting his stomach without enough food to coat it. Second, it may well be that the antibiotics, and not the UTI itself, are upsetting Herbie's digestive tract. Are you giving him anything like Pepcid AC or probiotics?

I think you ought to call your vet in the morning and discuss the lack of appetite and lethargy with him. You wouldn't want to fiddle with the Vetoryl dose at this point since you don't have any idea what Herbie's cortisol levels are. It may well be that his cortisol levels are low and that is causing the lack of appetite and lethargy. You could also ask the vet if it would be a good idea to give Herbie some prednisone (just a low dose for a couple of days -- .25 mg/kg) and see if that helps with appetite and lethargy.