Marley our Bulldog has Cushions

[GemmaH]

Hi,

I am new to the forum I have read through lots of your threads and have gained lots of advice so thank you.

We are based in Glasgow, Scotland.

Our Bulldog Marley is 8 years old and was diagnosed with Cushions in Oct 2015 after showing signs of excessive hunger, bot pelly apperance, lethargy, hair loss & weight gain. He was diagnosed by the Vetinary hospital here in Glasgow after a scan confirmed he had pituitary cushions, His ACTH levels were very high and his liver was enlarged ( sorry dont have exact figures now) He was started on Vetoryl he weighed 38kg so was started on 60mg, which increased then too 90mg then eventually went up to 120mg since diagnosis his levels have come down gradually being on the higher dose of vetoryl but after a while of feeling very helpless and our vet telling us on lots of different occasions this was just cushions we decided to change vets as marleys ACTH levels had come down but he still was showing all the clinical symptoms his hairloss was worse than ever, he is pretty bald now across his chest and shoulders, he is always ravenous, drinks more water than ever and we have been battling with calcinosis cutis after getting this diagnosed with a dermatologist.

We changed vets and I am glad I did but after a few months and seeing no real improvement our vet did more ACTH tests and suggested that the Vetoryl didnt seem to be controlling his cushions even though bloods show it should be, they done more ACTH tests and felt it was not working for the full 24 hour period and it would be an option to change the way we were giving the vetoryl 60mg in morning then 12 hours later give another 60mg as they seen it help on another similar case - has anyone else been advised to do this ?
We done another ACTH and the Pre levels were initially 154 and post 335 now they are pre 132 and post 291
Sorry I will get full reports from my vet to give more info this is just what I have from my notes that I jotted down.

Marley is doing ok he is such a gentle dog and takes this all in his stride but this past few weeks before we started splitting the vetoryl dosage his calcinosis cutis has been the worse ever its all across his shoulders and spread to the inside of his back leg and can see it starting on the bottom of his back and we feel so helpless, he has been given Cephalexin antibiotic and we have tried herbal creams and wash to help also malaseb shampoos but nothing helps.

I just feel or last vet felt marleys cusions was under control as at one point felt his levels dropped under 100 and we decreased his dose and now we are back at the higher does with the CC so bad !

I am going to the vets today and they considering changing him on to Mitotane, I feel so helpless and thought I would write a post to get your advise on the split dosage and also switching to mitotane and if anyone has any help with CC I know this is a secondary condition to cushions and will only get better once the cushions is under control though, just wondered if anyone else dogs have fluctuated so much like marley and not seen any good result of symptoms going from the vetoryl.

Sorry for the long post and thanks for any help.
Gemma

[Joan2517]

Hi Gemma, welcome to you and Marley. The CC can be very hard to control. Members more knowledgeable than I am will be along to try to help you. We have a member who has been through CC a couple of times and will be able to advise.

They will want to see numbers, so if you can get the blood work results and post the highs and lows with the reference ranges it will be a good start.

Joan

[Squirt's Mom]

Hi Gemma and welcome to you and Marley! :)

I will leave the conversation about Vetoryl to those better versed in its use - I am a Lysodren user. I can tell you MANY pups use the 2x a day dosing so that is not uncommon. Vetoryl has a very short life in the body, leaving in 2-12 hours, so dosing 2x a day is often helpful. It is also true that some pups simply don't respond well to one drug or the other and need to be switched....but whether Marley is at the point or not....I will leave that guidance to others who understand Vetoryl better than I. ;)

IF you do switch, be aware that a washout period is needed between the two drugs. I would want 30 days but it is not as critical going from Vetoryl to Lysodren as it is going from Lysodren to Vetoryl since the Vetoryl has that short lifespan and Lsyo has a long lifespan. ;) During the washout, the CC will more than likely get worse as will all the signs...tho it sounds like those haven't improved as it is.

I do want to share with you a thread of one of our members who battles CC and battles it well. CC is one of the most difficult and heartbreaking complications possible with Cushing's. I can also tell you that it gets much worse before it gets better. All the built up calcium has to come out before real healing can start...and that can mean a long time of many sores sadly. Renee and Tobey have taught us all a great deal about this condition. Here is their thread for you to read thru and garner valuable info - http://www.k9cushings.com/forum/showthread.php?t=5908

I am glad you found us and look forward to learning more as time passes.

Hugs,
Leslie and the gang

[lulusmom]

Hi Gemma and a belated welcome to you and Marley.

I have cared for multiple cushdogs but was fortunate that none had calcinosis cutis. While I don't have first hand experience with it, I've watched many members do battle with it so my heart goes out to you and Marley.

There are few general practice vets who have much experience with cushing's and even fewer have experience with CC. You therefore may want to consider a consult with an internal medicine specialist who has probably a lot more exposure to CC. I see that you are in Glasgow and the University of Glasgow has an excellent internal medicine department. Dr. Ian Ramsey is a renown and well published expert endocrinologist who is on staff there. He has had extensive experience with CC and has been deeply involved in CC research. I am an avid researcher of all things canine cushing's and Dr. Ramsey is one of the experts I closely follow. I was very much thankful for his graciousness in giving me the courtesy of a response to an email I sent him asking a few questions about CC. If Marley were my dog and finances allowed, I would definitely ask the vet for a referral to the University of Glasgow and I would make a special request to see Dr. Ramsey. I personally would not switch to mitotane without an opinion from an internal medicine specialist like Dr. Ramsey, who has extensive experience with both drugs. No matter what you decide, we're here to help in any way we can. It would help us greatly if you could tell us if all of the acth stimulation tests were done under identical conditions. By identical conditions, I mean were all of the acth stimulation tests completed within 4 to 6 hours after the morning dose of Vetoryl was given with a full meal? My dogs were dosed at 6 am with a meal and all of their stimulation tests were started at approximately 10:00 am.

I look forward to hearing more about your precious Marley.

Glynda

P.S. Some teaching hospitals here in the states are a lot less expensive than specialty hospitals but I don't know about the University of Glasgow. It may be worth a call to see if they can at least tell you how much they charge for an acth stimulation test.

[molly muffin]

Hello and welcome from me also.

One thing with cc (caliconosis cutis) is that from what we have seen here on the forum, you want that post level down below 5.0ug, which would be below 137.8 nmol. It doesn't sound like you have gotten there on the post level yet. It can be difficult as you don't want that pre number to go below 50 really. So, when you decreased the dosage when he went under 100nmol, that probably made the post go up even more.
Also, with cc, there are calicum deposits even when you get lower that will still need to come up through the skin. What you are aiming for is no new ones to develop, but it can take months and months for the ones already there to come through.
During this time, try to keep it dry and clip any hair around the sores, so you can keep it clean. A good antibiotic spray so can be used to help prevent infections from occurring in the sores. They are prone to getting bacterial infections, so this is important.
I think that about exhausts my knowledge of cc and the best way to treat it.

[GemmaH]

Thanks so much to all for your help and advice, I really appreciate it, we went to our vet last night and she basically told us she hasn't seen a case of CC so bad so she wants us to see the Vet hospital, The vet hospital is in Glasgow Uni Glynda so thank you for mentioning the consultant you have dealt with each time we go its usually a trainee and more qualified vet supervising and I do believe they are good but kind of seem at a loss too! but I have heard of the Dr. Ian Ramsey before my vet mentioned him I am not sure how we go about specifically asking for him but believe me I will try. Our vets given more antibiotics so will see that how goes and we arent changing meds till we go to the vet hospital we hope to get appointment next week so I will keep you posted and thank you again.

[molly muffin]

So glad you are going to the university and I really hope you get to see Dr. Ramsey.