Cushings & CC in 12 year old pittie

[ChulosMom]

Hello everyone! I’m new to the forum and (unfortunately) also new to Cushing’s and Calcinosis Cutis. I’ve found so much useful info on this site that has helped me keep my sanity through the last month & has helped me make informed decisions for my “little boy in a dog suit”. I thought I’d start a thread so maybe some of the things I learn during this journey will help another dog parent.

A while back, my 12 year old pit bull, Chulo, exhibited what I thought were symptoms of Cushing’s (excessive appetite/thirst, accidents in the house, thinning fur, muscle loss) so I had him tested. His tests came back negative so I chalked it up to old age and thought I’d have him rechecked at his semi-annual wellness check.

Right before his wellness check, he developed two large scaly spots on his shoulders and immediately began scratching both non-stop. His vet put him on antibiotics and prednisone but referred him to NC State’s dermatology department when the patches began spreading and his overall appearance & well-being quickly deteriorated.

During that two weeks, he lost weight (he’s down to 70 pounds from around 90), his muscles wasted (even his little face became sunken almost like a skeleton), and the skin infection spread and became very infected despite antibiotics. I was scared to death that every day would be his last.

NC State tested him for Cushing’s (he was positive) and confirmed that the patches were Calcinosis Cutis. They started him on 60 mg of Vetoryl (30 mg twice a day), 600 mg of Gabupentin (300mg twice a day), 150 mg Tramadol (75 mg twice a day), 600 mg Clindamyacin (300 mg twice a day), and also prescribed a daily bleach wash (I mix ¼ tsp of bleach with 1 cup water and spray on the oozing/infected calcinosis spots).

They did tell me the calcinosis would get worse before it got better and it definitely has – he now has spots on his head, neck, back, sides, back legs, and rear but they don’t seem nearly as severe as the spots that appeared prior to him starting treatment.
He has good days and bad – most days his appetite is good and he’s playful but some days he picks at his food and needs to be carried up the steps. I do think we’re on the right track and am so thankful I found this site!

We head back to NC State for his follow-up ACTH Stimulation test on Wednesday so hopefully we’ll find that his levels are improving!

[Squirt's Mom]

Hi and welcome to you and Chulo! :)

I am so sorry your baby and you are having to deal with CC. It is one of the rare complications that can be so tough to deal with. It sounds like you are off to a good start! One thing to keep in mind - the ONLY way to get the CC cleared is to gain optimal control over the cortisol. For a pup on Vetoryl that means a post, or second, number on the ACTH around 3.5ug/dl is ideal. Be sure to get copies of the ACTH coming up so you can share that info with us. In fact, we would love to see the test results used to diagnose the Cushing's...tho CC is almost Cushing's caused. ;) We just love details so the more you can tell us the better! :)

Here is a link to one of our members who successfully dealt with, and continues to deal with, CC in her Pug. https://www.k9cushings.com/forum/showthread.php?t=5908

I'm glad you found us and am sure others will be along to chat with you soon.

Hugs,
Leslie

[molly muffin]

Hello and welcome from me too. Do you remember what his diagnosed cortisol levels were? As Leslie mentioned we've found the best post results for getting rid of cc is below 5ug. So that is your goal.
The idea is that all the calcium deposits that are there already need to push up through the skin to get rid of them. The goal is to have no new ones develop that have to come out. That is why it gets worse before better and we are talking months and months for it to get better. So don't get discouraged.
Skin is the biggest organ and also skin and hair have to go through their cycles.

I'm so glad you shared the bleach spray idea, as I don't think I've heard that one before. How are you finding using that?

[ChulosMom]

Hi ladies, thanks for the warm welcome!
We've definitely seen the calcinosis get worse before getting better (and he does still have several spots that we're expecting to break out and has a lot that is still healing). It does seem to be much less severe now and it's encouraging to see the large patches of pink skin with no lesions.
I honestly didn't realize how bad calcinosis looked. I was genuinely afraid it would just take over his whole body and I'd lose him. I'll post some photos for reference in case anyone else gets the hopeless feeling I had.
I was worried about the bleach spray but it isn't even strong enough to bleach the color out of his bedding. It seems to be working really well at killing bacteria on his skin and drying out the oozing/infected areas. I used chlorhexadrine spray previously and I think the bleach works much much better.

Chulo's initial ACTH numbers were 4.7 for pre and 27.2 for post three weeks ago. He had just stopped prednisone the day before testing so the numbers were lower than the vet expected. His follow-up test is Wednesday so we're hoping to be under 5.

Does anyone have any tips on a diet or supplements that can help rebuild muscle and support his general well-being while his little body fights all these health issues? I started feeding him high protein/low carb food and ordered a probiotic for him since he's taking pretty strong antibiotics. Anything else you can recommend?

Thanks so much for the responses and all the great info!
Chulo & Kari

[ChulosMom]

Here’s a link to a photo album of Chulo’s calcinosis. It looks awful but he’s slowly starting to heal & new spots aren’t as severe.
http://www.k9cushings.com/forum/album.php?albumid=1199

[molly muffin]

Aww poor baby. Good to hear that he is getting better though. Crossing fingers for really good results on the ACTH this week.

[ChulosMom]

We're still waiting on ACTH results....
Although Chulo's calcinosis is doing better, he seems so weak. He doesn't have much of an appetite (still drinking water like crazy) and doesn't have very much strength either. I can get him to eat some canned food but he loses interest after a day or so I have to switch to a new flavor. Maybe cooked food or puppy food would help? Anyone have any experience with this?
He lays around and naps a lot (he was previously very hyper for a 12 year old) and is having a terrible time trying to go up and down steps.
He's on pain medication and trilostane so I'm sure some of this is due to the meds but I just worry that there's something else going on.
The vet didn't seem too concerned yesterday but Chulo's been my best buddy for 12 years so I usually freak out over every little issue.
Is the lethargy, decreased appetite, and weakness to be expected or should I be concerned?

[labblab]

Hello and welcome from me, too! I think we'll know more once you receive the results of yesterday's ACTH. Even when cortisol levels have not dropped to a level that's actually unsafe, dogs can feel yucky from the sudden lowering that can accompany the start of Cushing's treatment. So depending on the monitoring test results, your vet may decide to alter Chulo's dosage in order to allow him to adapt to the decline in cortisol more gradually. I do understand, though, that control of the calcinosis cutis is a huge issue here, and therefore will also factor into the dosing decisions.

I'm guessing that the tramadol (and perhaps gabapentin) may also be contributing to Culo's lethargy. My mom sometimes takes tramadol for arthritic pain and she tells me it definitively makes her feel dopey. As a result, she often takes it at bedtime or before a nap during the day. So I'm guessing it could have the same effect on dogs, too.

I commend you for keeping such a close eye on your boy! It's important to take note of changes such as these. As I say, though, let's first see how the ACTH results turn out and then go from there.

Marianne

[ChulosMom]

I received Chulo's test results this morning and it seems like he's on the right track but isn't quite where he needs to be yet.
His baseline was 2.9 and the post was 7.9.

Since he's 70 pounds and is only taking 60mg of trilostane per day, should I ask the vet to increase his dose by 5-10 mg to see if we can get him under 5 ug/dl?

He still drinks constantly and has a lot of accidents in the house and his hind legs are becoming weaker. His appetite is hit or miss though - he used to gobble up all his kibbles so quickly that he had to have a special bowl. Now he refuses to eat any kibbles or canned dog food and will only eat chicken and veggies (refuses to eat anything first thing in the morning so I have to go home and feed him 'breakfast' at 11am and give him his medicines then). His appetite at dinner time is pretty good.

[labblab]

If Chulo were mine, I would not want to increase his trilostane until he's completed at least thirty days at this dose (he's not yet been taking it that long, right?). This is because cortisol levels frequently continue to drift downward during the first month, even when the dose is unchanged.

We've already seen quite a big drop in cortisol -- from 27.2 down to 7.9. Especially given his appetite issues, I do believe I'd want to wait a bit longer before increasing. That way, you'll have a more accurate idea as to what the current dose will maximally achieve, and how much to increase if a higher dose does seem warranted.

Marianne

[molly muffin]

I think you said he had been on vetroyl for 3 weeks and then the next week had the follow up ACTH right? So it's bee 30 days already on 60mg a day?

The finicky eating though isn't good and I too am concerned that he might not want to eat at all if he goes lower. Even though it is optimal for cc, to be under 5, there are other considerations. Also another questions is have they done any follow up blood work to see what liver levels and other things are at now?

I personally would probably hold off a bit too and see if he can't regain some appetite.

[ChulosMom]

Thanks for the advice - it sounds like slowly lowering his cortisol levels over the course of weeks/months is the safe way to go. I find myself getting impatient and wanting him to be better now instead of waiting for the trilostane to work as it’s intended.
I went ahead and scheduled another ACTH test in 2 weeks so hopefully his levels will continue to drop a little in order to get the cc under control without an increase in trilostane dosage. Friday will be one month on the trilostane.

He had regular blood work done about a month and a half ago and all his levels were within the acceptable range except for the ALP, which was about 20 times the recommended range (to be expected with Cushings). I also had his electrolytes checked last week everything was normal.

He seems to be doing better with both eating and mobility for the last 3 Days. He hasn’t been falling down and can go up and down stairs on his own for the most part. I’ve also been cooking chicken and veggies for him and have found some high protein kibbles that he will tolerate (if they’re covered in chicken). I’ve been able to get him to eat about 4 cups a day so he’s definitely got his appetite back. He’s also getting a muscle mass supplement that the vet approved.

I just need to learn to be patient and realize that getting the Cushings and cc under control isn’t an overnight process! :-)

[molly muffin]

Hopefully the eating and mobility will continue to improve with time.

Yes, it's true, cushings is all about patience. I, at least, am very bad when it comes to patience, but really it's the best way slow.

You're doing good and a lot of the food stuff is just trying to find what they will like.

[ChulosMom]

We got Chulo's Cushings and Calcinosis under control and he did much better for about 4 months. At his last checkup, the vet heard a "crackling" noise in Chulo's lungs when doing the ACTH test and noted that Chulo's breathing seemed to be labored. He did an x-ray and found some calcification in his lungs but said it was nothing to be concerned about & was just something that happens to dogs with Cushings. He also did routine labs and although a lot of the results were not within the normal ranges, everything was fine. Over the last week or so, Chulo has been getting up in the middle of the night and pacing around the house (he has always slept through the night) and is having 4-5 accidents in the house each night (in addition to 4-5 that he has started having during the day). He's no longer able to get in bed by himself so he wakes me up to help him into bed but only sleeps 20-30 minutes before he gets down and starts pacing around again. He's also ducking his head if I try to pet him so I'm afraid he's in pain, although the vet has assured me that he isn't. His appetite has also decreased and he has vomited twice in the last week and he has developed 4 small spots of calcinosis after having clear skin for over 2 months. Has anyone else had a similar experience with these types of symptoms in a dog whose Cushings had previously been under control? I've included his latest labs below in case anyone has any insights.

Small Animal Profile Specimen Tested: Serum
Glucose 91
Urea Nitrogen 13
Creatinine 0.56 L
Phosphorus 5.3 H
Calcium 9.4
Total Protein 5.8
Albumin 2.9
Globulin 2.9
ALT (GPT) 122 H
ALKP 2703 H
GGT 20 H
Total Bilirubin 0.2
CK 318 H 305
Cholesterol 331
Triglycerides 136
Sodium 147
Potassium 4.8 H
Chloride 106 L
CO2 29 H
Anion Gap 16.8
02/22/18 12:46 PM Automated LIH cannot be determined. Serum/plasma appears: Slightly hemolyzed.

LIH Specimen Tested: Serum
Lipemia ABN
Icterus ABN
Hemolysis ABN

Cortisol (Pre) 1.72 (was 2.23 on 10/19/2017)
Cortisol (Post) 3.05 (was 4.05 on 10/19/2017)

CBC Small Animal Specimen Tested: Whole Blood
RBC 7.98
Hemoglobin 19.3
Hematocrit 60.0
Packed Cell Volume 56.1
MCV 75.2
MCH 24.2
MCHC 32.2 L
RDW 14.8
nRBCS 1 /100 WBCs
Reticulocyte # 104.8 H
Reticulocyte % 1.31 H
Anisocytosis 1+
WBC 5.770
Seg Neutrophils 5.251
Band Neutrophils 0.000
Lymphocytes 0.289 L
Monocytes 0.231
Eosinophils 0.000
Basophils 0.000
Platelets 413 H
MPV 10.8
Platelets Clumped Appear increased
Platelet Morphology Large
Plasma Protein 7.0
Plasma Appearance Normal

Urinalysis Specimen Tested: Urine
Color Straw Yellow
Transparency Clear Clear
Specific Gravity 1.006
pH 7.5
Glucose Negative
Ketones Negative
Bilirubin Negative
Blood Negative
Protein Negative
Urobilinogen 0.2 E.U./dL
RBC/HPF None Seen
WBC/HPF 2-5
Epithelial Cells/HPF 0-4
Cast/LPF None Seen
Crystals None Seen
Bacteria/HPF None Seen
Fat Droplets/HPF Rare

[Harley PoMMom]

Could you do us a favor and edit your post to include the reference ranges for those lab values...thanks! Is Chulo still taking 60 mg of Trilostane? The vomiting sure is worrisome, has the vet advised you to discontinue the Trilostane until Chulo is feeling and eating better? I see that his cortisol has dropped a bit from the October ACTH to this most recent one (4.05 ug/dl to 3.05 ug/dl), so I'm just wondering if that cortisol continued to drift downward, if so, it could be that his cortisol is too low and stopping the Trilostane would be required. Stopping the Trilostane won't hurt him and if he seems to feel better after a day without the Trilostane than probably his cortisol was too low and lowering the Trilostane dosage would be needed. After he is feeling better, administering his Trilostane (on a lower dose) twice a day may be more beneficial in getting that cortisol on an even keel.

Also, cushdogs commonly have diluted urine, which Chulo does have, and when a regular urinalysis is done it may not pick up bacteria that is present in the urine so an urine culture and sensitivity test is recommended. An UTI would make a dog drink/urinate more and would account for those accidents in the house, UTI's can be painful too so his pacing could be from that.

Two more questions, is Chulo getting his Trilostane with meals and are those ACTH stim tests being done 4-6 hours post pill?

Lori

[LeahCC]

Hi, Chulo's mom. I feel like I'm kind of in the same boat as you with the symptoms. My pitt was diagnosed with Cushing's just after her 13th birthday in February and we've just recently got her cortisol levels to a normal range. Despite that, she does walk around panting during the evening and in the middle of the night, and has frequent accidents in the house while we are at work and overnight. The vet did find some bacteria in her urine when she went in for her ACTH stim test last Wednesday, so she is on day 6 of her 10 day antibiotic, though I have not noticed marked improvement as of yet. The vet did say we may need to try a more aggressive antibiotic if the UTI does not clear with this one, but chose this one to also address any skin infections she may be battling since her CC is still rather bad.

For context, the panting, pacing, and frequent urination have been occurring since shortly after starting Trilostane. The meds helped with the volume of the urination, but not the frequency. I sometimes give her a 1mg melatonin to help with the stress, or a small dose of xanax if it's really bad. Also she is trembling almost constantly, when she's not pacing around and panting. Or sometimes she is panting and shaking. I really don't know what to do or how to help her.. according to her tests, she should be ok.

Here is Phoebe's CC gallery:
https://photos.app.goo.gl/RilEfECYugjNWcXR2

I don't have any real solutions or help for you, just wanted to let you know we're going through a similar situation and I will definitely follow up if we do find something that helps.

Leah

[ChulosMom]

Hi Lori,
Thanks for the response! Sorry it took so long for me to respond - I couldn't figure out an easy way to show the ranges so I just uploaded his test results to an album here: http://www.k9cushings.com/forum/album.php?albumid=1241
I guess what's most concerning is that the vet said everything looked ok but after searching through this forum, I'm really worried about his liver. The ALT was 122 this time and 107 in February but the acceptable range is 16-75 U/L and his ALKP was 2703 this time and 446 last time and the acceptable range is 8-70 U/L. Is that okay for Cushing's pups or should I be concerned? I read that liver issues sometimes have symptoms that include loss of appetite and increased drinking/urinating.
Chulo is still taking 60 mg of trilostane and the vet has said to continue on that since Chulo had such a terrible case of calcinosis cutis, which is somewhat under control now. I tried going a day without trilostane and Chulo did sleep through the night but he's still having a lot of accidents in the house, is drinking water like crazy, and just doesn't want to eat at all. Since he's eating less, he has lost about 10 pounds so you may be correct in thinking that his trilostane dose is too high. I'll ask the vet about that.
He is getting the trilostane with food (when he'll actually eat) and the ACTH tests were done around 4.5 hours after he has his meds.
I think we might take your advice and see if he has a UTI as well.
Thanks again for the helpful info!

[ChulosMom]

Hi Leah,
I'm so sorry to hear that you and your baby are having problems. The battle against Cushings is definitely very frustrating! One thing that did help Chulo get his calcinosis under control was the antibiotic we chose. I had read a study from UC Berkeley that talked about how minocycline affects the way minerals are absorbed by the body and seems to work better on calcinosis than other antibiotics. Chulo took that for 2 months and we saw a remarkable improvement. He was completely covered in lesions and they started clearing up within a few weeks of taking the antibiotics. Now that he's off it, his calcinosis isn't as well controlled as before. You can see what he looked like before the antibiotics by looking at his photo gallery here: http://www.k9cushings.com/forum/album.php?albumid=1199
Thank you for sharing your situation. I'll definitely post any useful information that I find in hopes that it might help Phoebe too!

[Harley PoMMom]

Cushdogs commonly do have a very elevated ALP so if that liver enzyme value was the only one really high it wouldn't alarm me so much, however, I do see, as you mentioned, that Chulo's ALT has climbed and now the GGT is in the high ranges too, so this does concern me because normally we don't see significant elevations in the GGT with Cushing's. As you said, a lack of appetite and increased drinking/urinating are symptoms of a liver issue, performing a bile acid test and/or an ultrasound may help diagnose a liver problem.

[ChulosMom]

Chulo went back to the vet yesterday for some additional testing and his liver levels are down a little. The ALKP is still at 2100 but that's at least down 600 points from the previous test. The GGT and ALT are both still in the "high" range but have dropped significantly as well. He was also tested for a UTI and that came back negative, which was encouraging.
The vet seemed very happy with the results and Chulo seems to be feeling better and eating more so perhaps he just had a bug or was just feeling off for a week or so. I did find some recipes for homemade dog food for dogs with liver issues and also found a supplement (Denamarin) that contains SAM-e and milk thistle so I'm going to start him on that as well to see if I can get his ALKP down a little more before his next appointment on the 23rd.

[molly muffin]

Denamarin is a good supplement to give for liver support, since it has both in it.
How is he doing now as far as vomiting? bathroom accidents, restlessness?

[LeahCC]

Over the last few days, Phoebe has been pacing and panting and started whining like she's in pain. She's been doing this at various times, often in the middle of the night. I talked to my vet about it and he prescribed her some allergy medicine (Apoquel) and another antibiotic to address the UTI in case that was the source of the pain. She seems better shortly after starting the allergy medicine. Also, she had a recent eruption of CC on her lower back, which is normally sensitive and has become much more sensitive lately. I think that the whining and general discomfort she was feeling over several days was the CC working its way out of her back and has finally finished. Maybe Chulo is going through something similar and could benefit from allergy medicine. Pitts are so good at masking the source of pain so it's sometimes hard to know where it's coming from.

The minocycline that you mentioned helping the CC... did you use it to treat while the CC was still forming? Phoebe's cortisol levels are normal now so (hopefully) the CC shouldn't be forming; what we're dealing with is the aftermath and the healing of the skin that was damaged. The study indicates that it helps reduce the size of the calcium deposits, so if her body isn't forming the deposits, I'm not sure how much it would benefit her. Also since she's on an antibiotic currently and just finished a previous cycle; I'd like to let her system rest a little before starting another.

[ChulosMom]

Leah - Chulo did use the minocycline while the CC was still forming and then for a month or so after so that may not help your baby since her levels are now under control.

We started Chulo on the Denamarin and he has been doing well for the last week or so - no vomiting, no stomach issues. He has been sleeping through the night but still drinks and urinates a lot. As a precaution, I had an ultrasound of his liver done and they didn't see anything concerning there. They did find a tumor on his Thyroid in the process and just confirmed that it is thyroid carcinoma. I went from being so relieved over the news of a healthy liver to being devastated within a few seconds.

There is a clinical trial that I'm hoping to get him into, as surgery to remove the tumor is around $6000 and radiation is over $10000. Hopefully we'll get some good news from the clinical trials coordinator next week.

[ChulosMom]

So Chulo had his CT Scan at Virginia Tech yesterday and we didn't get the news we were hoping for. The tumor is very invasive and has become tangled with all the blood vessels in his neck, which the oncologist said would exclude him from being a candidate for surgery. Unfortunately it has metastasized into his lungs so she doesn't feel that radiation or traditional chemo will work for him. We started him on Palladia this morning in hopes that it may either shrink his tumors or at least prevent them from growing. He's also taking a curcumin supplement, fish oil, and melatonin at night, along with an anti-cancer/low carb homemade diet. We're hoping to keep him happy and comfy as long as possible.

[Joan2517]

That's so sad, I'm sorry.

[Squirt's Mom]

I am so sorry to hear this. Since your previous post about trying to get him into a trial I have been holding my breath hoping for good news. This is not what any of us wanted to learn. :(:(:( You are doing a good job with the circumstances you have been dealt and I am sure Chulo is going to love the extra TLC he will get. Please know we are here anytime you need to talk, vent, cry, anything. You and Chulo are family and we will be here for you all the way.

Hugs,
Leslie

[lulusmom]

Hi Kari and a belated welcome to you and Chulo

You have already gotten some excellent guidance from Lori and Marianne so there is no need to echo them. The reason for my post is to let you know that if you are interested, there is a facebook group that was established for the sole purpose of pet owners who are dealing with one of the worst and most heartbreaking symptom of cushing's. This is not a support group for cushing's. It is a place where members can find comfort from others who are dealing with CC as well as a place to share their experience with various treatments that are prescribed. The woman who started this group had an Old English Bulldog, Burt, who had a horrific case of CC. I have followed a lot of dogs with CC and in my experience, some of the worst and chronic cases have been Old English Bulldogs. You will definitely see pictures of pitties there as they are also a breed that seems to be genetically predisposed. In case you are interested in joining that group, I have provided a link below.

Now that I have that out of the way, I would like to commend you on being an excellent advocate for Chulo. Getting him seen by specialists was the absolute best thing you could do for him as was reaching out to us. You've landed in the best support group you could possibly hope for. I also moderate a fb support group and always refer members with complicated cases here as the knowledge and resource library in this group are unparallelled. I look forward to hearing a lot more about your precious Chulo.

https://www.facebook.com/groups/988564191285009/

Hugs,
Glynda

[ChulosMom]

Thank you all so much for the kind words and for the recommendation of the Facebook group! Chulo is a tough little old guy so he's definitely fighting the cancer as best as he can. So far, he's tolerating the palladia and isn't experiencing any side effects. He's eating and has gained a couple of pounds since I switched him to the homemade low carb anti-cancer diet. He had developed Horner's Syndrome because the tumor was pressing on his sympathetic nerve but that seems to have gone away (hopefully because the tumor is shrinking a little). He sleeps pretty much all day and sleeps through the night (thanks to melatonin) so he's definitely well-rested - hopefully that will help a little. He seems to be happy and comfortable so I'm just going to keep him that way until he decides it's time. He's been my baby for 13 years so life without him is going to be very hard but I'm just trying to stay positive and be happy with whatever time I have left with him.