Controlling Tyrant's skin sores

[happy2help]

Tyrant is a 10 yr old min pin weighing 23 lbs and he has lived up to his name every minute of his life...but through it all he has brought me so much joy (even when he is being a tyrant) because he has such a zest for life. Nothing seems to faze him...except this skin problem which is a result of his pituitary dependent cushings.

It took a while to diagnose him as most of his symptoms came on slowly and as he aged I put them in the category of him getting older and plumper because he has always been a food driven dog. I am familiar with cushings in horses but not dogs and they are very different. It wasn't until I took him to a dermatologist for the skin problems that cushings was first mentioned. After researching it online and before blood test were completed I was sure that was what he had...most of the symptoms were there.

The skin problems/sores started about 18-24 months before diagnosis. He would have small lesions that would open and ooze. Clavamox helped clear them up but they would come back after a few weeks. He then developed a large tumor between the shoulders and his micro chip was in the center of it. We had it removed and biopsied and it came back as his fatty cells reacting to the microchip, he had the microchip since 4 months and he was then 7 yrs.

Fast forward to Jan 2017, we biopsied a few of the sores and sent it to the dermatologist who could not find anything abnormal in it. We then did a follow up with him and immediately upon seeing him he asked if he drank an excessive amount of water, I said no, not anything unusual for him. Well I had just grown used to him eating and drinking more excessively over time and it became his new normal to me. As I thought back through the last 2 years I realized he had all of the symptoms of cushings.

We ran lots of blood work and started him on 10 mg Vetoryl and after each test we increased it by 5 mg until he was at 25 mg and my vet did not feel comfortable going any higher. Although his numbers were not ideal, his clinical symptoms had improved greatly. He no longer woke during the night to go out to potty or get a drink, he lost a couple of pounds and his skin sores were almost no existent...until February 2018 when all of the symptoms started to return.

Took him back to the vet for re-check and his numbers were again out of ideal range. He was currently on the 25 mg Trilostane chewable tablet made by Wedgewood Pharmacy.

His skin sores are the worst he has had, covering his hind quarters, neck, left hind foot and a few other random ones throughout his body. I bath him regularly with MiconaHex+Triz shampoo. He is currently taking 32.5 mg Trilostane after the recent increases.

Blood taken 4 hours after morning dose of Trilostane

Date Cortisol Pre Dex Cortisol 4 hr Post Cortisol 8hr Post
3-20-17 3.9 0.2 2.8
4-14-17 3.9 8.0
6-13-17 9.5 10.8
7-16-17 2.8 9.5
3-14-18 4.7 9.5
4-5-18 3.6 6.1

VetLyte Electrolyte Analyzer
4-15-17
Sodium 161
Potassium 4.9
Chloride 118

7-7-17
Sodium 160
Potassium 4.8
Chloride 118

4-5-18
Sodium 150
Potassium 5.7
Chloride 121

My apologies for such a long post, I hope I have provided enough information to get some good feed back from all of you experienced cushing dog lovers!

Cheryl

[Harley PoMMom]

Hi Cheryl!

Welcome to you and Tyrant, awww, what a cute name for your boy!!


Tyrant is a 10 yr old min pin weighing 23 lbs and he has lived up to his name every minute of his life...but through it all he has brought me so much joy (even when he is being a tyrant) because he has such a zest for life. Nothing seems to faze him...except this skin problem which is a result of his pituitary dependent cushings.

There is a skin affliction that some cushdogs can get called Calcinosis Cutis which is usually confirmed with a skin biopsy and I do see that Tyrant has already had a couple skin biopsies performed. With this new bout of eruptions was a biopsy done?




It took a while to diagnose him as most of his symptoms came on slowly and as he aged I put them in the category of him getting older and plumper because he has always been a food driven dog. I am familiar with cushings in horses but not dogs and they are very different. It wasn't until I took him to a dermatologist for the skin problems that cushings was first mentioned. After researching it online and before blood test were completed I was sure that was what he had...most of the symptoms were there.

Can you tell us exactly what symptoms Tyrant has? Is his urine diluted? Besides the Trilostane is he taking any other herbs/medicines/supplements?



He no longer woke during the night to go out to potty or get a drink, he lost a couple of pounds and his skin sores were almost no existent...until February 2018 when all of the symptoms started to return.

What symptoms returned?


Took him back to the vet for re-check and his numbers were again out of ideal range. He was currently on the 25 mg Trilostane chewable tablet made by Wedgewood Pharmacy.

His skin sores are the worst he has had, covering his hind quarters, neck, left hind foot and a few other random ones throughout his body. I bath him regularly with MiconaHex+Triz shampoo. He is currently taking 32.5 mg Trilostane after the recent increases.

Is his Trilostane still be compounded by Wedgewood?


Blood taken 4 hours after morning dose of Trilostane

Date Cortisol Pre Dex Cortisol 4 hr Post Cortisol 8hr Post
3-20-17 3.9 0.2 2.8
4-14-17 3.9 8.0
6-13-17 9.5 10.8
7-16-17 2.8 9.5
3-14-18 4.7 9.5
4-5-18 3.6 6.1

The test performed on 3/20/2017, was this a LDDS? And the other ones, were those ACTH stimulation tests? Also, is Tyrant getting his Trilostane with a meal?


VetLyte Electrolyte Analyzer
4-15-17
Sodium 161
Potassium 4.9
Chloride 118

7-7-17
Sodium 160
Potassium 4.8
Chloride 118

4-5-18
Sodium 150
Potassium 5.7
Chloride 121

Could you edit your post and include the reference ranges and units of measurements for those lab values? As an example: ALP 200 U/L (5-50)...thanks!


My apologies for such a long post, I hope I have provided enough information to get some good feed back from all of you experienced cushing dog lovers!

Cheryl


No need to apologize, we love details so you're doing a great job!! Regarding Calcinosis Cutis (CC), if this is what Tyrant has, unfortunately it gets worse before it gets better, and we have also observed that a dog's cortisol should be 5 ug/dl or less to get some kind control of it...more on that later.

I sure am sorry for the reasons that brought you here but glad you found us and we will help in any way we can. Please do not hesitate to ask any questions that you have and know we are here for you both.

Lori

[happy2help]

Tyrant is a 10 yr old min pin weighing 23 lbs and he has lived up to his name every minute of his life...but through it all he has brought me so much joy (even when he is being a tyrant) because he has such a zest for life. Nothing seems to faze him...except this skin problem which is a result of his pituitary dependent cushings.

It took a while to diagnose him as most of his symptoms came on slowly and as he aged I put them in the category of him getting older and plumper because he has always been a food driven dog. I am familiar with cushings in horses but not dogs and they are very different. It wasn't until I took him to a dermatologist for the skin problems that cushings was first mentioned. After researching it online and before blood test were completed I was sure that was what he had...most of the symptoms were there.

The skin problems/sores started about 18-24 months before diagnosis. He would have small lesions that would open and ooze. Clavamox helped clear them up but they would come back after a few weeks. He then developed a large tumor between the shoulders and his micro chip was in the center of it. We had it removed and biopsied and it came back as his fatty cells reacting to the microchip, he had the microchip since 4 months and he was then 7 yrs.

Fast forward to Jan 2017, we biopsied a few of the sores and sent it to the dermatologist who could not find anything abnormal in it. We then did a follow up with him and immediately upon seeing him he asked if he drank an excessive amount of water, I said no, not anything unusual for him. Well I had just grown used to him eating and drinking more excessively over time and it became his new normal to me. As I thought back through the last 2 years I realized he had all of the symptoms of cushings.

We ran lots of blood work and started him on 10 mg Vetoryl and after each test we increased it by 5 mg until he was at 25 mg and my vet did not feel comfortable going any higher. Although his numbers were not ideal, his clinical symptoms had improved greatly. He no longer woke during the night to go out to potty or get a drink, he lost a couple of pounds and his skin sores were almost no existent...until February 2018 when all of the symptoms started to return.

Took him back to the vet for re-check and his numbers were again out of ideal range. He was currently on the 25 mg Trilostane chewable tablet made by Wedgewood Pharmacy.

His skin sores are the worst he has had, covering his hind quarters, neck, left hind foot and a few other random ones throughout his body. I bath him regularly with MiconaHex+Triz shampoo. He is currently taking 32.5 mg Trilostane after the recent increases.

3/20/17 Dex Suppression (1 pre, 2 Post)
Pre 3.9 ug/dl 4hr 0.2 ug/dl 8hr 2.8 ug/dl

ACTH Stim (1 pre, 1 post)
1st Blood draw taken 4 hours after morning dose of Trilostane


Date Cortisol Pre Dex Cortisol 4 hr Post
4-14-17 3.9 ug/dl 8.0 ug/dl
6-13-17 9.5 ug/dl 10.8 ug/dl
7-16-17 2.8 ug/dl 9.5 ug/dl
3-14-18 4.7 ug/dl 9.5 ug/dl
4-5-18 3.6 ug/dl 6.1 ug/dl


VetLyte Electrolyte Analyzer
Reference Values:
Sodium 144-160 mmol/L
Potassium 3.5-5.8 mmol/L
Chloride 109-122 mmol/L

4-15-17
Sodium 161 mmol/L
Potassium 4.9 mmol/L
Chloride 118 mmol/L


7-7-17
Sodium 160 mmol/L
Potassium 4.8 mmol/L
Chloride 118 mmol/L


4-5-18
Sodium 150 mmol/L
Potassium 5.7 mmol/L
Chloride 121 mmol/L


Urinalysis 3/15/18
Collection: Free catch
Color: Dark yellow
Clarity: Cloudy
pH: 6.0
Protein 2+ (200-300 mg/dl)


Symptoms present:
Skin lessions
Excessive panting
Excessive thirst
Fat pockets over shoulders and on back over hip area
Less active, dosen't play with toys anymore
Reluctant to jump on furniture
Wakes during the night to urinate


My apologies for such a long post, I hope I have provided enough information to get some good feed back from all of you experienced cushing dog lovers!

Cheryl

I have updated the post with some of the info requested that I had not included...or I think I did, not sure how to submit replies. I did ask the my vet if about the Calcinosis Cutis and if it is possible. He didn't believe this is Tyrant's condition but said it could be possible but another biopsy would be needed. Tyrant also has a signifigant heart murmur therefore we are always reluctant to put him under anesthesia.

He is still on the compounded Trilostane from Wedgewood pharmacy. He is not on any supplements or herbs, although that is how I found your forum, I was searching for any info on CBD oil for cushings sores. He is currently taking Deramax and Gabapentin for the pain and inflamation. He has always been free fed, I know, not good for a cushings dog...he is a pig and my 13 yr old Rat Terrier is a picky eater and very trim. They are currently on Canidae Platinum dry food. I just started give him a tablespoon of wet Canidae when I give his meds as I recently read that somewhere...can't remeber as I have read so much stuff lately. Started this 5 days ago. His appetite is not as ravinous but he won't turn down wet food. I just ordered Grain Free Canidae to start him on, should be here tomorrow.

Please let me know if I missed any other info you requested and thank you all for helping!

[Harley PoMMom]

Hi Cheryl,

Thanks so much for the additional information, and one more question :eek: So until recently Tyrant wasn't getting his Trilostane with a meal? The reason I ask is because Trilostane has to be given with a meal to be properly absorbed, if it is not than those ACTH stimulation test results are skewed, which means that those results may be reflecting higher readings than what Tyrant's cortisol actually is. You would not believe how many vets are not aware of that most important protocol.

With regards to the CC, I'm including a link to one of our member's album which has pictures of her beloved dog, Tobey, with various degrees of CC. One note of warning is that some of the pics are a bit graphic: http://www.k9cushings.com/forum/album.php?albumid=805 Also, here's a link to a post of hers which she includes information on what she did to deal with the CC: http://www.k9cushings.com/forum/showthread.php?7001-Blue-6-1-2-yr-old-Lyso-Calcinosis-cutis-(Blue-is-at-peace)&p=173250#post173250

Although before any treatment for CC is started it should be diagnosed with a biopsy.

Lori

[Joan2517]

My vet never told me it had to be given with a meal. I only found out when I joined this forum. I have no idea if any of Lena's test results were accurate. It appalls me that the meds are given without being told how they need to be administered.

[happy2help]

Hi Cheryl,

Thanks so much for the additional information, and one more question :eek: So until recently Tyrant wasn't getting his Trilostane with a meal? The reason I ask is because Trilostane has to be given with a meal to be properly absorbed, if it is not than those ACTH stimulation test results are skewed, which means that those results may be reflecting higher readings than what Tyrant's cortisol actually is. You would not believe how many vets are not aware of that most important protocol.

With regards to the CC, I'm including a link to one of our member's album which has pictures of her beloved dog, Tobey, with various degrees of CC. One note of warning is that some of the pics are a bit graphic: http://www.k9cushings.com/forum/album.php?albumid=805 Also, here's a link to a post of hers which she includes information on what she did to deal with the CC: http://www.k9cushings.com/forum/showthread.php?7001-Blue-6-1-2-yr-old-Lyso-Calcinosis-cutis-(Blue-is-at-peace)&p=173250#post173250

Although before any treatment for CC is started it should be diagnosed with a biopsy.

Lori

That is correct he was not given a meal when I would give his medication. I just started doing that. He is a big eater but I did not actually give him food and make sure he ate when giving the Trilostane and I am not sure when he ate after giving it. He is now and I will continue to give food with meds. He will go for another ACTH test on Thursday.

Prior we were never able to get his numbers into ideal range but his symptoms did improve and therefore he left him at the 25 mg twice a day. He wasn't comfortable going any higher in dosage as he is a small dog and that already seemed a high dose for his weight. That seemed to work for controlling the symptoms for about 7 months.

I know skin sores are very common with Cushings...that is what actually brought him to his diagnosis. We were not able to control the skin problems and ended up at a dermatologist.

I also forgot to mention the few neurological symptoms he had. They were very mild seizures. He would lose his balance and could not control his limbs...almost like an equilibrium problem. He never lost consciousness but would look very distressed. I live 5 minutes from the vet but each time he had one they would be over before the vet had a chance to see it. He would become very clingy to me afterward. He hasn't had one in 3 months. He was never given medication for them. They were frequent for about 2 weeks but then seemed to go away.

I will take a look at the links you shared.
Cheryl

[happy2help]

I will definitely be continuing to give a meal now. Wonder if any of Tyrant's test are accurate.

[lulusmom]

Unless you gave Tyrant his dose with a meal 4 to 6 hours before the acth stimulation test, those results are invalid. Had your vet used those results to justify an additional increase in dose, you could have overdosed Tyrant so I'm happy that this did not happen in all these months. Since you will now be giving the dose with food, the drug will be properly absorbed so you can expect his cortisol to drop. Please keep a close eye on him for signs that cortisol has dropped too low. I have provided a link below to General Guidelines for Dosing and Monitoring Treatment with Vetoryl that can be found in our Helpful Resources subforum. This should help you gain a better understanding of things. Please let us know if you have any questions.

http://www.k9cushings.com/forum/showthread.php?8925-GENERAL-GUIDELINES-for-Dosing-and-Monitoring-Treatment-with-Vetoryl-(trilostane)

[happy2help]

Unless you gave Tyrant his dose with a meal 4 to 6 hours before the acth stimulation test, those results are invalid. Had your vet used those results to justify an additional increase in dose, you could have overdosed Tyrant so I'm happy that this did not happen in all these months. Since you will now be giving the dose with food, the drug will be properly absorbed so you can expect his cortisol to drop. Please keep a close eye on him for signs that cortisol has dropped too low. I have provided a link below to General Guidelines for Dosing and Monitoring Treatment with Vetoryl that can be found in our Helpful Resources subforum. This should help you gain a better understanding of things. Please let us know if you have any questions.

http://www.k9cushings.com/forum/showthread.php?8925-GENERAL-GUIDELINES-for-Dosing-and-Monitoring-Treatment-with-Vetoryl-(trilostane)

Thank you, the guidelines link is helpful information. Yes I will now definitely give it with food.

Does a dose of 32.5 mg for a 23 lb min pin seem too high? I would like to know if his skin lesions are CC but worry about putting him under for a biopsy. I posted pictures of his skin but I don't know where they posted. I think it said in an album...maybe that album is under my profile. Still figuring out how to navigate your site so I really appreciate when you include the link!

Cheryl

[lulusmom]

Hi Cheryl,

I just viewed the pictures of Tyrant's skin issues and it looks like it very well could be calcinosis cutis (cc). Given that you have never administered Vetoryl with food, there is no way to tell if 32.5 mg will be too much for him if properly absorbed so please keep a close eye on him. Signs that cortisol has gone too low are refusing food, vomiting, diarrhea, lethargy, weakness and trembling. What I can tell you is that dogs with cc should be on twice daily dosing of Vetoryl to insure that cortisol is being well controlled throughout the day. To confirm that what you are seeing is cc your vet should do a punch biopsy which does not require sedation. A local numbing agent can be used. It is important that you keep the areas clean as secondary bacterial infections are common. Given your vet's lack of counseling on appropriate administration of the drug, it is unfortunate that Tyrant's cortisol is not yet well controlled after all these months which is not a good thing if cc is involved. Was Tyrant's skin issues apparent at diagnosis or is this something new that arose? If not apparent at diagnosis and it is cc, the lack of control of cortisol has played a great deal in allowing it to progress to this point. You may want to consider having a frank discussion with your vet as to why you did not receive appropriate instructions on dosing and monitoring the drug. You have spent a lot of wasted money on acth stimulation tests that are invalid and I think you deserve some refunds. I highly recommend that you print out the Dechra flow chart (link below) and give a copy to your vet so that s/he understands the importance of counseling the client on administering the drug with food. The flow chart clearly shows that. The package insert that comes with the drug also makes it clear that Vetoryl must be given with food and I believe your vet should have gone over the information with you. Often times, we pet owners provide free continuing education for our vets. If finances allow, I would highly recommend that you ask for a referral to a board certified veterinary internal medicine specialist. These specialists are highly educated and experienced in all things involving the endocrine system and if it were my dog, I would trust no general practice vet to properly address and remedy cc. I firmly believe that while specialists charge more, they can save us money in the long run and spare our dogs a lot of discomfort. No matter what, we are here to help in any way we can so please don't hesitate to ask as many questions as you may have. We'll do our best to provide answers with supporting reference material whenever possible.

Hugs,
Glynda

http://www.k9cushings.com/forum/attachment.php?attachmentid=8284&d=1522201966

P.S. I reread your original post and do see that Tyrant had some skin issues before diagnosis. Is what you are seeing today identical to the skin problems that existed before diagnosis? I also see that you had Tyrant seen by a dermatologist before diagnosis. Did this derm vet identify the skin disorder at that time and if so, what was it.

[Harley PoMMom]

I just took a look at Tyrant's pictures and I think it could be CC too. I also agree with everything Glynda has said, Glynda is one of our resident canine cushing's experts and continues to educate herself (and us!). So please take heed to what Glynda says, she's been here long before me and helped me tremendously.

I'm including a link that hopefully will make it easier to navigate our forum: Board FAQ (http://www.k9cushings.com/forum/faq.php?faq=vb3_board_faq#faq_vb3_board_usage)

Also, here is a link to your album: http://www.k9cushings.com/forum/album.php?albumid=1237

Lori

[happy2help]

Good morning Glynda,

Thank you for all of the info. The skin condition was the reason for the majority of his vet visits in the 2 years prior to the diagnosis of Cushings. The skin problem was not this severe when it first started. It has definelty progressed in the last year. He has had the skin issues for about 3 years now and been on the Trilostane for a year. I am wondering if taken with a meal was mentioned and I just missed it...I know it was always very clear as to when the first draw needed to be after his dosing. I know that was always stressed but I just don't remeber taken with food as an instruction. I will discuss this with him.

Tyrant has always been on the twice a day dosing. I will defitnetly watch for even the slightest sign that he is recieving too much meds. I will also ask about the punch biopsy. He gets so stressed at the vet now because of all the pokes, do you know if I give him a natural calming supplement, like Rescue Remedy, before his visit, could it interfere with the blood work? He is currently on Clavamox and he has done many courses to control the infection or at least try to ward them off. I also use MiconaHex+Triz shampoo. I read in someone else post that there is a anti bacterial spray that I am going to order today. I will ask about a referral to an internest. I believe our closets one is 2 hours away but if we can get some help with this it would be worth it.

Just read your P.S....The skin condition before diagnosis was not as severe. It would start with small lessions and sometimes progress to the thinning and hair loss in patches. The dermatolodist is the one that suspected cushings. He is 2 hours away form me as well but does a clinic every other month in a town 1 hr away. He did a blood test but it was inconclusive and that was his last day there so he recommended that I follow up with my vet for the 8 hr LDDS which I did 2 days later and that confirmed the diagnosis. The dermatologist immediately recongized his skin issues as a result of cushings and his pot belly. He asked over and over again if Tyrant drank a lot of water. I kept saying not more than usual but again...most of his symtoms I chalked up to him aging and being an agressive eater. He was getting heavier so I abributed that to his panting and getting wore out. I was familiar with cushings in horses but not dogs and they are very different symptoms. The dermatologist never gave an actual diagnosis of the skin other than it was related to the cushings. He is the dr that did the prior biopsy anlaysis but it was inconclusive as well.

Cheryl

[happy2help]

Thank you Lori...sorry I could't figure out how to get the pictures to load the correct direction.

[Harley PoMMom]

Thank you Lori...sorry I could't figure out how to get the pictures to load the correct direction.

You did upload your pictures perfectly!! I just thought I'd share the link to your album for it to be handy and if any other members wanted to look as well!

I do believe a dog can get a sedative for the punch biopsy, I've read that and even posted that tidbit to another member today, I'd discuss this with the vet though.


Skills Laboratory: How to perform a skin biopsy

Want to optimize your chances of getting a diagnostic skin biopsy sample? Follow these easy instructions on obtaining and processing useful samples.
source-image
Oct 18, 2011
By Kimberly S. Coyner, DVM, DACVD

...Administer mild sedation if needed. Hair overlying the lesion may be gently clipped, but the clipper blades should not touch the skin or crusts, if present. Then, nodular lesions may be lightly prepared, but do not scrub or prepare crusted, papular, or pustular lesions, as important surface pathology may be destroyed. Next, inject about 1 ml of 1% to 2% lidocaine subcutaneously under the lesion using a 25-ga needle. Allow enough time for the lidocaine to reach full effect before beginning the biopsy.

http://veterinarymedicine.dvm360.com/skills-laboratory-how-perform-skin-biopsy?pageID=2

Lori

[happy2help]

You did upload your pictures perfectly!! I just thought I'd share the link to your album for it to be handy and if any other members wanted to look as well!

I do believe a dog can get a sedative for the punch biopsy, I've read that and even posted that tidbit to another member today, I'd discuss this with the vet though.



http://veterinarymedicine.dvm360.com/skills-laboratory-how-perform-skin-biopsy?pageID=2

Lori

Thank you Lori. Gosh that looks painful! I believe this is what he had previously but this was before he was diagnosed with Cushings. He had 2 done but from what I have read to look for or confirm CC, the slide is prepared differently. So I do not know if they would have found this or have suspected this as the lessions were much smaller and only bumps a that time. I will discuss all of this with our vet tomorrow. Again, thank you.

Do you know if there is a better shampoo and spray to use? I currently usew MiconaHex+Triz shampoo...whould TrizCHLOR be better? Or even Dermalyte?

[Harley PoMMom]

I don't know if one is better than the other, I think that dogs can respond differently so what works for one may not for the other. Some medicines I've seen used on the forum for CC are: trizchlor spray conditioner, mupirocin ointment, ketochlor, and Renee used tea compresses (just tea bags, like lipton or chamomile tea).

[happy2help]

I don't know if one is better than the other, I think that dogs can respond differently so what works for one may not for the other. Some medicines I've seen used on the forum for CC are: trizchlor spray conditioner, mupirocin ointment, ketochlor, and Renee used tea compresses (just tea bags, like lipton or chamomile tea).

Thank you. I am going to order the spray and try it. When I got home today from work the other hind foot now has open sores and the spot on his hind quarter is now crusty. Thank you

[Harley PoMMom]

From reading a member's post regarding their own dog's skin/hair issue another possibility for Tyrant's skin sores could be demodectic mange and demodectic pododermatitis (which is a secondary bacterial infection/s between the toes and the pads of the feet) a skin scraping or biopsy is needed to diagnose.

Here's a link to her and Rambo's photo album where she has pics of his skin/fur issue: http://www.k9cushings.com/forum/album.php?albumid=1233

[happy2help]

From reading a member's post regarding their own dog's skin/hair issue another possibility for Tyrant's skin sores could be demodectic mange and demodectic pododermatitis (which is a secondary bacterial infection/s between the toes and the pads of the feet) a skin scraping or biopsy is needed to diagnose.

Here's a link to her and Rambo's photo album where she has pics of his skin/fur issue: http://www.k9cushings.com/forum/album.php?albumid=1233

Thank you for sharing. Tyrant's skin looks much worse than just the hair lose. He has oozing sores that will even bleed. Some of these are on his rump/hip area that he is unable to reach so the bleeding and oozing is not from him agitating the area. Yesterday when I got home he had even more sores that appeared and they are running from the rump/hip down the hind legs and now on the other hind foot as well. Waiting to do another ATCH test until he has been taking the Trilostane with a meal for 2 full weeks so he won't have the test until the middle of next week. I am hoping to see some good results with the next test and hopefully his skin will start to clear up. He is pretty miserable right now even with the pain meds, but he is still eating and active, although less activity than usual but I expect that with the pain meds. I will do some more research to see if those might be his skin problems. Will also be making an appt with the dermatologist.

[molly muffin]

That does sound like it could be cc and if so, what you see are calicum deposits that form under the skin due to high cortisol and then they push up and out. It doesn't clear up until the deposits have all pushed up and out and no new ones have formed. Often on the forum here we have seen that a cortisol level under 5.0ug is optimal to prevent any new forming of calcium deposits. Keeping the areas clean and dry and using the anitibacterial sprays does help with them healing and not becoming infected.

[happy2help]

That does sound like it could be cc and if so, what you see are calicum deposits that form under the skin due to high cortisol and then they push up and out. It doesn't clear up until the deposits have all pushed up and out and no new ones have formed. Often on the forum here we have seen that a cortisol level under 5.0ug is optimal to prevent any new forming of calcium deposits. Keeping the areas clean and dry and using the anitibacterial sprays does help with them healing and not becoming infected.

Thank you for your insight. I have been bathing him with the MiconaHex+Triz shampoo and using the spray in between. The left hind foot is still the worst and swollen and oozing. There have only been some small new sores on the body that appeared yesterday but not as bad as they have been previously. Hoping for good test results this next week.

Again I thank everyone for their sharing and caring!
Cheryl

[happy2help]

Tyrant had another ACTH Stim test yesterday. He was given his morning meds (32.5 mg Trilostane, 100 mg Gapabapentin, 12.5 mg Dermax, 125 mg Clavamox) at his usual time of 6 am with a meal and the test was done at the same time of the day as his previous test...approximately 4 hrs after morning meds, 10 am. His numbers are:

4/23/17
Cortisol-pre ACTH 1.1 ug
Cortisol-post ACTH 5.5 ug

previous test numbers:

4/6/18
Cortisol-pre ACTH 3.6 ug
Cortisol-post ACTH 6.1 ug

3/15/18
Cortisol-pre ACTH 6.1 ug
Cortisol-post ACTH 9.5 ug


Looks like he is finally in theraputic range but I am concerned that his pre number is too low. Any input is greatly appreciated.

[Harley PoMMom]

It always makes me a bit uneasy when I see a pre number < 2 ug/dl but with his post being 5.5 ug/dl I'm not real concerned with his low pre. Did he seem relaxed when they did the pre? Also, did he always take the 100 mg dose of Gapabapentin with the other ACTH stim tests?

[happy2help]

It always makes me a bit uneasy when I see a pre number < 2 ug/dl but with his post being 5.5 ug/dl I'm not real concerned with his low pre. Did he seem relaxed when they did the pre? Also, did he always take the 100 mg dose of Gapabapentin with the other ACTH stim tests?

No he has not been on the Gabapentin for any of the prior test. He has been on it for 2 weeks for the pain of his skin lesions. He also had 4 drops of Rescue Remeedy Pet yesterday morning to help with his anxiety that he has while at the vet. That probably all explains the low number. Thank you for helping me think this through!

[Harley PoMMom]

Yep, I think that the Rescue Remedy Pet along with the Gapabapentin made him more relaxed which could explain that low pre. I'd just keep an eye on him and if he should start acting unwell that I'd stop the Trilostane, but I really think he will be fine.

[happy2help]

Thank you...talking things out loud can really help see things we weren't thinking of. Yesterday and this morning he was very alert and active. He is weaning off the Gabapentin and his appetite is returning. Skin still has some bad spots but slowwly seeing an improvement. Hopefully this will continue.

I tuly appreciate everyone's input and making me aware that he needs to take his Trilostane with a meal...I really believe that is what has resulted in his numbers finally being in theraputic range. Hopefully the skin issues will now resolve and he will go back to being a 'tyrant'!

[molly muffin]

Glad to see that you hit a better range and as Lori said, I wouldn't be overly worried about the pre with a good post like you have.

Just keep doing what you are doing. How are those lesions looking this week?

[happy2help]

His skin is still looking awful. The lesions are progressing down his hind legs and the right hind foot is now developing sores. The left hind is still very, very swollen with lumps on the bottom and in between the pads. The neck sores are still growing in size. I was weaning him off of the Gabapentin but he is still very painful so he is getting it twice a day. 20180426_202750
Trying to figure out how to upload images to my reply but looks like I will have to add the updated photos to my page.

http://www.k9cushings.com/forum/attachment.php?attachmentid=8383&d=1525311705
http://www.k9cushings.com/forum/attachment.php?attachmentid=8382&d=1525311659
http://www.k9cushings.com/forum/attachment.php?attachmentid=8381&d=1525311619
http://www.k9cushings.com/forum/attachment.php?attachmentid=8380&d=1525311571
http://www.k9cushings.com/forum/attachment.php?attachmentid=8379&d=1525311541
http://www.k9cushings.com/forum/attachment.php?attachmentid=8378&d=1525311499
http://www.k9cushings.com/forum/attachment.php?attachmentid=8375&d=1525311264

[Harley PoMMom]

Poor Tyrant :( Hopefully those sores and lumps will heal up soon. When you have uploaded a photo, you can place it in your posts by using the BB code text that is displayed below the image when you view it at full size. Here's a pic of my boy, Harley, that I uploaded to my album with a red box around the BB code.

http://www.k9cushings.com/forum/attachment.php?attachmentid=8385&d=1525325388

[happy2help]

Let me try this upload thing...any suggestion how I get the photo in the correct direction. They are straight on my file but when they upload they are sideways.
http://www.k9cushings.com/forum/attachment.php?attachmentid=8384&d=1525311781

[happy2help]

Let me try this upload thing...any suggestion how I get the photo in the correct direction. They are straight on my file but when they upload they are sideways.
http://www.k9cushings.com/forum/attachment.php?attachmentid=8384&d=1525311781

Here is how the left hind looked when I got home today. It hadn't been open and weeping on the bottom so I am hoping this is all of the yucky stuff breaking through and coming out.
http://www.k9cushings.com/forum/attachment.php?attachmentid=8391&d=1525389313
http://www.k9cushings.com/forum/attachment.php?attachmentid=8390&d=1525389260

[Harley PoMMom]

Oh poor guy :( that looks sore. With the picture orientation, I'm sorry that there's nothing you can do to correct this as it's a vbulletin issue.

[happy2help]

Your little guy is darling!

[happy2help]

I am happy to report that Tyrant is finally on the mend. Harley PoMMom was a huge help in sharing another member's photos of her dog that had Demodex Mange. It helped me research and get results. Tyrant did in fact have Demodex Mange and a very severe case. His skin was in very bad shape. Despite all of the supplements for his immune system and holistic approach for treating the mange it got much worse and he had to be put on NextGard. He is now about 85% healed and hair is stating to grow back, even in his very worst damaged skin areas. He is just about back to his normal self...which is a TYRANT!!! He had another stim test yesterday and the results this morning are:
Pre 2.6 ug/dl
Post 3.7 ug/dl.

I don't know how if would have come along if the demodex mange had not been suggested as we were at a loss. The dermatologist is pleased with his progress. He will remain on the NextGrd for the remainder of his life as he is older and has a comprimised immune system because of the cushings. Thank you all for your help and support. I will add more pictures to his album of him at his worst and ones from this week.

[Harley PoMMom]

I am so happy to hear that Tyrant has made huge improvements...YAAA!!!! And thank you for coming back and sharing this wonderful news with us! Can't wait to see his pics!

Lori

[joalgopa]

I've just seen your pictures and my dog Mia has a strange looking sore in one of her hind paws, she's starting on Vetoryl this weekend but I will ask the vet about demodex.
I gave her Nexgard before Cushing's diagnose and it worked really well on a ticks invasion that my dogs had earlier this year.