Brit has crossed The Bridge - new to cushing

[jtarlecki]

Hi,
My 10 year old boxer has just diagnose with cushing. She had a skin rash that was infected. they put her in antibiotics.(has not taken any in the last 2 days). Now she will not eat or drink. she is scheduled to start he cushing meds next week. has anyone else experience this . any help would be appreciated.

jim

[spdd]

I am an old poster on this forum, and no expert, however there will be someone along soon to help you out. The first thing they are going to ask is how was your boxer diagnosed? What tests were performed? They will want to see copies of the tests. It is a good idea to provide them here, as my pup was diagnosed, and with the test results I posted here found out he did not have cushings... and the meds they prescribed sent him into an Addisonian crisis. Please wait for someone with loads of experience to get back to you before you start anything. In our experience we have found multiple times dogs are misdiagnosed believe it or not and that a lot of vets just are not very qualified when it comes to cushings. If you can get copies of the tests performed and post them here, that would be a great start.

[Squirt's Mom]

Hi and welcome to you and your Boxer baby!

Ok, we are gonna play 20 Questions! :D

What antibiotics was she given? Did they tell you what kind of skin infection she had? Did she see a derm vet or her GP vet for that diagnosis? Was a skin punch performed to diagnosis the infection?

Now for questions about her Cushing's diagnosis -

What tests were given to diagnose the Cushing's - LDDS, ACTH, abdominal ultrasound?
What signs did you see at home that concerned you - increased appetite, peeing a lot more, drinking a lot more, panting for no reason, hair loss or failure to regrow hair, pot belly?
How much does your baby girl weigh?
What drug did her vet prescribe to treat the Cushing's and at what dose?

The answers to these questions will help us help you much better so the more you can tell us the more meaningful feedback we can offer. If you do not have the test results call the vet and ask for copies of all the recent testing - the actual results not the invoice that simply says what was done. We want to see the actual numbers. ;)

If she is not eating DO NOT start any treatment for Cushing's. Both drugs used to treat Cushing's are fat soluble meaning the must be given with a meal to be absorbed and used by the body. In addition, loss of appetite is one of the signs that the cortisol has dropped too low which is a life threatening situation. It is a general "rule" to never ever give either Lysodren (Mitotane) or Vetoryl (Trilostane) to a dog who is not well. Food she can go without for a few days but water is crucial. If she is still not drinking anything by morning, get her into the vet asap. You might try making her some plain chicken or beef broth (no seasonings at all), let it cool, and see if she will take that.

Please keep us informed on how she is doing today.
Hugs,
Leslie

[labblab]

Hi Jim, and welcome to you and your girl. I noticed that you had started a second, duplicate thread. So I have removed that duplicate from view, and am posting this quick note so as to “bump up” your original thread to the top of the index page ;-).

We’re so glad you’ve joined us, and we look forward to learning more about your girl!

Marianne

[jtarlecki]

Here is what I have so far. not actual results(will get tomorrow).

1/9 vet visit they did the following test Skin Cytology w/tape test gave her cephalexin 500mg for 14 days.

performed pet wellness blood work

intestinal parasite check.

1/18 urine protein ctreat ratio

lo dose dex supp test. this is what they used to tell me she has cushing I am getting Trilostane 70 mg liquid form because it is tough to give her pills.

she was eating all the time the last several years after we got her fixed. never a big drinker, the reason I made the appointment was because her activity level was dropping. it is very low now. she was 90lb in may but her on weigh management food and she is now 75lb.

tried to post a picture of the rash, i could not do it

[Harley PoMMom]

Definitely get copies of those tests and post the results here, in that way we can get a better perspective of what is going on...thanks!

Even though the Trilostane dose of 70 mg is within the recommended starting guidelines for your girl's weight of 75 lb, there is one study that suggest that larger dogs may need lower doses of Trilostane per pound than smaller dogs to control clinical symptoms, and we have witnessed this on the forum too. Here's a link to that study: https://www.ncbi.nlm.nih.gov/pubmed/22708554

Regarding posting a picture of your sweet girl, here are instructions :)




How do I use albums?

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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.


Lori

[jtarlecki]

Hi and welcome to you and your Boxer baby!

Ok, we are gonna play 20 Questions! :D

What antibiotics was she given? Did they tell you what kind of skin infection she had? Did she see a derm vet or her GP vet for that diagnosis? Was a skin punch performed to diagnosis the infection?

Now for questions about her Cushing's diagnosis -

What tests were given to diagnose the Cushing's - LDDS, ACTH, abdominal ultrasound?
What signs did you see at home that concerned you - increased appetite, peeing a lot more, drinking a lot more, panting for no reason, hair loss or failure to regrow hair, pot belly?
How much does your baby girl weigh?
What drug did her vet prescribe to treat the Cushing's and at what dose?

The answers to these questions will help us help you much better so the more you can tell us the more meaningful feedback we can offer. If you do not have the test results call the vet and ask for copies of all the recent testing - the actual results not the invoice that simply says what was done. We want to see the actual numbers. ;)

If she is not eating DO NOT start any treatment for Cushing's. Both drugs used to treat Cushing's are fat soluble meaning the must be given with a meal to be absorbed and used by the body. In addition, loss of appetite is one of the signs that the cortisol has dropped too low which is a life threatening situation. It is a general "rule" to never ever give either Lysodren (Mitotane) or Vetoryl (Trilostane) to a dog who is not well. Food she can go without for a few days but water is crucial. If she is still not drinking anything by morning, get her into the vet asap. You might try making her some plain chicken or beef broth (no seasonings at all), let it cool, and see if she will take that.

Please keep us informed on how she is doing today.
Hugs,
Leslie


here is what I got

CORT baseline cortisol 8.9

CORT 4 hour post low dose dex 7.8

CORT 8 hour post low dose dex 8.2

[Harley PoMMom]

The picture you sent to our gmail, which I've included here, really looks like she has Calcinosis cutis (CC) and if so, it can be difficult to get under control, one main thing is that the cortisol needs to be under 5 ug/dl. I do recommend that you get a biopsy done on the area to confirm Calcinosis cutis.

[labblab]

Hello again from me. I do agree with Lori that the photo strongly appears to be calcinosis cutis. For some reason, it seems that boxers seem to be over-represented here in terms of exhibiting that particular Cushing’s symptom :-((((. And as Lori says, unfortunately it can be challenging to get under control unless cortisol levels remain at relatively low levels through the use of medication.

As far as the current lack of appetite, it’s possible that the antibiotics were upsetting her stomach. Hopefully that problem will reverse once the antibiotics have ended.

One thing I do want to note are your LDDS results:


CORT baseline cortisol 8.9

CORT 4 hour post low dose dex 7.8

CORT 8 hour post low dose dex 8.2

Has your vet explained that this pattern can occur in conjunction with either a pituitary or an adrenal tumor? If an adrenal tumor is the cause, surgery can offer a complete cure. However, this type of surgery is very expensive and also risky, so it may not be an option that you would even consider. However, I just wanted to let you know that these LDDS results do suggest that an adrenal tumor is a possibility. An abdominal ultrasound would likely provide you with more complete information in this regard.

Marianne

[jtarlecki]

thanks for the info. Considering her age We are not going to do surgery. Vet called me to day and we are going to try prilosec 20mg. If thinks do not improve tomorrow we will take here to have an IV started to get her strength back before starting the cushing meds. she has been off antibiotics for 4 days now. the Calcinosis cutis just started 2 weeks ago. Thanks for everyones help.

[lulusmom]

Hi and a belated welcome to the forum. I'll try not to repeat what others have already shared so I will keep my comments focused on things that have not been covered in detail. Boxers are definitely a breed that seems to be genetically cursed and are predisposed to calcinosis cutis (cc) which is a rare and very trying symptom of cushing's. A skin cytology with tape may pick up a secondary bacterial infection which is common with cc, but I'm not sure cc can be identified without sending a piece of one of the lumps out for examination. Cushingoid dogs with cc need to be on twice daily dosing of Vetoryl or compounded trilostane. I see that you will have liquid trilostane so this good because you will be able to split the dose prescribed in half and give with a meal in the am and pm. As Lori has already mentioned, it is known that many large dogs require much smaller doses of trilostane to achieve effective control of cortisol and has provided a link to the 2014 study done by UC Davis. The results of that study have also been validated by many veterinary teaching institutions across the globe who have set their own starting dose protocol ranging from .1 to .5 mg per pound of body weight. With your dog weighing 75 lbs, most specialists would likely start her on no greater than 15 mg twice a day. We have seen so many big dogs overdosed so we go to great lengths to share as much information as we can with members. In addition to the link Lori provided, I am providing additional links to handouts for lectures/presentations given by prominent endocrine experts that touches on this subject. If your vet has taken any continuing education on the canine endocrine system, he/she will most likely have heard of Dr. Edward C. Feldman, Professor Emeritus UC Davis and Dr. Claudia Reusch, Professor and Director of Clinic for Small Animal Medicine at University of Zurich. Please either share these links or print out the documents for your vet so he/she is aware of this most important development.

https://drive.google.com/file/d/0B5RToo4GC5HPWXQtVUZrNmlXZHM/view
https://www.vin.com/apputil/content/defaultadv1.aspx?pId=12886&catId=57088&id=7054636&ind=21&objTypeID=17&print=1&fbclid=IwAR0JrL_W15ZPqvkzQ8rvFVD0ngZL_XLcVdpBrs6BK 3jOEUE5AlZP-w5HfCg

If you have a facebook account, I recommend that you consider joining the Dogs with Calcinos Cutis support group. Please use link below. Members there share their experience with what has worked and what hasn't worked for their dogs. Unfortunately there is no single oral or topical medication that works for all dogs. There are lots of pictures posted by members of that group as well. You will definitely see a lot of short snouted breeds like Boxers, French Bulldogs, Boston Terriers and English Bulldogs. The administrator of that group created it as a moral support network, not a place to learn about cushing's so you definitely want to stay here as you'll find no better educators or resource library elsewhere.


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

[jtarlecki]

we brought brit home tonight they tells us her kidneys are failing. It looks like we will have to make the tough decision within the next week. They did IV flush and meds and she still will not eat or drink. the antibiotics she was on was cephalexin 500 mg 2 tablets twice a day. just seems funny she was ok eating and drinking prior to her taken these, now we are talking about making that tough decision. thanks for all the feedback on the cushing, I have learned allot

[Harley PoMMom]

Oh Jim, I am so sorry to hear this news about Brit. I did see that the SDMA kidney test results were slightly above normal 15 ug/dl (0-14) but her creatinine was within the normal ranges, have these levels elevated?

I've uploaded her blood panel results, hope that was ok.

Hugs, Lori

[Squirt's Mom]

This never the news we want to hear and I am so sorry. Please know we are here anytime you need to talk, vent, cry, whatever. We DO understand and are here to help any way we can.

Hugs and ear scritches,
Leslie

[lulusmom]

Jim, like Lori, I am wondering if subsequent blood and urine tests were done after the ones posted. I've had dogs with end stage kidney disease and have a recently diagnosed cushingoid dog whose labs looked much worse than Brit's and he is doing well after an internal medicine specialist got him diagnosed and on appropriate medication for hypertriglyceridemia, hypothyroidism, severe hypertension and blood thinners for chronic increased platelets. Brit's results just don't look like you should be having to contemplate euthanasia. If it were my dog, I would ask for an immediate referral to an internal medicine specialist as I believe Brit's complications are well above the knowledge and experience of a general practice vet. I would hate to see you euthanize your precious Brit without a second opinion from a board certified veterinary internal medicine specialist. If this is something you can afford, I would do this immediately on an emergency basis.

No matter what you decide, we're all here for you.

Hugs,
Glynda

[jtarlecki]

thank Lori, just to let you know Brit past tonight at 9:30 pm at home (naturally). I do not know what the second set of blood test were but the vet said everything was very high. they went up in two weeks not sure why. But this is the second dog I lost to kidney problems in 7 months, but our other one was 17 years old. One thing i notice with both of them about 2 months before passing they stop barking not sure why. Sad night. thanks for all the help. Just an FYI we do have two pups from each of her litters, but one is Diabetes insipidus. not sure if you every heard of that. he is 6, takes desmopressin twice a day and is doing great. Thanks again, going to try and get some sleep

[Joan2517]

I'm so sorry for your loss of Brit. Losing them is so hard.

[Squirt's Mom]

Dear Jim,

I am just so sorry to hear about the loss of your sweet girl, Brit. I know only too well what you are feeling today and wish I could take that angst from you. All of our babies bring such joy to our lives and when they leave the pain we feel is just as immense as that joy. But one day you will find yourself smiling when you think of her, of some silly thing she did, of a certain look on her face. And that pain you hold today will fade a little bit. I don't think we ever stop hurting or missing them but it does get better and the memories we cherish will bring back some of that joy we once felt. Please know we are here any time you wish to talk. We understand very well. Also please feel free to start a memorial thread to your precious girl in the In Loving Memory section if you wish. We would be honored to help you celebrate her life.

My deepest sympathies,
Leslie

“Some of you, particularly those who think they have recently lost a dog to “death”, don’t really understand this. I’ve had no desire to explain, but won’t be around forever and must.

Dogs never die. They don’t know how to. They get tired, and very old, and their bones hurt. Of course they don’t die. If they did they would not want to always go for a walk, even long after their old bones say:” No, no, not a good idea. Let’s not go for a walk.” Nope, dogs always want to go for a walk. They might get one step before their aging tendons collapse them into a heap on the floor, but that’s what dogs are. They walk.
It’s not that they dislike your company. On the contrary, a walk with you is all there is. Their boss, and the cacaphonic symphony of odor that the world is. Cat poop, another dog’s mark, a rotting chicken bone (exultation), and you. That’s what makes their world perfect, and in a perfect world death has no place.

However, dogs get very very sleepy. That’s the thing, you see. They don’t teach you that at the fancy university where they explain about quarks, gluons, and Keynesian economics. They know so much they forget that dogs never die. It’s a shame, really. Dogs have so much to offer and people just talk a lot.

When you think your dog has died, it has just fallen asleep in your heart. And by the way, it is wagging it’s tail madly, you see, and that’s why your chest hurts so much and you cry all the time. Who would not cry with a happy dog wagging its tail in their chest. Ouch! Wap wap wap wap wap, that hurts. But they only wag when they wake up. That’s when they say: “Thanks Boss! Thanks for a warm place to sleep and always next to your heart, the best place.”

When they first fall asleep, they wake up all the time, and that’s why, of course, you cry all the time. Wap, wap, wap. After a while they sleep more. (remember, a dog while is not a human while. You take your dog for walk, it’s a day full of adventure in an hour. Then you come home and it’s a week, well one of your days, but a week, really, before the dog gets another walk. No WONDER they love walks.)

Anyway, like I was saying, they fall asleep in your heart, and when they wake up, they wag their tail. After a few dog years, they sleep for longer naps, and you would too. They were a GOOD DOG all their life, and you both know it. It gets tiring being a good dog all the time, particularly when you get old and your bones hurt and you fall on your face and don’t want to go outside to pee when it is raining but do anyway, because you are a good dog. So understand, after they have been sleeping in your heart, they will sleep longer and longer.

But don’t get fooled. They are not “dead.” There’s no such thing, really. They are sleeping in your heart, and they will wake up, usually when you’re not expecting it. It’s just who they are.

I feel sorry for people who don’t have dogs sleeping in their heart. You’ve missed so much. Excuse me, I have to go cry now.”
by Ernest Montague

[NMalfam]

I'm very sorry For your loss Jim.


Nancy