New here - suspect Cushing's in 4.5 yr old beagle mix

[JoniMom]

Good morning,

We have a rescue dog, Joni, who is 4.5 yrs old, 47lb (she should be 42lb). She was diagnosed with hypothyroidism about 1.5 years ago and is currently on .3mg levothyroxine twice daily. Initially, she responded well, and many of her clinical symptoms improved for a month or so. Then they started to return. They adjusted her dose from .2 mg to the current .3mg. But little was accomplished. She remains lethargic, irritable, sheds like crazy, licks obsessively and recently - which is what caused us greater concern - has started panting and drinking more than usual. She pants at night after being at rest for some time, and at other intermitten intervals inside our AC house. She is also newly exercise intolerant. She has gained wait and has a strong appetite. To us, her belly looks like it's becoming a pot-belly. She's definitely putting on weight - last weigh in was 47, and she's been 42-43lb consist for the past many years. She's always been incredibly fit, so we notice this right away, but others not so much as she just looks 'normal' to some, but we know she's getting heavy. She's normally an incredibly athletic dog, and now she pants like she ran a marathon if we take her just around two blocks. Usually she is happy to hike and run for hours on end. She also is shaking her head intermittenly - her ears appear clear and no infection. And her licking and shedding have become worse.

The Vet ordered a Cortisol to creatinine urine ratio test that we just an hour ago got the results from:

10.6 ug/dL cortisol
195.4 mg/dL creatinine
17 ratio

We are awaiting official response from our vet, but I take it this rules out Cushing? I can't really find the reference ranges in these values online....

We just know our pup is not happy and not herself. If it's not cushing's, does anyone have other ideas as to what this might be? Any thoughts would be welcome and thank you in advance.

Shelton

[labblab]

Welcome to you and Joni — we’re really glad you’ve found us! Boy, I have to admit that her symptoms are so classic for Cushing’s that it’ll be very surprising if those UC:CR results are indeed within normal range because, if so, that does make Cushing’s quite unlikely. One question, though: was the urine test based on only one sample, and was the sample obtained at home or at the office? (I guess that’s actually two questions ;-) We’ve been told that pooling samples obtained on three successive mornings at home can result in a more accurate picture, since cortisol production can be variable and you also want to eliminate the effect of stress. As far as stress, that could artificially elevate the reading, and that doesn’t seem to be Joni’s issue. But still, I’m curious to know how the sample was obtained.

Also, have there been any other abnormal results on Joni’s lab profiles other than her thyroid? Cushpups commonly exhibit elevations in liver markers and cholesterol, and also sometimes have abnormalities in certain blood cell counts (platelets and white cells). Also urine is typically quite dilute with low specific gravity. Urinary tract infections are also common. If Joni’s blood and urine panels have all been normal, that also makes Cushing’s unlikely. But if she’s had other results that are consistent with Cushing’s, that makes me scratch my head even further and makes me wonder whether you might still want to advance to a more specific diagnostic Cushing’s blood test even in the face of these urine results.

I’ll go ahead and close for now as opposed to peppering you with more questions! But once again, we’re very glad you’ve found us and we hope we’ll be able to help chart the best path forward.

Marianne

[JoniMom]

Hi Marianne,

Wow thank you for the fast reply - I have to say I feel some relief just having someone else thinking on her scenario in such a thoughtful way! I really appreciate it. We went through a string of not so great vets for a number of years chasing the thyroid issue, and finally found one we liked, only for her to leave the practice. Now we’re basically with a new vet every time we go in.... I think they are generally well intended, but I just fatigue of not feeling like we have a partner to really help us figure it all out.

So Joni has always had some irregularities with her lab work. Her most recent physical and full blood panel was done in January of this year, so know that it’s now 7 months ago from whatever is happening today. But here are the ways she was irregular back then - I don’t really know what any of it means, and wasn’t really given an explanation from our vet - my emails weren’t responded to at the time (different vet then who we corresponded with this past week for the urine test, though they are all a part of the same vet practice here in Philly).

Hemoglobin - slightly high outside reference range; 21.0
MCH - slightly high; 26.1
Reticulocytes - high; 129
Glucose - low; 59
Albumin - high; 4.3
Creative Kinase - high; 245

And since you mentioned cholesterol specifically, it was normal but towards the upper limit within the given reference range at 321. All other values were within the reference ranges, but some other values were right at the very top or very bottom of the ranges. Let me know if you want to know those values.

Also, her T4 even on supplementation always remains low - it was at 1.3ug/dL still. I never have understood why we can’t get that to go up more when she’s on .3mg twice daily.... feels like it should be a bit higher. When she was diagnosed, she was at .8, so I guess it is all relative... but feels odd.

Thank you again and please let me know if you have any other questions - I’m grateful to have someone who is thoughtfully interested!

Best wishes,

Shelton

[labblab]

Thanks so much for all this additional information! Joni’s situation definitely remains perplexing :-(((. I’m not sure what to make, if anything, of the particular abnormalities that you’ve noted. They are not lab values that we commonly see associated with Cushing’s. The liver markers that I was talking about previously are the ALKP (or sometimes noted as ALP) and ALT. Elevated levels of ALKP (sometimes exceedingly high) are very typical of Cushing’s, as are moderate elevations in ALT. If those values were both normal for Joni, then her clinical picture is definitely odd: observable symptoms that are very common with Cushing’s, but lab values that are not really consistent at all.

I wish I was more knowledgeable about thyroid abnormalities, but I know only enough to be dangerous, as they say. Low thyroid can be a primary problem in a dog, but it also can be secondary to other conditions, of which Cushing’s is one. My own Cushpup was initially diagnosed with hypothyroidism based on low T4 readings, but when his symptoms did not resolve with supplementation, we proceeded with further diagnostics and found that he indeed suffered from Cushing’s, as well. I’ve since learned that it’s probably best to perform a more complete thyroid panel prior to beginning thyroid supplementation, as opposed to simply relying on basic T4 levels. More complete thyroid analysis can help guide supplementation decisions— sometimes supplementation is necessary and sometimes it’s not, especially if the low readings are due to another condition. Unfortunately, the difficult part is that if owners want to retrace their steps and have a complete thyroid workup done, the dog has to be removed from supplementation for several weeks in order for new diagnostic testing to be accurate. As an example as to how complex thyroid testing can be, here’s a link to an informational page about thyroid testing found on the website for Michigan State’s Veterinary Endocrinology service:

https://cvm.msu.edu/vdl/laboratory-sections/endocrinology/thyroid-function-in-dogs

I know I’ve probably gone overboard here with my thyroid discussion, but it just caught my attention since Joni has not been responding to her supplementation in the way you would have hoped or might have expected. In honesty, Joni’s situation is puzzling enough to me that unless your local vet comes up with some reasonable diagnostic suggestions, I’d encourage you to request a referral for a consultation with an internal medicine specialist. I’m sure there are many private specialty practices in the Philly area, but if I’m not mistaken, you’ve got one of the premiere veterinary schools of the nation located there : UPenn. I’m confident they’ve likely got an outpatient clinic there that accepts patients for diagnostic consultation. Either way — UPenn or a private specialty practice — you may find that your money would be well spent to get the opinion of an endocrinological expert. Clearly, something has changed significantly for Joni, and it may take some searching to figure out exactly what’s gone wrong. But specialized professionals may be able to help you find the answers more quickly.

I’m so sorry that I don’t have more immediate answers for you, but please do feel free to continue asking more questions and discussing more options, OK?

Marianne

[JoniMom]

Thank you Marianne! I very much appreciate your thoughts and the links. We're going to follow-up with the vet again tomorrow - it seems since it has been 7 months since we ran a complete blood work on her, maybe it's time to recheck. And maybe that will give us some new insight of something has shifted / changed more recently. Just because you inquired, the ALKP markers were within normal range back in January. And though I'm also no expert on the thyroid issues, I will share when she was diagnosed we did have a full panel with free T4 and T3 and the thyroid stimulating hormone as well - but I agree, it is still puzzling to us that she hasn't responded quite the way we thought she would on supplementation.

Once we have some new markers to go on I will write back in, but thank you again for your support! It means a lot just to have someone else consider all this.

Best wishes,

Shelton and Joni

[labblab]

Dear Shelton, just a quick note to let you know that I’ve moved your thread here, to our main Questions and Discussion subforum. When I replied to you earlier, I hadn’t noticed that your thread was located on one of our subforums that receives less “traffic.” Hopefully more folks will see our conversation here, and join in alongside us ;-).

Marianne

[Harley PoMMom]

Hi Shelton,

A belated welcome to you and Joni!! I just wanted to mention that I took my boy, Harley, to UPenn (Ryan Veterinary Hospital of the University of Pennsylvania) and thought it was well worth the 2 hour drive, now, this was almost 10 years ago. If you have any questions for me please do not hesitate to ask.

Lori

[JoniMom]

Hello Marianne and Lori,

I just wanted to give an update since we've had some news. Joni's concerns have remained much the same since I wrote in, and we got a little vet fatigue and she wasn't getting worse so we just acquiesced for a time. But in February we took Joni for her standard physical, and her ALP came back high - in the 300s. The vet recommended rechecking this month. We just rechecked, and it's high again - this time higher - just shy of 400. Her ALT has gone up too, though still in the normal range she's jumped from usually being in the 40s to 94. She also has developed a new balding spot on the very tip of her tail, which is disconcerting to us, together with the other symptoms I shared before (drinking more, eating more, maybe peeing a bit more, darkening of her skin on her belly, and shedding). So, after some discussion, and though the levels aren't exceedingly high like other cush pups (I've read they can be over 1000??), the vet agreed that it's reasonable to do the LDDS testing.

So my questions are - do you ever see cush diagnosed with ALKP levels in the 300-400 range?
Any advice on what to consider relative to the LDDS testing / how to interpret results?

We are scheduling her after our next pay day, so she won't go back until March 26.

Finally, I am just curious - do you ever see behavioral impacts with cush? Joni has some anxiety based behaviors, and I'm just wondering if she does have cush, could it be making her more irritable?

Thank you in advance and hope you are well!

Shelton

[labblab]

Hello again, Shelton, and welcome back to you and Joni! Under the circumstances that you've described, I do believe it makes sense to go ahead with the LDDS testing. One of the earlier perplexing pieces of Joni's profile was that she was exhibiting observable symptoms that are consistent with Cushing's, but her lab results did not follow suit. Now that you are seeing increases in her ALP and ALT, I do think that further diagnostic testing merits a second look. As far as abnormal liver levels exhibited by Cushpups, the range we see is broad. Even though Joni's levels are not exceedingly high right now, I do think it's significant that they are elevating. This pattern is something that we commonly seen in Cushpups prior to treatment. So depending upon the stage and duration of untreated Cushing's, the elevations can vary from relatively mild or moderate, to extremely high.

As far as proper interpretation of LDDS results, here is a link that goes into quite a bit of detail and has been very helpful to me in terms of making sense of the results:

https://www.dvm360.com/view/clinquiz-interpreting-low-dose-dexamethasone-suppression-test-results

Last but not least, I'm guessing the most common behavioral changes that people report with Cushing's are probably increasing lethargy and exercise intolerance. Whether or not Cushing's might be responsible for making Joni more irritable, I don't know. But if a dog is generally feeling poorly in terms of ravenous appetite and excessive thirst/urination, etc., it wouldn't surprise me to think that this could result in a dog being more irritable, as well. I know those things would make *me* feel crabby!

So all in all, I think it is reasonable to move forward with the testing. Definitely check back with us when the results are in, OK?

Marianne

[JoniMom]

Hi Marianne,

Thank you for all of your help! I wanted to report that Joni went in for her test on Friday, and the vet has contacted us to share she has Pituitary Dependent Cushings. They are going to start her on a trilostane (sp?). They said her levels were consistent with cushings, but low, and that we had caught it early. Her test results were:

Cortisol - baseline 8.6 ug/dL
Cortisol - 4 hr post dex .3 ug/dL
Cortisol - 8 hr pst dex 2.9 ug/dL

I am curious to know - and I think I've seen other threads about this and can have a look, but recognizing that she will now be on another maintenance medication (she is already on the levothyroxine for hypothyroid) I am really eager to know of any resources for costs. The vet said the trilosane for 1 month would be $82! Joni is worth every penny but any resources that you know of I would be so grateful for! Thanks
Joni mom

[JoniMom]

I'm sorry, I also meant to ask - what are your thoughts about prognosis? We've seen very scary stuff online about 2 year life expectancy... is that true? Will this shorten her life? She is only 5.5 yrs.... just wondering long term impacts?

[Harley PoMMom]

Please forget that 2 year life expectancy, Cushing's is a treatable disease and with treatment dogs with Cushing's can have a good quality of life and there is every reason to believe that they can live out their normal life span. However, for the treatment to work safely and successfully it requires an educated pet owner along with an experienced vet as adverse side effects are mostly only seen when the proper protocols are not followed.

One remark I do want to address, cortisol levels can only be checked with an ACTH stimulation test, so if the vet is stating that her level is low judging solely from those LDDS test results, that's a mistake.

How much does Joni weigh? And what dose of Trilostane is being prescribed?

I'm providing a link to a thread with cost saving ideas: https://www.k9cushings.com/forum/showthread.php?9066-Cost-Savings-for-Owners-of-Cushingoid-Dogs

Hugs, Lori

[Squirt's Mom]

Hi Shelton,

Welcome to you and Joni!

I wanted to talk to you about that 2-year myth....yes, myth. That is exactly what that claim is. Maybe, MAYBE, many years ago that was seen as fact but today it certainly is not and because of changes in the Cushing’s world that 2-year survival claim qualifies as a myth.

Years ago most dogs were not seen as family nor kept inside. They were working animals and seen more as livestock. As a result when a dog got sick it was the norm to let them go on as long as they could then simply put them down when they could no longer do their job. Very rarely were they treated for any diseases. But today that is not the case. Our babies are part of our family and most of them live inside with us. So when we see them changing we take them to the vet just as we would take a human child to the doctor. And, just like with our human children, when we are told our furbabies have a disease, we treat that disease if at all possible.

Even tho most cush pups are diagnosed when older with most of their lifespan behind them more often than not they still outlive that 2-year claim. This is due to several reasons. For one thing, that fact that most of our babies live with us, sharing our spaces which allows us to notice quickly when they aren’t their usual selves. Even those working dogs who do live outside are held in higher esteem today than they used to be and we are more apt to treat them than our ancestors were. In addition, there have been advances in the diagnosing and treatment of Cushing’s. For another we, as parents, demand more from their vets and ourselves. We demand their vets keep up with the advancements in Cushing’s and we demand of ourselves that we learn all we can to help our babies live their best life possible with the disease. For these reasons that 2-year myth has been busted to smithereens. Barring one of the rare complications with Cushing’s, most cush pups live out their normal lifespan and beyond simply because of the attention and care they receive from their loving and attentive parents who want to the best thing for their furbabies.

Unfortunately, there are some factors that can make that myth a fact. The two most dangerous things for a dog with Cushing’s are 1) a vet who doesn’t understand the disease nor the treatments used to manage it, who don’t keep up with advances, who won’t listen when confronted with their mistakes or advances they may have missed, and who refuse to follow specific protocols for the drugs they prescribe; and 2) parents who won’t take the time to learn about the disease, the drugs used to treat it and the signs associated with low cortisol, who blindly follow anything the vet says even when what they are saying and doing is not correct, and who will not listen when they are presented with sound, scientific proof that their baby is not being properly cared for by their vet. In these cases, that 2-year lifespan might be sadly generous.

You are here, asking questions, trying to learn how to best help your sweet girl so that puts you in the category of those parents who do go that extra mile. Just try to put what you are reading on the web away and don't think on it any more. ;)

Hugs,
Leslie

[JoniMom]

Thank you Leslie and Lori for the resources and also candor about prognosis! It definitely makes us feel better! I am wondering - the complications you mention, and I've read that sometimes the tumors can be more aggressive - how do you know if this is the case or not with your dog? I asked our vet about Joni's outlook. She said it was largely dependent on her response to the medication overtime, and repeat testing. Regarding her weight - she is overweight just now, and is just over 50lb. At her healthy weight she is closer to 43lb. The vet said the typical starting dose was 1 (mg? I forget the unit) per lb, and that Joni would be started using that. Rechecked in 10 days, then on day 30, then at 3 months, then at 6 months. She said the 10 day or 30 day checks demonstrated an adjustment to the dose was needed, then the process would repeat (10 day after adjustment, day 30, 3 month etc). Regarding the ACTH - I am unsure if they performed that test or not. I will ask. I did ask for the results of the LDDS intending to share here, but I didn't ask / didn't know to ask about ACTH. We go this afternoon to pick up the trilostane and start her (I guess today or tomorrow? Unsure if it's given morning or night, with / without food?).

Is there any reason to be concerned that given Joni's younger age she might have a more aggressive / complicated form? Does concurrent hypothyroidism (which was also early onset - diagnosed at approx 2 years of age) raise any flags?

Thank you for the resources regarding the meds. My thought at the moment is to use the vet's own pharmacy until we get her dose right / stable, and then maybe look to source it on a longer term maintenance basis through a cheaper supplier, assuming that makes sense.

Thanks again!

[Harley PoMMom]

The pituitary form of Cushing's is from a tumor on the pituitary gland, usually benign, however a small percentage, around 15%, do grow to be a macroadenoma. The only way to visualize the pituitary tumor is with a computed tomography (CT) or magnetic resonance imaging (MRI).

I do want you to be aware that studies have found that dogs weighing over 40 pounds are sensitive to Trilostane and therefore need smaller doses than the 1 mg per pound that is recommended. If this were me, I would not start Joni on a dose higher than 20 mg. Also, it is vital that the medication be given with a meal so that it is properly absorbed, generally it is administered in the morning with a meal.

The monitoring tests for Cushing's are the ACTH stimulation and this test is conducted 4-6 hours after the dose of Trilostane is given with a meal. For the first 30 days of treatment no upward adjustments to the Trilostane dose should be carried out because cortisol can continue to drift downward during the first 30 days of treatment.

If you have any more questions, please do not hesitate to ask them!

Hugs, Lori

[JoniMom]

That is interesting about the dose - thank you! I am sometimes bad at learning things verbally, so when the vet relayed on the phone, I might have gotten it wrong. I can't recall the number she said Joni would start at - so I will look at this when we pick it up at the vet's office, and if it's 1mg to pound (ie - 50 mg), I'll ask if maybe we should start a bit more conservatively.

Regarding the macroadenoma - how would we know without doing CT / MRI? And when would that be warranted / suggested? Will her symptoms just get worse even with the medication? Also, is it concerning that her ALP was on an upward trajectory? Like getting worse by 100 points within less than a month?

[Squirt's Mom]

As Lori said, studies have shown that dogs weighing over 40lbs should start on no more than 0.05mg per pound per day with a max dose of 30mg a day. I will give you some links on this so you can share with her vet. I also want to caution you about the dose increases....that should not happen until the 30 day test. This is because the cortisol usually continues to drop for the first 30 days on the same dose. By increasing at that 2 week mark the dog is put at higher risk of an overdose. So don't let the vet talk you into increasing her dose until that 30 day test. Then if the cortisol is still high and her signs are not improving a small increase of no more than 25% is warranted.

As far as I know, age has no bearing on prognosis so I wouldn't worry about that. I would keep a close eye on all the signs for the thyroid once treatment starts just to be sure that med dose doesn't need to be lowered. The endocrine system is tricky and seems to interconnected so if one thing goes whacky others will and as one thing is brought back to a more normal range other conditions need to be reassessed. So just watch. And there is a condition called Sick Euthyroid Symdrome in dogs that is connected to Cushing's and once the cortisol is under control that disappears. But that is something I would want to talk to her vet about to see if that is a possibility since she was diagnosed with thyroid issues earlier.

As for complications, the macros Lori mentioned are probably the most heartbreaking. Two other conditions come to mind that can occur and those are a skin condition called Calcinosis cutis and a muscle disease called Pseudomyotonia. But as we said, these are rare. Most cush pups have nothing more than the usual signs associated with elevated cortisol and live life pretty darn normally. So don't worry about these extreme possibilities. Just focus on getting Joni settled in on the right dose and loving every day with her.

Here are the links on large dogs and smaller doses:

https://pubmed.ncbi.nlm.nih.gov/22708554/

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1939-1676.2012.00956.x

And one written by one of the Admins here:
https://drive.google.com/file/d/155aj2gOey6_fypWyihlhenygpCjmRdUz/view


A link on Pseudomyotonia:

https://endocrinevet.blogspot.com/2011/02/q-pseudomyotonia-in-dogs-with-cushings.html


And a link on CC:

https://drive.google.com/file/d/0B5RToo4GC5HPQ2ZMNEttcnlaX1k/view

Hope that helps!
Hugs,
Leslie

[BonnieandDre]

JoniMom, how is your pup doing?
I have a young dog with Cushings so have a lot of the same questions you asked in this chain!

[JoniMom]

Hello fellow cushpup owners,

I’m sorry I’ve not posted for some time - this forum was incredibly helpful to us when Joni first received her diagnosis. And for the past several years - 3 to be precise, we feel her symptoms have been well controlled on trilostane, and in many ways got our dog back. We also moved, left a city environment that was incredibly stressful for Joni, and ended up in a bucolic and beautiful rural environment where Joni has been able to (safely) enjoy off leash walks through trails in fields. Truly dog heaven! But unfortunately, just in the past two weeks as if out of no where Joni’s skin has erupted. She has incredibly itchy arms and legs, and is back to obsessive licking and scratching. She also seems to tire faster and pant more, though she is now 9 and it’s hard to tell what’s age related and what might be cushing’s. I honestly first suspected an allergy - and maybe it is, but we’ve had no food changes and no environmental changes for 3+ years now (when we moved). We keep her on a consistent diet with the same high quality kibble and a homemade food topper we’ve made with the same rotation of ingredients for 6 years. So my question is - have any other families experienced the skin and lethargy issues very suddenly after controlling well for years on trilostane? What does later stage cushing’s look like? Does this sound like cushing’s related issues to you? Or maybe allergy or her hypothyroidism? Were working to get her in to see her vet, but I’d appreciate any insights you all may have.

Love to other cush pup families.






Hi Marianne,

Thank you for all of your help! I wanted to report that Joni went in for her test on Friday, and the vet has contacted us to share she has Pituitary Dependent Cushings. They are going to start her on a trilostane (sp?). They said her levels were consistent with cushings, but low, and that we had caught it early. Her test results were:

Cortisol - baseline 8.6 ug/dL
Cortisol - 4 hr post dex .3 ug/dL
Cortisol - 8 hr pst dex 2.9 ug/dL

I am curious to know - and I think I've seen other threads about this and can have a look, but recognizing that she will now be on another maintenance medication (she is already on the levothyroxine for hypothyroid) I am really eager to know of any resources for costs. The vet said the trilosane for 1 month would be $82! Joni is worth every penny but any resources that you know of I would be so grateful for! Thanks
Joni mom

[Harley PoMMom]

Sounds like an allergy to me, sometimes the pet food manufacturers will change the ingredients in their food and not alert customers, so I believe that is what I would check first. When was her last cortisol test done? And if recent, what were those results?

Hugs, Lori

[JoniMom]

Hi Lori,

Thanks so much for the reply. Her last cortisol was this past winter, and the vet reported all was in normal range - I didn't ask, and they don't automatically give the test results like my old vet used to - I can request them, but I've fallen out of habit as things with Joni just seemed well controlled and on the path so to say. Relative to the allergy, she eats Taste of the Wild Pacific Stream formula (https://www.tasteofthewildpetfood.com/taste-of-the-wild/grain-free/dog-formulas/pacific-stream-canine-recipe-with-smoke-flavored-salmon/) with a food topper we make at home with ground turkey, coconut oil, and vegetables including carrots and peas, and sometimes spinach, and butternut squash. Occasionally, like when staying at daycare, we'll pack her The Honest Kitchen's slow cooked stews - the chicken one or turkey one. But again, she only gets these on occasion - not everyday. Finally, she does get a treat every day after taking her medications - she gets either a greenie dental chew, or a dentastix chew. We usually do greenie's but sometimes have dentastix as a back up. I'm just writing all of this out to see if anything sends alarm bells off as a likely suspect? If we were to try changing something up, what you might suggest we change first to see if it makes a difference? It is just so odd to us as it came on so suddenly and she's been on a consistent diet now for a long while. But I did read last night that allergies can appear at anytime, and can be formed around an ingredient that was once / previously tolerated. Even created because of regular feeding of a certain ingredient ... oy. I just wish we could make her more comfortable too - her arms and legs are just increasingly red and inflamed and angry. I worry she will create a problem on top of a problem. Vet can't see us till Saturday. Thanks for any insights. Shelley

[labblab]

Hello, Shelley, and welcome back to you and Joni although I’m surely sorry you’re having problems. I’m glad you’ll be having your vet visit today, and hopefully Joni can quickly get some relief from whatever it is that’s causing the itching. Everything you’re feeding her sounds great, so I wouldn’t know any specific item to question at this time. But your vet may suggest that you stop everything for the moment, and switch solely to a hypoallergenic food for the time being in order to see if food may indeed be the culprit. We’ll just have to see.

Since her itching is mostly on her legs, one crazy thought I had was to wonder whether she’s getting into any grass or weeds outdoors on her off-leash walks that might be prompting a reaction, especially if the ground cover has been treated with any chemicals or pesticides. As I say, just a thought.

And regardless of the cause of her itching, I’m really glad she’s having her cortisol level checked. It’s not uncommon for dogs to require dosing changes while taking trilostane, and a fluctuation in her cortisol may be contributing in some way. At any rate, it’ll be good to have that checked, no matter what.

Please do let us know what you find out today, and please also give Joni a big hug for us, as well!

Marianne

[Squirt's Mom]

Hi Shelley,

I'm wondering how Joni's itching is doing? I have a boy, Bud, who has allergies to any poultry - chicken, turkey, duck - as well as beef and lamb. When he eats any of those his skin starts breaking down and he licks and scratches constantly. I have been working for about 2 years to figure out what he does react to and those are all so far. He is eating a salmon, grain-free food - no poultry at all. And that is not easy to find because they use chicken fats in most kibbles even when they are other protein based. So if you haven't found what is causing her itching, I would start by eliminating all poultry from the diet. Find a novel protein, meaning one she had never had before, and start feeding that to see if it helps. We also use a spray called Betagen with an anti-fungal mixed in who's name I cannot recall at the moment but her vet should be able to help with an antifungal. I spray that on the inflamed areas as needed. It really does help Bud.

Bud's sores are not limited to his legs tho so Marianne may have hit the nail on the head with something he is coming into contact with outside. But just in case I wanted to share our experiences with you and Joni.

Hope to hear from you soon!
Hugs,
Leslie