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