Hello, all. I have been lurking on this forum reading lots of stories and getting a lot of really useful information, but I wanted to get your perspective on our situation.
Our fur baby, Phoebe, was diagnosed with Cushing's almost three weeks ago. She is a 13 (just turned) year old female pit bull, and has had no significant health issues before.
Here’s a truncated timeline of the last three weeks:
2/9/18 - Blood test to diagnose (what turned out to be) Cushings symptoms, elevated ALP levels (I think.) Current weight 44lbs
2/12/18 - Ultrasound
2/16/18 - LDDS test confirms pituitary dependent Cushing's
2/22/18 - Begin 60mg Vetoryl once a day
3/9/18 - What we believe is calcinosis cutis appears and looks really bad, vet visit, she lost 4 lbs in about two weeks (symptoms were better but started coming back). Current weight 40lbs
3/12/18 - ACTH stem test
3/15/18 - ACTH stem test results:
Pre: 8.1 ug/dL
Post: 9.2 ug/dL
Here is the way more detailed account of the evolution of her illness to give you some context:
5/27/17 - Rapid weight gain (approx 8lbs over 6-7 months,) blood test to determine if hypothyroidism is the cause. (54ish lbs) Test results: included a ALP 446 u/l level.
Test was inconclusive for hypothyroidism, so we did an additional thyroid test which was close to higher levels, but not close enough to start medication. (I don’t remember the name and I don’t have access to the results at this time, but I probably could if it’s relevant.) Instructions were to lose weight, but the doctor warned me that we shouldn’t be surprised to have to address a thyroid issue the next time we had a checkup.
Thanksgiving 2017 - Small intestinal bacterial infection, diarrhea, treated with antibiotics, weight is normal at about 45ish lbs. I don’t think the illness is necessarily related, but it was the first confirmation that she was again at a normal weight.
2/9/18 (The last three weeks) - Over the past couple of months, we noticed muscle loss along the spine and dramatically increased thirst/urination (pu/pd), as well as intermittent trembling without obvious stimuli (no thunder, not cold.) She was going through about 2.5 gallons of water over two to three days and having accidents inside, which was highly unusual behavior for her. Had another blood test, the doctor said that her ALP levels were twice as high as the last blood test from May of last year. (Full disclosure, I’m pretty sure they were talking about ALP levels, but I’m not positive. I can get access to the blood test records if that’s more helpful.) Possible liver cancer or Cushings and ordered ultrasound for diagnosis.
Ultrasound the day after blood test results indicated that there are no problems with the liver, so Cushings is now the main suspect. Low Dose Dexamethasone Suppression Test (LDDS) conducted (8 hour test.) Doctor confirms that it is pituitary dependent Cushings and prescribed 60mg Vetoryl (Trilostane) once a day, and explained that we will need to do an ACTH stem test within 30 days if her symptoms improve, or sooner if we see any complications.
For the first week of treatment, we noticed improvement in symptoms: decreased thirst/urination, decreased trembling, and it even appeared that her back was filling in… or so I thought. During the second week, we noticed that her back had formed some thick layer of scaly skin that, when you ran your hand against the grain of her fur, sounded like shuffling a deck of cards. It seemed very sudden, but I can’t tell for sure because I wasn’t rubbing there all the time. I brought her in to the vet the next day (15 days after start of treatment, this past Friday the 9th) to examine her back, and report the resurgence of some of the symptoms: the excessive thirst/urination had decreased, but the trembling had come back and we discovered that she had lost four lbs in about two weeks. He gave us some medicated mousse to treat the back while he sent a sample to get tested, but theorized that it was calcinosis cutis. (I don’t have the name of the product but I can add it later when I get home.) We also scheduled her for an ACTH stem test for this past Monday. I have not spoken to the doctor yet but I have the results of her ACTH stem test (see above).
So I have a few questions... Can you help me understand these results? Is calcinosis cutis showing up suddenly after treatment begins a normal thing? Or is it possibly something else? Our doctor did mention that he can recommend two internists if we get to the point where we need more specialized care.. Should that be the next step? I feel like he’s done a really good job explaining each step, and he has been clear that he has no problem with us seeking a second opinion or asking questions.. I get the impression that he will be honest and let us know if he reaches the limit of his knowledge.
I recently read (in this forum) that it is better to give her the Vetoryl in the mornings because of the half life of the drug (as it wears off, the symptoms may appear while she is most active if given in the evenings.) We currently dose her in the evenings. What is the best way to transition to morning? Should I gradually back it up over several days, or can I just switch?
Also, should I look into some supplements? I currently just give her glucosamine/chondroitin twice a day, but I heard that some give milk thistle and I read some good reviews of Cushex. Of course, with any supplement, often the results are inconsistent, but I’m willing to try something if it won’t interact with her meds and it might help her.
I really appreciate any input and suggestions for questions I might bring up with the doctor. Sorry if this is a bit rambling.. The last few weeks have been hard on all of us, especially Phoebe. We just want her to feel better.
Thanks in advance,
Leah