a hopeless french bulldog owner - Elizabeth has passed

[lulusmom]

Lola, if you have a facebook account, I recommend that you join a relatively new group called Calcinosis Cutis in Dogs. You will see many pictures of dogs as well as read about treatments other members are using that might be helpful. You will definitely see pictures of French Bull Dogs. I have provided a link to that group below:

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

[lolakocsy]

Dear Marianne and Glynda, thank you for your kind replies! (:

1. She could have recieved steroid medication before we adopter her ( October 2016 ) but since then she has not got any steroids.
2. The test which was taken on January 6 was the diagnostic test. Elizabeth’s started getting 60mg Vetoryl on January 12.
3. Yes, the vet used abdominal ultrasound to examine her kidneys and liver and they were healthy.
4. In February the vet examined resting cortisol level.
5. Elizabeth gets Vetoryl at 5 pm with meal and she is not in a good shape after it, she slows down and sleeps sitting up. I asked the vet about it and she told us these were the symptoms of Cushing’s disease. The February test was taken 15 hours after she got her pill with her dinner.

Besides increased thirst and urination, Elizabeth had a pot belly, but this is the only symptom which actually got better. The skin problems started in February, after she started getting Vetoryl.

Maybe these pieces of information could be important:
- Elizabeth has a good appetite and now she is only active when she gets treats, breakfast and dinner. She has not lost weight.
- Last year, when Elizabeth got her annual vaccines she had an allergic reaction, so the vet gave her calcium injection. She got better, but because of the calcium a little bump appeared at the place of the injection and this bump disapeared within a month.

On Sunday and yesterday I gave Elizabeth 30mg Vetoryl with meal. Today she jumped on the couch by herself. I know maybe it was irresponsible to give her half of the prescribed dose, but she seems better now.

I joined the group, thank you very much for all your help and kind words!! (:

Lola

[labblab]

Lola, thanks so much for this additional info. I’m really glad to hear that Elizabeth is doing a little bit better, and I think it’s interesting that this corresponds with a lower dose of trilostane. I do wonder whether Cushing’s is really the correct diagnosis for her problems.

I’m especially puzzled by the January diagnostic cortisol results. Usually when we see two cortisol values here in the United States, it’s because an ACTH stimulation test was run. But Elizabeth’s January results do not correspond with what we’d expect to see with an ACTH. With that test, a “resting” cortisol level is first taken. Then a stimulating agent is injected, and one hour later the cortisol level is checked again. The second level should be higher than the first, because the adrenal glands have been stimulated to release a stored supply of cortisol. In Elizabeth’s case, the second reading was lower than the first, and neither would qualify as a “positive” result for Cushing’s here in the U.S. For our readers here in the U.S., I’m converting her results to the lab values we see here.

t1 = 219 nmol/l = 7.9 ug/dL

t2 = 168 nmol/l = 6.1 ug/dL

So I’m wondering whether a different diagnostic test was performed. For instance, perhaps these were the second two of three values that we usually see with a Low Dose Dexamethasone Suppression (LDDS) test. If so, that would be a positive response for Cushing’s.

Interestingly, her February resting cortisol test (after starting Vetoryl) was just the same as the second of the two diagnostic cortisol readings. As I mentioned earlier, since her resting cortisol was tested 15 hours after taking her pill, I’m guessing your vet is evaluating her response to the Vetoryl using a new monitoring protocol that has been introduced in Europe. For the benefit of all our readers, here’s a link to a new posting on our Resources forum that explains this new protocol in more detail.

http://www.k9cushings.com/forum/show...=1252#post1252

According to this new protocol, a cortisol level of 168 nmol/l taken right before it’s time for the next dose of Vetoryl could justify a dosing increase if a dog was still showing symptoms. But in Elizabeth’s case, she’s already receiving quite a large dose for her weight, plus it’s really interesting that she seems to be feeling better on a smaller dose of Vetoryl. So I’m back where I started — wondering about that January diagnostic test, and wondering whether the Cushing’s diagnosis is actually correct for her.

However, if her skin condition truly is Calcinosis Cutis, then we’re back to suspecting Cushing’s. So perhaps an actual biopsy of her skin condition would help confirm that we’re on the right track.

I’m sorry to be raising more questions than answers right now. But most of all, I’ll be wondering whether you continue to see improvement in Elizabeth’s behavior on the lower 30 mg. dose.

Marianne

[lolakocsy]

Thank you Marianne for your reply! (: Last Friday we visited our vet and she told us that hypothyrodism could show similiar symptoms as Cushings’s disease and maybe the source of Elizabeth’s problems was her thyroid. Tomorrow the vet will take blood and will check resting cortisol and thyroid. She will also take biopsy of her skin. If everything goes well, we will get the results on Friday.

During the weekend Elizabeth was very happy and active, I’m still giving her 30mg Vetoryl. I’ve started using Aloe vera on her skin and the lesions seem better, though, there are new ones.

Lola

[lolakocsy]

Dear all,

I am so incredibly devastated. Today the vet used abdominal ultrasound again and one of Elizabeth’s adrenal gland is bigger than the other one. Last time Elizabeth had her breakfast before the ultrasound and that is why the vet could not examine her properly, I just cannot understand why she did not ask us to take Elizabeth back with an empty stomach.

Abdominal ultrasound: left adrenal gland: 15,5 mm x 10,9 mm , right adrenal gland: 5,5 mm x 11m

According to the vet, if Elizabeth’s cortisol level get lower the Vetoryl works, if it does not, she has adrenal Cushing’s Syndrome.
I feel so overwhelmed now. We will get the results on Friday.

Lola

[labblab]

Hi again, Lola. I understand why you’re feeling so worried, but I have questions about what your vet has told you. If the ultrasound report is accurate, then it’s very true that Lola’s Cushing’s symptoms may be caused by an adrenal tumor. However, even if so, Vetoryl is known to have the ability to lower cortisol levels just as it does for pituitary Cushing’s. The medication is “approved” to treat both forms of Cushing’s. So in my mind, Elizabeth’s response to the Vetoryl will not tell you which form of Cushing’s she might suffer from.

Turning to the ultrasound results, if a tumor is indeed present, it is somewhat “better” for it to be located in the left adrenal gland rather than the right one. This is because it is less likely to invade the vena cava, a major blood vein to the heart. If you were to consider surgery to remove the tumor, the procedure might be a bit less difficult. However, I realize that surgery may not be an option for you to consider. That being the case, time will tell as to how much or how quickly the tumor may cause additional problems. But one possibility is that it could grow very slowly, and that the Vetoryl will help control Elizabeth’s symptoms in the meantime. I think the fact that she is outwardly doing well now on the 30 mg. is a good sign.

So, again, I do understand why you’re worried and upset. But I think your vet is giving an unclear picture as to the significance of the Vetoryl monitoring results. If Elizabeth’s cortisol remains too high, she may simply need a dosage increase. That would be the case regardless of the type of Cushing’s she has.

Marianne

[lolakocsy]

Thank you for your answer Marianne!(: We did not get the results yesterday because from 2018 Good Friday is a non-working day in Hungary (I totally forgot it). I called our vet and the lab will send the results on Tuesday.

I want to take Elizabeth to Budapest to the Clinics of University of Veterinary Me. It will not be easy because the wait time for an appointment is one month and if she needs a surgery it will be very expensive, but I will do everything to see her healthy again.

I have two new questions:

Elizabeth still sleeps standing and sitting up. These have not changed with 30mg Vetoryl. Should I be worried?

I would like to try giving Elizabeth her Vetoryl dosage in the morning. We tried it with 60mg and after she got the pill she was super dizzy, but maybe with 30mg it could work and would be better as well. What do you think?

I wish I had found earlier this forum, your help and support mean so much to me! Thank you very much!

I wish Happy Easter to all of you with my puppies: Elizabeth, Bruno and Bradford! (:



Lola

[labblab]

Oh my, what a wonderful picture of your babies!!! They are beautiful :-))))))))))))

I really don’t know what to think about the sleeping sitting up. But I do think it would be good to try giving Elizabeth the medication in the morning in order to see whether that helps even more with her symptoms during the day. I wish you a very happy Easter weekend, too, and we’ll be anxious to see those test results next week!

Marianne

[lolakocsy]

Hi everyone,

Finally we got the blood test results. The Cortisol level got lower.

Cortisol: 158 nmol/l = 5.7275 ug/dL ( In February it was 168 nmol/l = 6.1 ug/dL )

Unfortunately Elizabeth's T4 level has not changed, it is still 6,4 nmol/l = 0.4972 ug/dL

Our vet wrote this:
- Unfortunately the Cortisol and T4 levels almost have not changed, probably because of the adrenal tumor and in this case Vetoryl is ineffective.

I do not understand it. Elizabeth's Cortisol level, compared to the previous results, is lower. I thought this is good.

We have not got the result of the skin biopsy yet.

Lola

[lolakocsy]

We got the result of the skin biopsy. Elizabeth has Calcinosis Cutis.