a hopeless french bulldog owner - Elizabeth has passed

Hi everyone,

My name is Lola and I have a five year old french bulldog, Elizabeth. We adopted her a year ago from a dog breeder where she was given hormones because of her fertility problems. She was diagnosed with Cushings in January and was prescribed Vetoryl 60mg after the ACTH test. The problem was that she had not stopped drinking and started losing her hair. We went to another vet, where she was diagnosed with hypothyroidism as well. (The vet prescribed Forthyron for hypothyroidism. ) She is still getting Vetoryl 60mg, but her skin problems are getting worse, she has red sores and she is still drinking a lot of water. Unfortunately we are from Hungary, where vets are not really familiar with Cushing's disease. I've just found this forum and I read that the recommended starting dose for Vetoryl is 1mg per pound of a dog's weight. My baby is 26lbs and still the vet prescribed 60mg. She has been getting Vetoryl for 3 months and there is only a small improvement, she seems happier. I am devastated. We are trying our best to help Elizabeth, but it is very hard and I am scared. :(
Are there any chances that she will recover one day?

Hi and welcome to you and Elizabeth!

Could you get copies of her ACTH stimulation tests and post those results for us? Also, is she getting her Vetoryl with a meal and are those ACTH stimulating monitoring tests being performed 4-6 hours post pill?

The first test was taken in January. The second one was a simple blood test which was taken 15 hours after she got her pill. The vet also used ultrasound to monitor her kidneys and her liver, they were in a good condition. At the end of the month we are going to have a test again.

She is getting her Vetoryl with a meal, usually at 5 pm.

(vér = blood, eredmény = results)

https://www.kephost.com/image/JJxk
https://www.kephost.com/image/JJx2

Thank you very much! I am very grateful!

Hello, and welcome from me, too! If you tried to post some test results in your reply, they are not visible to me. I am using an Apple tablet right now, though, so I’ll check later on my desktop computer to see if I can see something more there.

In the meantime, I want to let all our members know that we are just learning about a new trilostane monitoring system that is being used in the UK and Europe. It does not involve ACTH blood tests, but instead simply checks the dog’s cortisol level right before the next dose of trilostane is due. It’s our understanding that the closer to the next dose that the test is done, the better — like at 23 hours after the previous dose. So if this is the monitoring protocol that your vet is using, 15 hours may be earlier than is ideal. As I say, though, we’re just now learning about this protocol.

I’m sorry I don’t have time to write more now, but I did want to welcome you and talk about the monitoring testing. I’ll return later on today or tomorrow to write more.

Marianne

Hi,

I uploaded the pictures again, I hope they will be visible now, I can't see them on my tablet either.

I wish I could tell you more about the monitoring protocol my vet is using, but we were at four different vets. The first vet in November tested Elizabeth for Diabetes only, the second one in December took a simple blood test and forgot to sent it to the laboratory ( blood tests are usually examined in Budapest ) due to the holidays. The third vet diagnosed her with Cushing's disease, prescribed Vetoryl 60mg. My baby had been taking the pills for 15 days, when she started losing hair and red sores appeared on her skin, but when I called the vet he said he could not help. The fourth, who is helping us now, is a very nice but young vet. She took a simple blood test and diagnosed Elizabeth with hypothyroidism. Although it turned out that the cortizol level decreased, Elizabeth is still drinking a lot and her skin problems are getting worse. Now we are using a thermal water cream for her skin.

(vér = blood, eredmény = result)

http://www.k9cushings.com/forum/atta...0&d=1521366170
http://www.k9cushings.com/forum/atta...1&d=1521366192

Thank you for your replies! I cannot describe how grateful I am! We went through so many things during the past months and I only want my baby to get better.

Lola

Hello again, Lola. Now I’m able to see the thyroid result with no problem, but the photo of the other result — which I’m assuming is cortisol — is too small for me to clearly read. When I try to enlarge it, it is too blurry for me. So I f you will, just go ahead and type the cortisol information into your next reply. That way, we can forget about trying to see a photo image. You are doing such a great job, and working so hard, to help little Elizabeth. She is a very lucky girl to have been adopted by you!

Do you know any specifics about the hormone treatments she received? How long she received them, and how long ago they ended? I have to wonder whether they may somehow be involved with any continuing imbalances...

Marianne

Hi Lola and welcome to you and Elizabeth! :)

I can't make out the dates of the tests but here is the info given on them in the order you first posted them:

image JJxK:
2018/4315
T4 <6.4 nmol/l -17-37 nmol/l
Cortisol 168.0 nmol/l +15-120 nmol/l

image JJx2
2018/607
cortisol (t1) 219.0 nmol/l +15-120 nmol/l
cortisol (t2) 168.0 nmol/l +15-120 nmol/l

(Kortizol minta eredete means "origin of cortisol" in English - in this case ker, or "blood" - via Google)

Hi,

Thank you so much for your help!!! (:

January:
2018/607
cortisol (t1) 219.0 nmol/l +15-120 nmol/l
cortisol (t2) 168.0 nmol/l +15-120 nmol/l

February:
2018/4315
T4 <6.4 nmol/l -17-37 nmol/l
Cortisol 168.0 nmol/l +15-120 nmol/l

Unfortunately we know nothing about the hormones Elizabeth got. She had a miscarriage in September 2016 and we adopted her in October 2016. I know that she had low progresterone and that is why she got hormones. When she had two miscarriages in a row, she had to leave her previous home. The dog breeder and I have a friend in common, who told us about Elizabeth and we immediately adopted her. Last year she was neutered.

I read about Calcinosis Cutis and I saw pictures too, Elizabeth skin looks like that. Can we do anything with it? Or Vetoryl should help her skin problems?

Lola

Hello again, Lola! I just wanted you to know that I’ve not forgotten about you and Elizabeth. But before trying to interpret her test results, I’m reading more about the European trilostane monitoring system that is new to us here in the U.S. We just got more information about it this past week, so it is taking a little time for me understand what it means and how it works. But I will add more info here just as soon as I better understand things!

Marianne

Hi Lola and a belated welcome to you and Elizabeth. Without a clarification and additional information from you, we will not be able to provide you with meaningful feedback regarding the results you posted. I have listed questions below to keep myself organized and make it easier for you to respond:

1. Was Elizabeth receiving any steroid medication before, during or after being diagnosed with cushing's?

2. It appears your vet confirmed a cushing's diagnosis based on an acth stimulation test done in January. Are the results you posted the diagnostic test or was that the first acth stimulation test after starting dosing with Vetoryl?

3. Was an abdominal ultrasound done to determine whether Elizabeth has a pituitary or an adrenal tumor? Unfortunately an acth stimulation test does not make that distinction which is why an abdominal ultrasound or an endogenous acth test should be done. Treatment would be the same; however, prognosis for an adrenal tumor is not as favorable.

4. The February results you posted have only one result for cortisol. Can you tell us if that was resting cortisol only?

5. Based on current dosing recommendations, 60 mg is quite a large dose for Elizabeth so I am happy that you have seen no adverse effects. Is that a once a day dose and if so, are you giving it to Elizabeth in the morning with food? When was the last dose given to Elizabeth before the cortisol test was done in February and was that last dose given with food?

If Elizabeth's skin condition is calcinosis cutis and not caused by oral or injectable steroids, you can pretty much assume that she has naturally occurring cushing's. However, if the results of acth stimulation test you posted was done prior to treatment, those results are not consistent with cushing's. The acth stimulation test is not very sensitive so a good number of dogs with cushing's will have normal acth stimulation test result so Elizabeth's results could be a false negative. Your clarification regarding that January test will be helpful.

With respect to the calcinosis cutis, French Bulldogs and other bully breeds seem to be predisposed to this very rare symptom of cushing's. It can be very, very difficult to control. Most dogs will eventually see improvements but there is always a small possibility that dogs can have chronic flare-ups. In order to see any meaningful improvements, a dog must be on twice daily dosing of Vetoryl to insure that there is adequate control of cortisol throughout the day and the post stimulated cortisol must be within the lower therapeutic range of 44 nmol to 138 nmol. Calcinosis cutis most often gets much worse before it gets better after starting treatment. I have included a link below to a thread started some years back that might be helpful in reading about various treatments tried by members. That thread is dated but there has been little change in treatments since then. Unfortunately, there is no magic drug for calcinosis cutis and there are no guarantees that the medications that are routinely used will be effective. Again, it is critical that cortisol be well controlled. I apologize for asking so many questions but the more information we have, the better able we can provide you with meaningful information. We have had a number of members in countries where finding veterinarians knowledgable of cushing's is difficult and the good news is that you came to the right place for support and education. We are here to help you and your precious Elizabeth in any way we can. We look forward to hearing a lot more about Elizabeth.

http://www.k9cushings.com/forum/showthread.php?t=6093

Glynda

P.S. Can you also tell us which cushing's-like symptoms Elizabeth has besides in the increased drinking and skin issues.