Miss Millie Mayhem (Eng Bulldog) - NEW Dx: Cushings PDH and AWFUL Calcinosis Cutis

What a wonderful forum I have had the chance to scour for endless information as my baby girl went through lots and lots of testing to receive a final diagnosis of Cushings (PDH) and Calcinosis Cutis (AWFUL!!!). I can’t thank everyone enough for all of the posts that have helped me to become more informed and a better mama for my girl. Millie Louise (almost 10 yr old English Bulldog), was diagnosed on 6/28/13 with Cushings (PDH) after an ultrasound was performed. She weighs 55 lbs and started on Trilostane 6/29 – 60 mg every morning with food. What is just visually awful is her calcinosis cutis – I have such sympathy to all of you out there who are also dealing with this horrific skin issue as well as Cushings itself. Miss Mille has had open, oozing wounds and scabs from her neck all the way down her trunk (a good 8-12 inches wide) and on her cheeks – face cheeks that is. I pray that this quickly gets under control and am treating with DMSO and an antibacterial mousse in addition to Clindamycin and Rilexine due to staph and strep infection. This was the most aggressive skin disease I have ever seen and at the very onset took her to a dermatology specialist (went from a couple spots to the entire neck/trunk and sides of face in 2 weeks). So I thought I would post what seems to be protocol as it relates to symptoms and test results and would appreciate any thoughts or things I should be asking/looking for…I want to be the best I can for my girl. She is also taking Previcox, Phenobarbital and Tramadol (and yes, I have a spreadsheet to manage her meds and as recommended by a couple of you out there, a journal outlining any irregularities). Oh – poor thing also has an interdigital cyst that likes to keep re-appearing as well.
Symptoms:

•Excessive drinking
•Heavy urination but no accidents in house
•Big appetite
•Thinning hair coat turning into awful calcinosis cutis (determined by biopsies) – open oozing soars
•Weakness in rear legs – no more jumping up favorite “low chair”
•Little bit of a pot-belly
•Lack of desire to go on even short walks

Testing Done:

Urinalysis: Sp. Gr. 1018 (?), Color: lt. yellow, PH: 6.5, Protien: Trace – Reading handwriting so hope I got this correct…no other values noted.

LDDS: Pre-Dex: 2.5 ug/dL, 4Hr: 2.4 ug/dL, 8Hr: 2.3 ug/dL – I thought it was strange her baseline was within the normal range, but both vets said that it can fluctuate through the day. Also thought since baseline was somewhat normal, I was surprised her calcinosis cutis was SO EXTREME.

Bacterial/Skin Test: I cannot decipher these results, but it was determined she had staph and strep infections.

Biopsy: Clinical Summary – Three week history of erosions, dorsal neck, spreading along the back. Lesions are surrounded by erythematous plaques. White irregular serpiginous plaques on lateral neck. Two punch biopsies of erythematous plaques and one of white plaque. History of allergic disease. Suspect calcinosis cutis. Skin scrapings negative. Cocci seen on cytology. Patient is PU/PD with increased appetite. Gross Description - One container labeled “Millie,” three specimens, six sections in one cassette. 3 skin punch biopsies, bisected and totally submitted as six sections in one cassette, specimens inked blue, yellow, unlinked identification of halves. Diagnosis – Skin biopsies, dorsal plaques: calcinosis cutis, multifocal. The epidermis is acanthotic and suffers multifocal edema and vacuolar degeneration. There is a thick layer of loose orthokeratotic keratin on skin surface. Somewhat cystic follicular keratosis with follicular casts is also evident. The dermis is becoming mineralized. This has incited a granulomatous response and fibrosis. There are also small fragments of mineralized bone in the affected tissue (SHOULD I BE CONCERNED ABOUT THIS…BONE IN TISSUE??). Comment – Clinical Diagnosis of Calcinosis Cutis is confirmed…

ACTH: Time 1: 3, Time 2: 4, Cortisol Sample 1: 2.1 ug/dL, Cortisol Sample 2: 8.5 ug/dL (I believe the vet said this test was inconclusive?)

Superchem: Just reporting “abnormal” – Albumin: 2.1 (LOW), A/G Ration: 0.7 (LOW), Alk Phosphatase: 1704 (HIGH – this seems off the charts to me…normal is 5-131 U/L), Magnesium: 1.4 (LOW), Potassium: 5.6 (HIGH)

CBC: Just reporting “abnormal” – Platelet Count: 595 (HIGH), Differential Neutrophils: 11097, 81% (HIGH)

OK - so wow, I know this is a lot, but I just don’t know what else I should be looking for, what additional questions I should be asking. You all have helped me wipe away my tears over the past few weeks as I feel you are all an amazing support group. This has been very difficult and I just hope to do my best for my little girl. THANK YOU ALL in advance for and words of wisdom you can offer, I know I am in good hands with all the wonderful support I see flowing through this forum. Sorry to be so long-winded but didn’t want to miss anything! ACTH Test scheduled in 9 more days to see how she is doing on the 60 mg

P.S. We call her “Millie Mayhem” cause she has such an attitude and such sass! She is so stubborn and I look forward to helping her get back to her old crazy self!

Sincerely,
Millie's Mama (Kerry)

Hello and welcome :)
I am sorry for the reason that brought you here, but so glad you found us. You have come to the right place! There are many K9Cushing's angels standing by to help and stay with you every step of the way. They love details, test results, any information you can get your hands on. It looks like you've already made a good start with that.:) We will do all we can to help. Others will be popping in to welcome you also. Be ready for lots of questions. :)So again welcome to you and Millie,

Hugs,
Kathy

Love her name, my angel Tia had some sass of her own so your comment made me smile.

I don't know lots about the test results but I do know our experts like the reference ranges against the results to determine what that lab classes as normal range (you can edit the original post save typing it again)

I do have first hand experience of Calcinosis cutis as my little girl suffered from it too, I am so sorry she has it on her face, Tia got it down her whole back panel and it is wickedly bad to look at.

We shaved her back in the end so we coud keep it clean. We also used salt water from the sea and sudocream to help the itch and soreness. One of our members is also using manuka honey with success.

Big hug to you and kisses to Millie Mayhem

Mel
Xxxxxx

Ps I love her picture she looks like she is wondering what the heck you are doing!

Thanks Mel and Kathy,
Appreciate the welcome, and of course as I write this, Miss Millie managed to rip the scabs off the side of her face...arghhh...just opens up again. She certainly does not have a beauty pageant title in her near future, but she will always be the best looking girl to her dad and I. I appreciate the recommendations as my goal is to help use something that may soothe her and prevent itching. The one thing we have going for us is her bulldog body, so she can't really bite at things, but she can paw her face (can't wear cone cause of sores on neck). I just wish she could talk to me and tell my if it itches bad, and then if I put something on her, I just don't want it to sting or burn and I want her to say "oh mama that feels good" or "hey, get the heck away from me with that stuff." I will research the items you noted below. What kind of pup is Tia? I will also edit my response with refernce ranges per your recommendation

PS - Millie is always wondering what the heck I am doing...this pic was pre-disease. The dermatologist said it is the worst case of CC she has ever seen, and I have not even shared pics with family and friends because I fear it would horrify them :eek:.

Thanks much!

Kerry and Millie

Hi Kerry,

Welcome to you and Millie from me as well! I am so sorry for the circumstances that brought you to us but so glad you found your way here.

Sorry, again, but I have no experience with calcinosis cutis but there are members here that do and I am sure they will be along soon. One of Moderators, Angela, is very knowledgeable about calcinosis cutis since her beloved Vizsla, Sabre, had it too, I will shoot her a PM and let her know you are here. ;) In the meantime here are some links to other member's Threads regarding calcinosis cutis: http://www.k9cushings.com/forum/showthread.php?t=5108

http://www.k9cushings.com/forum/showthread.php?t=5316

http://www.k9cushings.com/forum/showthread.php?t=3956

Quote:

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Originally Posted by khockman

ACTH: Time 1: 3, Time 2: 4, Cortisol Sample 1: 2.1 ug/dL, Cortisol Sample 2: 8.5 ug/dL (I believe the vet said this test was inconclusive?)

Sincerely,
Millie's Mama (Kerry)

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One question I have is, when this ACTH stim test was done was Millie on Trilostane or was this done before treatment started?

Please know we will help in any way we can so do not hesitate to ask any and all questions, ok?

Love and hugs, Lori

Thanks Lori!

The ACTH Test and all other tests were done prior to Trilostane (we just started her on this yesterday – the day after the ultrasound ruled out adrenal tumors). Still need to get full blown ultrasound report faxed to me tomorrow from IMS, but adrenal glands were both enlarged, no tumors appeared present and narrowed it down to PDH. Is there some concern you have with the ACTH :confused:? I very much appreciate your welcome and your input and am also thankful for the links you provided! I hope you never have to deal with CC...Cushings is tough enough With everything that comes along with that...

xoxo,
Kerry

I must admit that I am quite baffled that Cushing's is suspected for the CC. According to those ACTH stim results Millie's cortisol is not elevated at all.

Cushing's is when the cortisol is way higher than normal. So I am a bit concerned with Millie taking 60 mg of Trilostane because Trilostane will lower her cortisol more and if it lowers it too much it could create an Addison's crisis.

Staffie...

When she had it around her neck I got the stretchy bandage and cotton wool stuff for underneath and put sudocream on before but it can stick if it dries out so needs changing a fairly regular otherwise the scabs can come off before they are ready.

It starts out like stretch marks then bumps then scabs which will fall off and then when the medicine starts working it will be new skin. Tia did get all her hair back, we had to shave her from her neck to her bum, get the vet to be very careful if you do get her clipped cause Tia defo found that uncomfortable but I think it helped me keep it clean and infection free

Big hug

Mel
Xxxxx

I did bring up the same concern you had as when I looked at both the LDDS and ACTH results it seemed that baseline cortisol levels fell normal. With the LDDS it appeared that even though baseline fell in normal range, she was unable to suppress at 4 and 8 hrs, but with the ACTH, I was told the results were inconclusive. Both vets said that cortisol have hit peaks and valley throughout the day depending on when the baseline is taken? I also brought up my concern of Addison’s given too high of a dose. Understanding both UC Davis and Dechra protocol (because of this GREAT forum), it looks like the 60 mg falls at the low end of Dechra given her weight of 55 lbs. What else can CC be caused from…any thoughts :confused::confused::confused:?

So possibly Petey and now maybe Millie....

I thought cushings was the only thing to cause CC. Might have to do some reasearch....

I think I read once diabetes but can't remember, will look!

I have done some reading and apparently in one case it was caused by leptospirosis. Usually they are vaccinated against this but might be worth an ask especially in light of what Lori thinks about the tests

Mel
Xxxxx

I will definitiely look into that. We have always been very good with vaccinations, etc... I think that in addition to the tests, all of the symptoms she had also helped support diagnosis. I just worry so much when placing faith in another individual (such as vet since I am not one) that every i is dotted and every t is crossed. I am sure in her medical record, they have a star at the top of the page that says "Millie's mom is crazy watch out for her." I would really be curious if anyone else who pops into this thread has had similar ACTH and LDDS results.

You are in good company. We all probably have notes of a similar ilk at our vets :D

I did read about Peety and the questions re: atypical cushings (can only be diagnosed through certain lab measuring the additional hormone levels...I believ I just wrote that correctly). In light of that I also though read that treatment would be the same for atypical and typical? I am just hoping that the doseage is right and if there are any additional questions I should be asking, that I do so!

PS - FYI Millie did have lepto vaccination

xoxox,
Kerry

Appreciating all the input!

Oh I am so confused...just read post in Peety's case that treatment is not the same between typical and atypical cushings...wondering if I need more testing cause her baseline cortisol was not overly elevated.

That was what Lori was getting as the vetoryl lowers cortisol, if it's not that elevated then it may cause Miss Millie other issues. Atypical s treated by melatonin and flax ligians I think.... Sometimes lydrosen as a maintenance dose

It's so tough as her skin needs a solution but I think if it were me given her cortisol isn't that high I would speak to the vet again. Are you scheduled for an ACTH in 10 days?

Yes - we are scheduled a week from Tuesday - July 9th. Neither vet (general and derm) were concened about this even when I brought it up! Hoping to get IMS perspective tomorrow - he did ultrasound.

When did she have the vaccine?

Good idea the the IMS, I think you have to ask questions just in case

It's stupid o'clock here so I must sleep, am sure others will be along to input soon. I will be back tomorrow to see what the IMS says

Big hug

Mel
Xxxxx

Not sure exact date - will check with vet tomorrow...I have it written down from old vet before moving...4 years ago, but I also think this was something she may have had recently as well? Going to check on this - is this vaccine given more frequently (like a distemper/parvo booster)? Shes not showing general symptoms of this either. Thanks for all of your brainstorming and questions! Nite-Nite

Glynda, one of our Administrators, has searched for other conditions besides Cushing's that can cause calcinosis cutis and appartenly Hypoparathyroidism, systemic blastomycosis, leptospirosis and paecilomycosis are disorders that can be the reason for CC.

Quote:

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Originally Posted by khockman

Both vets said that cortisol have hit peaks and valley throughout the day depending on when the baseline is taken? I also brought up my concern of Addison’s given too high of a dose. Understanding both UC Davis and Dechra protocol (because of this GREAT forum), it looks like the 60 mg falls at the low end of Dechra given her weight of 55 lbs. What else can CC be caused from…any thoughts :confused::confused::confused:?

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Unfortunately there is no test that is 100% accurate at diagnosing Cushing's. When other non-adrenal illnesses are present the LDDS test can create a false positive result.

With the ACTH stimulation test, although it can also create false positive results, it is more unlikely to do so.

There are two blood draws that are taken for the ACTH stim test. The first one is the pre or baseline blood draw, which can fluctuate. The second blood draw is called the post, this is when the dog is injected with a small amount of the synthetic form of ACTH and it stimulates the adrenal glands to produce Cortisol.

Trilostane inhibits the production of cortisol, so when one is giving a prescribed dose to their dog every day the production of cortisol from the adrenals will be limited.

Since a dog with Cushing's has an overabundance of cortisol running through their system, the goal of therapy is to keep the amount of cortisol produced limited to within the therapeutic ranges.

Millie's post cortisol is already in the normal ranges and the Trilostane will lower it more. Signs of too low cortisol are: diarrhea, vomiting, lethargy, and/or the dog just not acting them self. If any one of these is noted than the Trilostane needs to be stopped, and in some cases prednisone should be administered.

Hope I haven't confused you more.

Love and hugs, Lori

Hi and welcome to you and Miss Millie Mayhem,

I have been doing a little research to see what new information has come to fruition over the past couple of years with regards to calcinosis cutis.

What concerns me in Millie' case is that the ACTH test is normal. We had a wonderful flowchart link on interpreting the LDDS test but that link now no longer works so I can't remember where the LDDS results point to (I have always referred to this flowchart as it was just so wonderful and I never imprinted into my mind!).

I found this link for calcinosis cutis http://www.vetbook.org/wiki/dog/inde...lcinosis_cutis. Generally calcinosis cutis points directly to cushings syndrome. There have however been rare cases of calcinosis cutis which have been caused by other factors which Lori pointed out above.

With the management of calcinosis cutis you are on the right track.

I must admit I am a little perplexed with Millie's test results and the calcinosis cutis given that her ACTH is normal. However an ACTH stim may be normal in some cases of ADH .... which is why I wanted a good explanation of the interpretation of the LDDS test (which has disappeared unfortunately).

What other blood tests has Millie had and what were the abnormal values?

Angela

Hello and welcome from me! Thought I'd go ahead and throw my thoughts into the ring, too. ;)

This is just my personal opinion, but I do believe that Millie's list of classic Cushing's symptoms, the calcinosis cutis, and the positive LDDS all "trump" the ACTH and point to a genuine Cushing's diagnosis. Even though the ACTH is less prone to "false positives" than is the LDDS, it is far more prone to "false negatives," especially for dogs having the adrenal form of the disease. So in a situation such as this, where Millie is so symptomatic but has turned up with a negative on the ACTH, the recommended protocol would indeed be to turn to the LDDS for further confirmation. The abundance of false negatives on the ACTH is probably the main reason why many specialists discount the ACTH as the initial Cushing's testing tool, although I do believe there are situations where the ACTH has a testing advantage (but I won't bore you with an explanation here).

On their own, Millie's LDDS results do not distinguish between the pituitary and adrenal forms of the disease. But her ultrasound is consistent with PDH since both adrenals were enlarged. So if it were me, I would feel as though your vets are making the right decision in pushing ahead with treatment given Millie's entire symptom and testing profile.

One quick question for you: you mention that she is also taking phenobarb. Does she have a seizure disorder? I will come back and add another reply about the phenobarb, but it may end up having an effect on the trilostane dosing down the road.

Marianne

Thank you to everyone! So - as to the question when was her last lepto vaccination - it was in 2009 before we moved. Just talked to the vet and they said they don't really push it anymore because there are so many strains of lepto :confused:? As it relates to the phenobarb, she has been on it a while - 64.8 mg (on pill in morning one at night). She has what was diagnosed to be mild seizures (biting at the air, staring off into space, head tremor).

Back to the ACTH test and LDDS...with the LDDS, I was worried by the fact hat the baseline fell within normal as did the 4 hr and 8 hr (baseline:2.5, 4 hr: 2.4, 8 hr: 2.3 respectively)... The results indicated it is consistent with hyperadrenocorticism but further testing required to determine ADH or PDH (4 hr: >1.5 and >50% of baseline; 8 hr: >1.5 and >50% of baseline). I think the biggest thing was that she did not really supress at all?

All test results for everything are below:

Urinalysis: Sp. Gr. 10.18 (?), Color: lt. yellow, PH: 6.5, Protien:

Trace – Reading handwriting so hope I got this correct…no other values noted.

LDDS: Pre-Dex: 2.5 ug/dL, 4Hr: 2.4 ug/dL, 8Hr: 2.3 ug/dL – I thought it was strange her baseline was within the normal range, but both vets said that it can fluctuate through the day. Also thought since baseline was somewhat normal, I was surprised her calcinosis cutis was SO EXTREME.

Bacterial/Skin Test: I cannot decipher these results, but it was determined she had staph and strep infections.

Biopsy: Clinical Summary – Three week history of erosions, dorsal neck, spreading along the back. Lesions are surrounded by erythematous plaques. White irregular serpiginous plaques on lateral neck. Two punch biopsies of erythematous plaques and one of white plaque. History of allergic disease. Suspect calcinosis cutis. Skin scrapings negative. Cocci seen on cytology. Patient is PU/PD with increased appetite. Gross Description - One container labeled “Millie,” three specimens, six sections in one cassette. 3 skin punch biopsies, bisected and totally submitted as six sections in one cassette, specimens inked blue, yellow, unlinked identification of halves. Diagnosis – Skin biopsies, dorsal plaques: calcinosis cutis, multifocal. The epidermis is acanthotic and suffers multifocal edema and vacuolar degeneration. There is a thick layer of loose orthokeratotic keratin on skin surface. Somewhat cystic follicular keratosis with follicular casts is also evident. The dermis is becoming mineralized. This has incited a granulomatous response and fibrosis. There are also small fragments of mineralized bone in the affected tissue (SHOULD I BE CONCERNED ABOUT THIS…BONE IN TISSUE??). Comment – Clinical Diagnosis of Calcinosis Cutis is confirmed…

ACTH: Time 1: 3, Time 2: 4, Cortisol Sample 1: 2.1 ug/dL, Cortisol Sample 2: 8.5 ug/dL (I believe the vet said this test was inconclusive?)

Superchem: Just reporting “abnormal” – Albumin: 2.1 (LOW), A/G Ration: 0.7 (LOW), Alk Phosphatase: 1704 (HIGH – this seems off the charts to me…normal is 5-131 U/L), Magnesium: 1.4 (LOW), Potassium: 5.6 (HIGH)

CBC: Just reporting “abnormal” – Platelet Count: 595 (HIGH), Differential Neutrophils: 11097, 81% (HIGH)


P.S. - believe me I am all over the poor girl watching for signs for too low cortisol as I am a bit nervous.

Hi and Welcome,

I cant help with the test results. I can give you a link to a case study of a dog with calcinosis cutis on his body and face. He did recover, it took six months. I dont want to scare you but rather give you hope. In this case study the dog is being treated with Lysodren but still developed the calcinosis cutis. I thought you might glean something from reading it even though you are using Trilostane.

http://veterinarymedicine.dvm360.com....jsp?id=659278

My Zoe has mild calcinosis cutis and other skin issues as well. Her skin issues go a lot worse before they got better because our specialist led me down the wrong road for nine months or more regarding her skin.

I know the administrators will be by to recheck your lab work.

Glad you found us.

Yes - you did give me hope! I quickly scanned through (of course analyzing the pics and my girl has same face issues but a little worse down the trunk - it is just awful) and am going to print and read. I know everyone said it is going to be a long haul, but I am ok with it as long as I feel there is hope and as long as I am doing everything possible to make her comfortable. How did your specialist lead you wrong? Right now I am using DMSO and an antibacterial mousse...

Mel also mentioned she used Sudocrem and someone is using Manuka Honey - going to look at both options as well.

Mine discouraged me from frequent bathing, did not identify the mild bacteria and yeast though I repeatedly asked if she had it. She just did not know much about skin issues. Many dont here in the States. Ironically she recognized that and told me recently she was attending a conference in June and they had a class on 'Things Internal Medicine Specialists should know about Skin":):):)

Read as much as you can, I cant stress it enough, even if you may not think you understand the articles or technical terms, somewhere down the road, the information may give you an "AHA" moment.

hugs

Me again! As far as Millie's baseline cortisol, your vets are right in saying that the baseline reading does not have any significance for making a Cushng's diagnosis on either the ACTH or LDDS. It is only the subsequent blood draws -- after the testing agents have been administered -- that determine the diagnosis.

Also, in the case of the LDDS, the "normal" reference range is entirely different for the subsequent blood draws than it is for the baseline reading. For most labs, the normal "cut-off" is somewhere around 1.4 or 1.5 ug/dl. This means that if the 8-hour result is greater than the cut-off point, the test result is "positive" for Cushing's. At that point, you take a look at the 4-hour result, as well, in seeing whether the test points the finger at the pituitary rather than the adrenal form. Here's a link that explains the test interpretation in far more detail:

http://veterinarymedicine.dvm360.com.../detail/580093

And thanks for the info about the phenobarb. I'll come back and add some more about that in a little while.

Mariannne

Me again, again. :D :D

OK, first a question: I just want to double-check that second number for the ACTH test result. You've written 8.5 ug/dl, and I'm just wondering whether it might instead have been 18.5 ug/dl? That higher number still wouldn't have been conclusive for Cushing's, but it would seem less surprising than the 8.5 which does not reflect any elevation at all.

But regardless, switching to the phenobarb, I have a non-Cushpup who is treated with phenobarb for grand mal seizures. Boy, I have surely discovered that phenobarb interacts with a whole bunch of other drugs! It can be a real pain, sometimes, to find alternatives that don't interfere or compete with it. Phenobarb is known to interact with mitotane (brandname is Lysodren), which is the other commonly prescribed Cushing's med. And while phenobarb is not listed as actively interacting with trilostane, apparently some dosing alterations may be recommended along the way. Here's a related reply that I posted to another member some time ago:

Quote:

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OK, I just spoke with one of Dechra's technical reps, and what he told me pretty much coincides with what you were already thinking. Even though there is no documented interaction between trilostane and phenobarb (he is unaware of any clinical trials that specifically addressed that drug combination), dogs who are being treated with both drugs need to be monotored very diligently both in terms of liver function and also trilostane efficacy. He is aware of dogs that are currently being treated with both drugs, and no particular problems have surfaced thus far. But theoretically, phenobarb's effect on the liver could alter the way in which trilostane is metabolized by any given dog, leading to the potential for trilostane overdosing in the absence of appropriate dosing adjustments.

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I believe there has been some discussion that perhaps potassium or sodium bromide might be a better "match" with trilostane because the bromides do not have the same effect on the liver as does phenobarb. But I've recently been reading that the bromides are linked with a higher incidence of pancreatitis, and I think that Cushpups may already be more vulnerable to pancreatitis without adding in another complicating factor. So I don't know that there is a perfect answer in terms of drug preferability.

However, the bottom line is that I'd encourage your vets to call a technical rep at Dechra (manufacturer of brandname Vetoryl) in order to see what their most current advice is re: dosing recommendations for dogs taking phenobarb. That way, you'll know you're getting the most up-to-date advice in this regard.

Marianne

Thanks Marianne…you can offer advice and replies again and again and again! Yes I was correct in stating 8.5 (reference range was 8-17) it did state as you have mentioned, for HAC post results would be greater than 20. Perhaps this is why vet said inconclusive given all other symptoms? I appreciate your comments and information on phenobarb…I will be asking my vet questions regarding that and making sure a call is placed to Dechra

Everyone is offering such good insight and I am doing all I can to read, read and read some more. I would not call myself a dummy, but until all of this, if you asked me what the pituitary does, where the adrenal glands are and what cortisol is, I would have looked at you like a deer in headlights (I know I learned all of this years ago, but have some reason managed to bury it away)!

Positive note is that I think I am still capable of learning :D:D:D

And obviously you are doing a great job re: all that new learning!!! :) :) :)

One more thought does occur to me. I know that increased thirst, urination, and lethargy can also be side effects of phenobarb. Do you think there was any relationship in the timing of the symptom onset for Millie? When we started our non-Cushpup on phenobarb, she really looked and acted just like my pre-treatment Cushing's dog for a while. Fortunately, for us, those symptoms dropped away once she was stabilized on the phenobarb. But it does cross my mind to ask about that since we are basing Millie's diagnosis partly on those symptoms being part of her profile.

Well - I would not be even close to knowledgeable without all of you!!! You bring up a great thing to think about phenobarb, but, she has been on it a LONG time – I would guess 6-7 years.

P.S. Noticed we are in the same state too! Hope your puppy is doing well!

Hi Kerry,
Just popping in to tell you that you're doing a great job! :)I warned you in my welcome that there would be lots of questions!;) Yes, Marianne asks a ton of questions, but you can really learn a lot from her! I certainly continue to do so.;) My life is so much richer since I found this wonderful group of angels. Hugs to you and a belly rub for Millie.
Kathy

Hello there

How you both doing today? hope she hasn't been at her face again and that you are having a good day today

Big hug, belly rubs to Miss Mayhem

Mel
Xxxx

She loves all her hugs, belly rubs and kisses coming her way. She’ll be most excited I am sure when one day we can actually tickle her back, neck and face. So the update on calls today – We have a GP, Dermatologist and IMS that have all looked at her (IMS did ultrasound and I asked Dermatologist to consult with him as well on other test results and Trilostane dosage). All three vets are in unison with the 60mg to start, so hoping we are on the right path! Dermatologist wants my local GP to treat the Cushings as determined and monitor through testing (ACTH is scheduled a week for tomorrow – 11 days after initial Trilostane was started), and she will follow treatment of Calcinosis Cutis – stating they will work in coordination. Do you all feel like this sounds like a good plan? I also asked Dermatologist about possibility of Atypical Cushings and she was very fluent as to her response as to why it would not be that (although I really need to call her back and clarify as I was not in the right state of mind to listen to her answer).

I also asked her about the possibility of using Sudocrem or Manuka honey. She asked me to stay the course and said no to the Sudocrem and said honey did cross her mind, but given the extent of the problem, thought it would be an unbelievable mess – which I probably can concur with – although it would smell a heck of a lot better than the rotten garlic smell of DMSO…I will never get garlic on pizza again! When I say stay the course, she is a little too difficult to bathe right now and makes her so uncomfortable, so we are using an antibacterial mousse (once a day on all lesions: face, neck, trunk) – It is DUOXA Chlorhexidine + Climbazole Mousse with phytoshingosine. She is not thrilled when this goes on her face cheeks and I feel it may be hurting her – anyone have experience with this? She also gave us Comfort Spray by Animal Pharmaceuticals which she recommended spraying on face 2-3 per day. Millie will have nothing to do with a spray bottle coming at her face, so she recommended soaking a paper towel and dabbing. We tried this and felt like she was irritated by this as well –again, anyone have experience with this?

Love to all of you kind souls. How blessed I am to have you on my side – looking forward to getting to know your puppies better. I feel like all you are doing is taking care me right now and I know you all have many things you are dealing with as well!

Xoxox,
Kerry

Hey, I should have added that Tia didn't have open sores when we used the sudocream so it may still be an option once you have got to the stage where it dries up as it will, then scab then those scabs should fall off and eventually I really hope you will see hair and that's such a great feeling...

I have to say that I would watch Millie like a hawk for change in behaviour and if she refused food, seems off or whatever hold her vetoryl, get her in for the ACTH as her cortisol wasn't raging on her tests. Read the vetoryl insert and make yourself familiar with what to look out for. I don't want to scare you just want to help

Diarreah is also another sign that the cortisol is low

Big hug, hoping Mille can get kisses soon

Mel
Xxxxx

And ask here any time if you are worried. We have awesome people like Marianne Glynda Lori Leslie Debbie Sharlene Addy and John who have way more knowledge than me. There is always usually someone who will help :)

Thanks Mel - yes, watching her like a hawk! I am fortunate enough that my office is out of my home. All signs are good thus far, but I am looking for any of those signs which would show low cortisol as you mentioned. I've been reading more and have seen info on Cortisol:Creatine Ratio - any idea if this is something done during a urinalysis - I cannot find this in any tests that were done for Millie (or maybe vet just did not give to me). I guess I would be interested to see if that was relatively normal - If so it should have ruled out cushings...I guess my new motto is question everything!

I know she has all the signs, I just worry, worry, worry!

P.S. she is lerthargic, but for the past year she has done alot of lounging around and since the weakness in legs, she is not very active...not sure how I would tell if she gets MORE lethargic.

xoxoxo

In answer to your question about the UCCR ( urine cortisol: creatinine ratio), it is not part of a routine urinalysis. You have to request this test separately. It is a screening test for Cushing's, negative means you ARE NOT dealing with Cushing's, positive simply means that Cushing's is a possibility, further testing required. IMO, since you have started trilo, I think you are past the point of a UCCR providing useful information. Let's see what other members have to say.

Debbie

Hi Kerry,

It looks as though you have had some good advice and feedback since the lady from down under is able to get back online (ie me from NZ). I have not used DSMO (not available in NZ) but I would just note a word of warning with the use when I did research it that they do not recommend to use it on more than a certain percentage of the body. For the life of me I am not able to recall what it is but just wanted to give you a heads up just in case your vet did not enlighten you on this. You may find that Millie's areas are well within this.

You are doing a fantastic job in educating yourself ... well done!

Angela

Morning Kerry

I forgot we also used a topical steroid spray called cortavance to dry up her scabs when they were bad. That might be an option. Same rules as Angela mentioned though only can use on a certain % of the body

Tia was a lazy mare too, so I always used to say not sure how I could measure that!

Big hug

Mel
Xxxx