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

Thanks All - yes we alternate DMSO application - 1 day she gets neck and face, the next day she gets trunk/back. I will look into cortavance too. I am sending the following to the vet just to get some more documented answers, which she has probably already given to me, but I seem to only retain half of what verbally comes to me...emotions getting in the way. Are there any other questions I should ask?

1) Why atypical cushings has been ruled out?

2) Why baseline cortisol level for LDDS was not elevated as would be expected with cushings, and why 4 he and 8 hr were almost the same as baseline - can you help me decipher the meaning you took away from this?

3) why the ACTH was considered inconclusive?

4) was a cortisol: creatine ratio ever measured by yourself or general practitioner that you are aware of?

5) the ultrasound states for kidneys - bilateral dystrophic mineralization, small non-obstructing nephroliths - what does that mean?

So this was what I got back from the vet re: my questions - was curious if anyone has a comments or thoughts - HELP...anything else I should be asking?:

1) Why atypical cushings has been ruled out? Atypical Cushing's is when sex hormones are elevated only, without elevation of cortisol. (Some people also use this terminology for dogs that don't have typical Cushing's symptoms such as increased urination and drinking). We don't know if the sex hormones are elevated, but it doesn't matter, because the cortisol is elevated and that's what we monitor.

2) Why baseline cortisol level for LDDS was not elevated as would be expected with cushings, and why 4 hr and 8 hr were almost the same as baseline - can you help me decipher the meaning you took away from this? Baseline cortisol is not always elevated, we are usually more concerned with the cortisol after the injection is given. The cortisol should go below a certain value in a normal dog. In a dog with pituitary dependent Cushing's usually the cortisol suppresses, then escapes. In dogs with adrenal tumors we very often see that the cortisol does not suppress at all (like Millie's) but this can sometimes also happen with pituitary dependent.

3) why the ACTH was considered inconclusive? In a dog with iatrogenic Cushing's, the cortisol does not go up (or stimulate). With naturally occurring Cushing's, the cortisol goes up over a certain value, typically 20. The reason I say inconclusive instead of negative is because we still had a strong suspicion for Cushing's even though the test was not obviously positive for Cushing's.

4) was a cortisol: creatine ratio ever measured by yourself or GP that you are aware of? No. This is a screening test that isn't very reliable. A negative means they most likely don't have Cushing's. A positive result means that they might have Cushing's (which we already had a strong suspicion for). No need to add this test now.

5) the ultrasound states for kidneys - bilateral dystrophic mineralization, small non-obstructing nephroliths - what does that mean? Dystrophic mineralization means that there is calcium (presumably vs other mineral) being deposited into the kidneys diffusely, just like it is occurring in the skin. Nephroliths means that there are kidney stones, but they are not in an area that is obstructing urine flow.

Thanks so much for any input!!!

I think all the answers are right on the mark. This vet sounds like a keeper. ;) :)

Marianne

I was just thinking that too Marianne. :)
Your vet answered your questions promptly and knowledgably. That can be a real rarity in the cushings world.
I am hoping that this means that her game plan to get the cc under control will also pan out. Just realize that it does take time. It is one of the hardest symptoms to get under control and usually one of the last.
I have high hopes though. :)

Sharlene and Molly Muffin

Sorry I didn't check in yesterday we had a very sad day, I saw you posted on each of their threads am sure both Vicki and Kathy will appreciate that.

Just wondered how you were both getting on today?

Big hug and stored kisses for Millie

Mel
Xxxxxx

Yes - very sad day in the forum yesterday - can't even imagine the pain they are both feeling. But amazing the love and understandning that strangers connected by one thing can share. Such things renew my faith in humankind! Sharlene and Marianne brought some positive vibes to us last night and helped us to know that it looks like we are in good hands. Today is the 5th day on Trilostane and not seeing that much of a difference. The CC is not progressing as rapidly but the poor girl looks like a hot mess. She sleeps alot, is a little slow when we take her out, but good thing is no accidents in the house. The biggest issues are her lack of energy, the CC, and weakness in rear legs - she can go down steps, just not up a flight. I have a spreadsheet that helps me keep up with all of her drugs and various spray/cream/gel applications as well as a journal. I was hoping to see a little more spunk, but I know I have to be patient which I am not good at :mad::mad:! Appreciate you checking in on me.

xoxox,
Kerry and Miss Millie

You might not see spunk right away. Sometimes when their cortisol is dropping, and Trilostane can make it drop like a ton of bricks, they may feel yucky until they get used to the lower cortisol, kind of like withdrawals. The hind leg weakness can take awhile to improve if they have lost a lot of muscle.

The tramadol and phenobarb probably don't help either, but she has dropped from 3 to 2 tramadol a day... So maybe that will help!

It's such a great feeling when you do, it's a long road with the cc. Tia's took over 6 months to clear up properly but it did so there is no reason why Millie's shouldn't.

Hope you are both having a good day today

Mel
Xxxxx

Hi Kerry,
I have noticed that you have been following Buddy's thread very closely and I'm honored.:) Having said that, you are a newbie and I don't want you to get spooked by what you have/are reading. Buddy had a pituitary macro-tumor. Most of our fur babies do just fine with treatment. Please remember that as you continue to read Buddy's thread. Big hugs to you and our precious Millie.

I was thinking just today that it could take longer to clear up the cc since there is also staff present which can be quite hard to get rid of too. Millie is on antibiotics for that right?

Sharlene and Molly Muffin

Wow Kathy - even in a time where you need not be worrying about anyone else, you do! Know how very special you are. You were the first to welcome me with open arms to let me know there are people to help. I can't even explain how comforting that was as I have sat around shedding endless tears worrying. You are completely selfless and that is another reason I follow your journey. I thank you for being such a great example of kindness...I bet Buddy taught you some of that cause I can see it in his eyes :)!

I am not spooked - I am grateful there is a group to share experiences and support!

xoxox,
Kerry

Hi Sharlene - yes she had Staff and Strep - she is on Clindamycin and Rilexine. On second visit to Dermatologist, the Derm said infections were getting better but to still stay on the meds.

Thanks for checking in!
Kerry

Hi Kerry,
Been meaning to chime in and say welcome. Seems like everyone's been on giving you good advice. Millie looks like such a sweetie. Sorry the skin problem is is so stubborn and causing Millie discomfort.
My dog's symptoms were pretty slow to subside...we're still tweaking the dose and things are starting to get a bit better.
I hope Millie starts to improve really soon! :)
Barbara

Hi Kerry, I just read all your posts. So sorry you are dealing with everything. It becomes all consuming. You want to know all you can as fast as you can. Everyone here has great advice, and with that you add in your own research and you end up never feeling like you can relax. It's like overload from day one, :eek::eek::eek: when you find yourself thrown into this crazy world. I have had dogs all my life and I have never heard of any of this until now. But from day one you know what you have to do and you just keep doing all you can until you see some positive results.

With regard to the CC, I have been told and have also read that this could last a very long time. And as long as Peety is doing good I can see past the CC. In the beginning I didn't think that. His first Vet overloaded him with meds and he was so sick. Wouldn't eat, I tried everything. I finally took him off all the meds and he finally came around. Then I changed Vets, and the next one didn't have any practical experience with skin disorders, so put him on prednisone. That proved to be a disaster. And the Vet couldn't really offer me anything that I didn't already know. So referred me to a Derm Dr. Huge disappointment for me and Peety. We are now going to a reliable, trustworthy Dr. I've know many years. She does not believe he has cushing's but thinks his CC came from the prednisone. We are watching him closely for any signs. So far no symptoms at all. But Peety is almost 12 so we are looking at any senior health issues. I am happy that he is doing so well. He gets a vitamin, omega3 and brewers yeast, and lots of hugs and kisses. I don't make myself crazy analyzing everything he does everyday, but I do watch for any changes in any of his routines. And I make every day count for him. That's all I can do right now. He is my crazy lil guy that makes me laugh when he's not even trying to.

Hang in there, tomorrow is another day, with more information and even more questions. But we can do it because our precious lil ones are counting on us. Big hugs for Millie

hugs, Pat

Hi Kerry,

Just a word of warning with the calcinosis cutis .... it is likely to worse before it gets better. The biggest thing is to control any infections and you are doing the right thing with the antibiotics. Personally I would recommend that all infections are clear before you stop the antibiotics.

Generally it takes 4 - 6 months before it just "remains there" without causing issues.

Angela and Flynn

Thanks Angela - I appreciate the input on the antibiotics. Do you know if there are any issues that would arise from keeping her on too long - if not, the longer the better in my eyes...I do not want to have to continue dealing with infection on top of everything else!

And Angela, Pat & Barbara - would be interested in your thoughts on this - as things are drying up, her pinkish colored skin seems so dry (maybe it is actually the calcium that's causing it to look this way?). If it were me I would want soothing cream rubbed all over - we have never given any types of supplements like omega3/fish oil...would this help?

Want to do everything I can!

xoxox,
Kerry

Hi Kerry,
A very belated welcome to you and Millie. I am so sorry you are dealing with this, it is a tough thing to get under control. I am sorry that I can't offer any advice on if there is any cream that would help her skin, hopefully some of the others that have dealt with it directly can advise you. I do know that fish oil supplement is good for their skin and coat overall, as well as promoting kidney health, joint function and health immune system, among other things. It is certainly something you could ask your vet about. My pup Jasper gets it on his food twice a day specifically for kidney and cholesterol issues, but it has really helped his dry skin.

Your avatar pic is so cute, she is adorable.

Hugs,
Tina and Jasper

Thanks Tina - I am going to sound really ignorant, but is it a pill you put on the food, or drops?

Jasper is a mighty fine looking looking lad as well!

xoxox,
Kerry

You don't sound ignorant at all! It is a liquid, the brand my vet prescribes is Welactin, but there are many different brands of omega-3 supplements for dogs. Mine comes with a little spoon and I just measure 1/2 a spoonful on his food twice a day. There probably are pills that could be punctured and put on the food but I think that would be messy.

Thanks Kerry, I wish I had a better pic of Jasper, but he doesn't like his picture taken, he has become afraid of the sound my phone or camera make. When I try to get a picture he runs off and hides. So the avatar pic is the best I have unfortunately!

Hugs,
Tina and Jasper

Kerry, you can also try using coconut oil on her skin. I use it on Peety and it does keep the skin moist. Make sure to get pure coconut oil. I have Peety on omega3. I bought on line at 1-800-petmeds. It's a capsule, that I puncture. I like the idea that Tina has a liquid. But this works ok, maybe next time I order I'll look into that. Aloe Vera is also good. The one I have I got at the pet store and it is especially for dogs. There's a lot of things you can use. I try to stay as close to natural as I can. When his sores were real bad, I would bath him in Hibiclens and then put Neosporin on the sores. It was a while before I could use anything else. You will get very good at knowing what is good and what makes her feel better. And as the disease gets better you will even change your routine again. Right now, though just focus on keeping her clean and free of infections. That's real important. You're doing great and your love for her will also help you make right choices for her.

Hugs, Pat and Peety

Hi Kerry,

We used a couple of things along the way with Sabre... we started off supplementing with Fish oil .... and then we then tried EPO (evening primrose oil). There are some research studies on the use of EPO for skin issues in dogs but last time I searched I had difficulty finding them!!! We also added Flaxseed oil to his food. Sabre was fed a raw diet.

Angela and Flynn

Thanks for all the input! I just emailed our Dermatologist and asked her what her thoughts on Cocunut Oil and Fish Oil given Millie's condition. I am so happy my Derm is not ready to kill me yet with everything I email her way...oh well - gotta do what we gotta do :D!

I will ask about EPO and flaxseed in my next email to her. Thanks again to all of you.

Was also just told about a vet who also practices acupuncture and has a mobile veterinary hospital (and is located only about 50 minutes from us). She came highly recommended and I thought wow, this is interetsing. Looked up vet and saw:

Dr. Betz offers several types of alternative medicine such as acupuncture and “veterinary” chiropractic. She has completed over 200 hours of coursework in acupuncture and recently graduated from the only U.S. Department of Education accredited Veterinary “chiropractic” school.

Any one have anythoughts on cushings, calcinosis cutis and acupuncture (as a supplement to everythig else we are doing)?

xoxox,
Kerry

Hi Kerry and Millie,
I mailed tons of stuff to my vet, because they didn't know diddly squat about Cushing's protocol. My personal vet was the only one that knew, but he was on leave at the time.:o You are protecting your baby. That is a mother's job! Do not ever worry about contacting them with questions or concerns. That is their job! You are doing a terrific job Kerry! If they mess up, it's not gonna be with your baby!XXXXX

Several of our members have used acupuncture. I know Jackie has used it with Ugga, a french bulldog with cc also.

this is her thread:

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

Sharlene and Molly Muffin

Hi Kerry. I don't get on here as much as I'd like but your thread caught my eye so I wanted to pop in and say hi. I am so sorry you are going through this with your girl. My frenchie, Ugga, has CC as well. He takes Vetoryl (30mg BID) and I take him for acupuncture. The acupuncture has done wonders for his skin, it's really quite fascinating. He doesn't look and feel like an alien anymore, he actually has hair! Most people think I'm nuts for taking my dog for acupuncture but I don't care, it works. I did post some pics on my profile, some of them are pretty gross so if you do look, do so at your own risk ;). Some other things we've used are: ketochlor shampoo, humilac spray, and an herbal salve (I think i posted some pics of that as well). The super stinky brown chinese herbal salve worked the best (in conjunction with the acupuncture). Best of luck to you and Miss Millie Mayhem :)

Hugs,
Jackie and Ugga

Thanks everyone, I very much appreciate the input!

Jackie - what a sweet frenchie - how soon did you start taking ugga to an acupuncturist? Did you wait until open sores were cleared up?

Also would appreciate any words of advice or input - I take Millie Tuesday for her ACTH test (it will be 11 days since her first does of Trilostane. Are there other things that I should ensure are tested at this point - I've read electrolytes (can someone explain?), potassium? Other? Want to make sure while she is there that I get every possible thing done that will help us to continue to manage! THANK YOU ALL!

xoxox,
Kerry

Give Millie her regular does of med in the morning with a bit of food. The ACTH test needs to be completed at about the 4 hour mark, start, redraw an hour later. Completed all together within 4-6 hours of that first dose.
Electrolytes, like sodium and potassium is one of those things that can get out of wack if the cortisol gets too low or anything. Just a good idea to train your vet to do those every time they do the ACTH test.
Have a good weekend.

Sharlene and Molly Muffin

Thanks Sharlene - so I should just make sure that when dong the ACTH test, my vet also tests for potassium, sodium and electrolytes? Correct? Would these be tested through a blood sample before the ACTH test is done?

Just ask for electrolytest to be checked too. They do the blood draw for that prior to the ACTH test.

You'll be just fine you have all your ducks in a row so to speak.

Remember to get copies of all test results, past and future, train them to just give them to you, so you have them. We all basically keep files on our furbabies these days. It is soo much easier and the couple times I have had to go to the ER for various reasons for Molly, I go with file in hand. :)

hugs,
Sharlene and Molly Muffin

Thanks Sharlene - I may have all my ducks in a row so to speak, but I think sometimes I am losing my marbles!:D

Most of us have already lost our marbles. Join the crowd!:D xxxxxx

Hmmmm Isn't there a game you play with marbles LOL Does that mwan we can oe can!t play with our head ROFL

(couldn't resist) :D:D

sharlene and molly muffin

Hi Kerry! We did not wait until his sores healed but my vet had to get a little creative with some of the acupuncture points as the needles cannot go into the lesions. Ugga was in bad shape and the acupuncture was our last hope, we just wanted to start him ASAP. We are so thankful we've had such great results! I hope all goes well with Miss Millie's stim test today :)

Hugs,
Jackie and Ugga

Hello all - Millie had her ACTH test done today (11 days after start of Trilo), I also requested electrolytes be tested...here are the results:

Na - 152 mmol/L (normal range: 144 - 160) - right in the middle of normal
K - 5.7 mmol/L (normal range 3.5 - 5.8) - she was at high end of normal
Na/K - 27 (no refernce range given)
Cl - 126 mmol/L (normal range: 109 - 122) - she fell under HIGH but at the lower end

So, what am I supposed to be looking for??? Should I be concerned with the HIGH Cl?

Would love any of your opinions and thoughts as this is too new to me! Will also post ACTH results tomorrow for input. Just bought some USDA certified organic extra virgin coconut oil...should I bathe her and then gently rub some on her? keep in mind she is half hairless from this awful calcinosos cutis...any advice...pretty please :D

xoxox,
Kerry

Millie's high normal potassium (K) is what I am a bit concerned with but Trilostane can increase potassium levels, I would just keep a close eye on both sodium (Na) and the potassium to make sure they do not get too unbalanced.

Did the vet mention when her ACTH stim test results would be in?

Results hopefully in tomorrow! Thanks for input on electrolytes...

Lori, covered the elctrolyte results for you.
What I would say is that tests are there to not only give you current information but as a source by which to compare how treatments are working. That is one of the reasons that we all keep records of all our tests.
It's taken me Months literally to see a positive change in Molly's liver values, based on the liver supplements she is on. It's a way to gauge from where you are to where you want to be and how you are going to get there.

Hugs
Sharlene and Molly Muffin

Vet called...Just got the results back from her 11 day ACTH test following Millie's start on Trilostane. For reference I am posting the ACTH results pre-treatment as well:

Pre-Treatment:
Cortisol Sample 1: 2.1 ug/dL
Cortisol Sample 2: 8.5 ug/dL

11 Day ACTH:
Cortisol Sample 1: 0.8 ug/dL
Cortisol Sample 2: 5.0 ug/dL

Vet seems to think this all looks good? Thoughts? I have not seen much improvement in her clinical signs other then she is not as ravenous eating (still a healthy eater though). Still drinking a lot, Calcinosis Cutis still horrible, hind legs still weak. She has shown bits of he personality here and there, but just not where I was hoping she would be after 12 days :( We are sad that we have not seen much improvement, especially when i read that majority of dogs show good improvement within first 14 days...

Thanks,
Kerry

Don't get discouraged with lack of improvement. My dog was 18 days in and then some - on meds and we still aren't sure about the diagnosis. You are doing all you can and the people here are great with test results. They will tell you what they think... hopefully Miss Millie will be feeling better real soon.