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.