My girl pug (confirmed Cushings & confirmed calcinosis cutis) / Tobey has passed

Hi everyone,

My name is Renee. I have three pugs, a female and two males. I am also heavily involved in running pug rescue up here in Alaska (with another amazing animal lover).

My girl Tobey is my first pug. I got her as a puppy from a backyard breeder (before I knew better), and she is 10 years old now. Things have been quite baffling with her these last few years, although looking back, it seems that she has many symptoms that indicate possible cushings. Unfortunately, at the moment, she is unable to be tested for cushings due to being on prednisone (we are tapering her off right now).

About 2 years ago, she started getting UTI's. They were wicked too, and I was sending out culture & sensitivities every month for a long time. For a few months she even had MRSP bacteria (related to MRSA). It was a long road to get these infections under control, but eventually we did. She did have surgery earlier this year for bladder stones, which turned out to be very untypical looking struvites (they appeared to be oxalate, but they were confirmed as struvites from the lab). Before the surgery, the ultra sound showed her kidneys to be 'dark' and containing possible stones / tumors as well, however, her kidney function has never been out of the normal range. After the surgery, she started having incontinence in her sleep. She 'wets the bed' a few times a month.

Starting in October of this year, she began drinking a lot of water and having accidents in the house. She was also very gassy. I thought she may have another UTI, so we went to the vet for testing. She tested negative for a UTI, but given the possibility of early kidney disease (based on the ultrasound), we thought it was just a progression. We decided not to treat the gassiness and just wait and see how it progressed.

About three weeks later, I took her back because she was unable to jump up on chairs / beds, etc that she had previously been able to jump on. In addition, her stomach seemed very bloated, and the gas was continuing. She was still drinking an excessive amount of water as well. We did a complete blood panel and xrays. The organ function and all other levels on the blood panel were within normal range, except for her phosphorus levels, which were in the normal-high range. At this point, given the xrays, my vet suspected some type of blockage. The xrays were taken 10 hours after her morning meal, and yet, her stomach appeared completely full, but it was not recognizable as food.

She went back in the next day for a barium xray series. She had been fasted since the previous morning, and thankfully, her stomach was empty, so no blockage concerns. To help with digestion, I began home cooking for Tobey (which I still continue to do).

Thus began the task of figuring out what could be going on with this random set of symptoms. We tested for thyroid. That was negative. We tested for diabetes. We tested kidney function again. I brought up the possibility of cushings, but my vet didn't think it was possible since her liver functions have always been within normal range. I am kicking myself for not pushing harder for the testing, but frankly, I love and adore my vet. Not only is she amazing with my pets, she is beyond amazing with our rescue dogs. I had no reason to doubt her, and I certainly don't blame her.

Anyway, while we were still trying to figure stuff out, up pops these lesions on Tobey's back. We decided to try a week of abx to see how that affected them. The lesions got worse. My vet thought it was cancer. We did a biopsy last friday on five of the lesions, and proactively started a huge dose of pred. Of course, then the results came back this week that the lesions are calcinosis cutis. Not only has my vet never seen them, but she never even saw them in vet school, and in hundreds of rescue dogs, we have never seen them. She called and apologized and said that it is much more likely that it is cushings, although she is still baffled as to why the liver function is normal.

We are now tapering off the pred so we can take the next step into the cushings testing.

My poor girl seems miserable. Her lesions are painful, she's drinking so much water, and peeing a lot. She hates wearing diapers, but that is my only option for her at night. I hate to see her like this. Her digestion is better since I started cooking for her, which is an improvement. Since she is a pug, her appetite has always been good.

If you've made it this far, bless you. I have read through many other threads, and I know that not only am I not alone, but that everyone has been at this beginning stage before as well. I will post test results, etc, as soon as they are available. We are done with the pred next Monday, then we have to wait before the cushings test can be done, so it may be a while.

Hi and welcome to you and Tobey,

First I just wanted to thank you for all your rescue work.

We have a few members dealing with calcinosis cutis and I am sure they will stop by not only to welcome you but to share their experiences. We will all stay tuned for the cushings testing results.



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Glad you found us! It is a shame you started a huge dose of prednisone because prednisone is essentially cortisol. If your dog has cushings it is from too much cortisol so the prednisone added to the problem. You really do need to wean her off of it. Please tell us what you mean by a huge dose of prednisone.

Specifically tell us how long she's been on prednisone, what dose and how much does she weigh?

What is the weaning plan? Note that you must wait at least 24 hrs from the last dose of prednisone before doing a cushings test to make sure it is all out of her system and so that the test results aren't skewed.

Thanks, Kim

Hi Kim,

Thank you for the questions. She is18 pounds, and the dose is 20mg per day. My understanding is that is a fairly large dose for her size (as opposed to a past foster with a brain tumor that was on 10mg per day). We just started it last Friday, after her biopsies. I have already begun weening her off, and she should be completely done by next monday. My vet wants to wait a week before doing the cushings test to make sure the pred is completely out of her system.

I should add that she has never, up until last week, been on prednisone or any steroid for that matter.

Hi John, thank you for the welcome. Rescue is amazing. It frustrates me, breaks my heart, and makes me want to quit all the time... but, every time a dog is saved, I know something is right in the world. I've been doing pug rescue the last 5-6 years. Learned so much, but in all that time, I have not had a cushings dog!

Yikes that is a very large dose. Sounds like your vet has it under control. We have had many members deal with calcinosis cutis and hopefully some can give you their input re meds and shampoos that have helped. In the meantime you can do a forum search and find threads to read as there is a ton of experience here. Kim

Hello and welcome to the forum.

It seems like you have had a long journey to get to the point with poor Tobey going through so much.

What a sweetheart you are. We have others on here that do rescues too, it is heart breaking at times and heart warming always. :)

Yep, once the prednisone is out of the system and luckily she hasn't been on it for a really long time. (my golden was on pred since she was 2 years old and never could go off it completely) But once that is through and a suitable time has passed then you can start testing for cushings. It is strange that the liver enzymes aren't raised, as that is a general clinical sign, but it is not true for all cushings dogs. In fact it is great that they aren't. There are two tests, and because cushings is so hard to diagnose and because you definitely don't want to give cushings meds to a dog that doesn't have it, many of our members have both tests done to confirm. They are an ACTH test, which will be high if there is anything else going on too, and an LDDS, which determines their ability to suppress cortisol.

It sounds like you have already done a lot of research which is good. We also have a very good research section that you can browse through. Knowledge is key with cushings and since your vet doesn't have a lot of experience with it, um, or any, then you will have to work as a team to get this right. You can print out any studies or recommendations to take in to her, to help her to get up to speed.

One thing that we are real sticklers on, is protocols. Protocols for dosing and for testings. Following the most current recommendations for treatment, will produce the best results and be the safest. In conjunction with the protocols though is the knowledge that every dog is different and what they need might be different too. Some dogs do a bit better with higher levels of cortisol, some with much lower. Symptoms is the key to determining that. With the cc though, it can get worse before it gets better and is one of the last things to usually clear up.
Just a thought to keep her comfortable is tea compresses. Camomille, green tea is currently helping to keep one of our forum boxers comfortable. Onsies is another thing you can try to put on her to keep her from messing with the cc. (they also work pretty well to keep diapers on)

Wow, that is probably enough for now. I don't want to overwhelm you all in one post. LOL

Welcome again
Sharlene and Molly Muffin

Hi Sharlene,

Thank you for the welcome and the information. I did check out the resources forum. Lots of useful stuff in there! I've been slowly reading throughout the last few days.

I have already spoken to my vet about doing both the ACTH & LDDS testing. She said that she would like to start with the ACTH first, then the LDDS. She does not have a lot of experience with cushings, but she is also very open to working with other vets, and we do have a veterinary internist up here. I don't care much for the internist, so I'd rather try and stick with my vet and work in conjunction with the internist. That being said, I will of course put my personal feeling aside regarding the internist, and go to her whenever I need to.

It is good to have a team to work with, the internist and your vet. Does the internist have experience with cushings? I see both, my specialist for ultrasound and consultation and my vet for tests, etc.

Sharlene and Molly Muffin

Hi Renee,

Welcome to you and Tobey, so sorry for the reasons that brought you here but sure glad you found us.

Cushing's is one of the most difficult canine diseases to diagnose, which makes it one of the most misdiagnosed diseases. Many of the symptoms Tobey is showing can be attributed to prednisone, Calcinosis cutis included.

When it comes to canine kidney disease, 50%-75% of kidney function is lost before increases in the creatinine are seen. If this were me, since the ultrasound did show abnormalities with Tobey's kidneys I would have this issue checked out further...just my opinion, and I am sure others will be along to share theirs. ;)

If you have any questions please do ask them, and know we are here to help in any way we can.

Hugs, Lori

Hi Lori, Tobey has only been on prednisone the last six days, so it's definitely not the cause of her symptoms. She's never been on it before either.

We definitely will be exploring her kidneys more when we do an ultrasound.

Just updating here and asking for advice.

My girl finishes her pred this week, and we are scheduled for a vet appt on Friday to discuss the next steps.

We will most likely start with the ACTH test, but I was wondering if anyone had any recommendations on exploring the possible kidney disease, other than just an ultrasound? Bloodwork comes back normal, but as someone said, the disease has to be pretty far progressed before the bloodwork will reflect any abnormality.

Is it possible kidney disease could account for her issues? I don't understand how it could cause the calcinosis cutis?

I am also concerned that her liver function is normal, even though elevated liver function appears to be a cushings indicator.

Thank you everyone!

Well cc, is normally the result of high cortisol from what I understand as to cause and effect.

You could have a thorough urinalysis, to check protein, etc levels. Other than an ultrasound, if the blood work is not showing any problems yet, I don't know what else you would do. Maybe some of the others have some thoughts as we do have some pups on here that are being watched closely for kidney issues. Addy's Zoe, Tina's Jasper and Trish's Flynn, just off the top of my head.

I would do the ACTH and ultrasound if it was within my means to do so I think.

Sharlene and Molly Muffin

Hello Renee,
Welcome to our family, and god bless you for all your hard work as a rescuer. I'm sorry that your baby is ill I can totally relate to the CC, my girl Buttercup has a sever case of it. She was diag with the CC on 11/02/13 her vet went straight to the LDDS test first due to her having experience with Cushing's and it came back positive.
What I have been using on Buttercups CC is hibistat wipes to keep the areas that are weepy with blood or clear fluids clean and since the real bad spots she can not reach to lick at I use neosporin on them as well , which her vet did approve of. I can only find the Hibistat at walgreens. They have been working well to keep the open areas from getting infected.
If your little one scratches her self up and makes a bloody mess of her self(hopefully she won't) like Buttercup did, of course clean as best as possible with clean cool water then apply the neosporin and put a cold wet compress on the area, do not use anything warm, then put a ice pack on it, wrap a bag of frozen peas or corn and put it on top of the wet compress then place a towel over her, the cold pack will cool the skin and reduce the pain and inflammation,
for the other areas chamomile and green tea compresses are good for the skin.
Butters likes the warmth of the compresses and hopefully your girl will to.

You are on the right track, keep up the good work and know that you are a part of a very special family, we are here to help in any way we can, I do not know what I would have done with out all these wonderful people the last 30 days.

Dawn & Buttercup

Dawn, thank you so much for the great tips on the CC!! So far, the lesions are isolated to her back, so she cannot reach them to scratch, but it seems like they do itch, because I catch her trying to run along the couch sometimes. I will try the cool compresses to help sooth them.

Thank God that is one problem Tipper does not have. I thought it would be too from her allergic past. It must be awful for these babies to have CC. Do you wear a T shirt on her? Tipper does have the small hard lumps like calcium deposits. She has chewed the one at times, but has mostly left it alone as it is on her foot. Hope you find something that works as I know many on here have that problem, and I see how many things they try to get rid of it. Blessings
Patti

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Originally Posted by goldengirl88

Thank God that is one problem Tipper does not have. I thought it would be too from her allergic past. It must be awful for these babies to have CC. Do you wear a T shirt on her? Tipper does have the small hard lumps like calcium deposits. She has chewed the one at times, but has mostly left it alone as it is on her foot. Hope you find something that works as I know many on here have that problem, and I see how many things they try to get rid of it. Blessings
Patti

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Thanks Patti. Fortunately, she cannot get to the lesions, as they are on her back. No tshirts yet. I have been using DMSO on them and it seems like some parts are starting to peel up? It's weird. My kids think she's turning into a zombie, lol.

Renee: we've been using the DMSO on Cosmo's CC as well. It does seem to go through many gross stages along the way.
KJ & Cosmo

Quote:

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Originally Posted by thecoz

Renee: we've been using the DMSO on Cosmo's CC as well. It does seem to go through many gross stages along the way.
KJ & Cosmo

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Could this stuff smell any worse?? Ughhhh. We've been putting the DMSO on daily.

A huge part of one of her CC lesions peeled off today. The skin underneath looks like burn patient skin. :( I am hoping maybe with the big hard scab off that it feels better though.

yes, that stuff is very strong and we aren't supposed to let our other dogs near Cosmo for an hour after applying...because you can't let them touch it. When Cosmo's lesion peeled, the skin underneath looked very pink. I wouldn't say it looked burnt though. Our vet suggested dividing Cosmo's body into thirds, so each day only one-third of his cc area is getting an application of the DMSO. Therefore, each area/spot is getting the med only once every three days. It's slow going, but it's working.

I feel so bad for anyone having to deal with this CC it is surely a horrible thing to try and get rid of. Blessings
Patti

Quote:

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Originally Posted by thecoz

yes, that stuff is very strong and we aren't supposed to let our other dogs near Cosmo for an hour after applying...because you can't let them touch it. When Cosmo's lesion peeled, the skin underneath looked very pink. I wouldn't say it looked burnt though. Our vet suggested dividing Cosmo's body into thirds, so each day only one-third of his cc area is getting an application of the DMSO. Therefore, each area/spot is getting the med only once every three days. It's slow going, but it's working.

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Yes, the skin is very pink and raw looking, like it had been burned and now peeling away. I think exactly what you are describing.

I have been putting the DMSO on daily, not every three days... hmm... It smells so horrible, none of the other pugs come near it. And, every time I let them sniff part of her lesions, they take a sniff and back away from it. Its like they know its bad.

Renee:
This CC is certainly such a terrible thing to try and cure. I am sure your other babies can smell the flesh disintegrating. This has to one of the more wretched things this Cushings does. I am so sorry you and your baby have to go thru this. It hurts me just thinking about it. Blessings
Patti

Thanks Patti. It is really hard, almost worse than any other symptom at the moment. It sounds gross, but you know how dogs are, my Ichiro would eat any scab (barf), but he won't go near these lesions. I keep wondering how many layers of skin the CC will go through?

Renee: I have a few pics of Cosmo in my album on here if you want to see them. But I think you have to be in my "contacts" list, unless I make the album public.
KJ & Cosmo

oh, and my other two dogs treat Cosmo like he has leprosy, lol.

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Originally Posted by thecoz

oh, and my other two dogs treat Cosmo like he has leprosy, lol.

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Awww, poor baby! lol.

I'll see if I can access your album. Still figuring out all the navigation.

you should be able to access it. Pics #1 & #2 were recently added. #3, #4 & #5 were from a few weeks ago.

Just updating.

Just got off the phone with the vet and we are scheduled to run the ACTH and LDDS test next week.

Symptoms continue to persist. I will be so glad when we get this diagnosis behind us and can start treatment.

I think Cosmos cc looks a little better in the later pictures.

Next week is going to be a busy one it sounds like Renee.

hugs,
Sharlene and Molly Muffin

Met with my vet yesterday to make a plan for next week.

Tuesday is the ACTH and Wednesday is the LDDS. Assuming the results confirm cushings, we will start vetoryl on Friday. This will be my vet's first time using vetoryl for a patient.

Two more lesions of the CC busted open last night, so it's spreading. :(

OK so if its the first time - did he/she share what dosage and frequency? Please let us know that as well as weight of your girl so we can make sure it is ok prior to you ordering pills.

There are many schools of thought on dosing and trust me - from reading on this board since the drug was released you want to start LOW and tweak upwards slowly over time.

Kim

Quote:

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Originally Posted by frijole

OK so if its the first time - did he/she share what dosage and frequency? Please let us know that as well as weight of your girl so we can make sure it is ok prior to you ordering pills.

There are many schools of thought on dosing and trust me - from reading on this board since the drug was released you want to start LOW and tweak upwards slowly over time.

Kim

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My pug is 18.4 pounds. We ordered one bottle of the 10mg vetoryl to start. We have not committed to one or two pills a day, as we are still comparing the UC Davis to Dechra protocols. I wish the two weren't so different. It makes it much more confusing to try and decide what is the right amount to start with.

That said, my vet is so awesome about listening and making a plan WITH me, not FOR me. I know we will do what is right and not jump right into something bad. The minimum we talked about was 10mg once per day (following UC Davis) or 10mg x2 per day (Dechra).

I will say, I was expecting the medicine to be a lot more expensive, based on what other people have expressed, but the one bottle of 30 10mg is only $66 through my vet. Not bad at all!

From my experience starting Freckles on vetoryl, please do the minimum dose once a day and observe. Freckles weighed 29 pounds and was started on 10 mg once a day. After 3 weeks, her ACTH came down from 19 to 8.6.

The dosage was doubled and trouble started. There were other factors, such as other medications for other issues, but my IMS agrees that we keep her off for a month and then restart at the 10 mg per day.

It can cause tummy upset so be prepared.

Getting the dose right is a trial and error process that can be challenging. Read up on the symptoms of too much and too little medicine so you can catch it when it happens.

Good luck with the tests and keep us posted.

Louise

Renee:
I can tell you that low is the way to go. You may have to have more testing and more dose changes but the chances of something happening are really minimized by this approach. I have inched Tipper up every step of the way to ensure her safety. You dogs safety has to be the paramount concern here. The lower you start the least amount of trouble you will encounter from my experience. I know you will get it right, and everything will be ok. Blessings
Patti

Just updating.

The ACTH stim test was today (delayed a day). Results should be in tomorrow, hopefully, and the LDDS test is tomorrow too, with results from that coming in Friday.

I was planning to go with the UC Davis protocol, but after talking with my vet and my husband, we are leaning towards the Dechra protocol.

Of course, once I was all ready with my decision, I started reading other threads and came across the commentary in regards to the use of vetoryl and CC. Tobey's CC is fairly bad, and getting worse. Some spots look like they are clearing up / drying out, but new spots are popping up and busting open. I am usually pretty stoic about stuff (years in rescue will do that), but I am starting to get very discouraged on the CC and how to treat it. I definitely do not want it to get worse.

It's hard to decide what is right. I am not the type to question myself very much, but my head is getting so full from so much reading, that I am having trouble making decisions. I just want my poor girl to be happy again, and not have these painful lesions all over her back.

hmmm, I do understand your concern about the trilostane and the cc. Yes, Cosmo is getting better it looks like while on trilostane and Zoe got better too while on trilostane. I think that again, we are at the same point of every dog is different, and while some do better, in some it doesn't work as well.

I think though that since cc is one of the last symptoms to clear up and can get worse before it gets better, that you don't know until you try it. I've heard of it taking up to 6 months to clear up some cc, it can be real tough to get through that time.

I've sent messages to a couple of our other members who haven't updated in awhile to see how their cc is doing on the trilostane, so cross fingers that they'll get the message and reply.

hugs,
Sharlene and Molly Muffin

Thanks Sharlene. I had myself pretty upset last night, but today is a new day, and I am trying to stay positive. I am still going to try the vetoryl first. I went and visited Cosmo's thread and took a look at his pictures. It is encouraging to see his CC getting better.

Now remember, it's a long haul recovery with cc! So, set the expectation meter lower and don't get discouraged. Okay, we're right here with you and great at pep talks. :) We're also realistic so we'll call it as we see it, okay?
Just hang in there and remember our motto, baby steps. :)

hugs,
Sharlene and Molly Muffin

I think that once we got Cosmo on the vetoryl (even his small dose) the cc stopped progressing. It didn't take too long to notice it was starting to help. Hang in there!