Hi all, foster girl with Cushing's

Hi and sorry for my english:rolleyes: I am from Greece and I found this forum while searching for Cushing's syndrome, never thought there will be a specific forum! Glad I found it!

I have 2 mixed breed dogs of my own and i often foster strays, we really have a problem here.:(
Last 20 days I have a new foster girl, sweet Lucy . She is small, only 8 kgrs, around 10-11 years old, and was abandoned at the streets of Athens about a month ago so I don't know anything about her past.
From the first day I noticed the bad skin condition, the alopecia, the large belly, the excessive drinking and urination and how hungry she was, she was licking the floor for hours ! She had many of the symptoms, we did the blood work and she was officially diagnosed some days ago. I believe she was abandoned cause they found out she was ill and the cost of the exams and meds is quite big here.

I already found a lot of interesting and helpful information in the forum, thank you!
Hope the best for your fur babies

Hello and welcome to you and Lucy! I’m so glad you’ve found us, and your English is excellent — there is no problem at all with that! I’m afraid it will be tomorrow before I can write more to you, but I did not want to wait to welcome you and to let you know that your membership has now been fully approved and anything you post from now on can be seen by all our members. You do not need to reply to an email request for membership confirmation if you should receive one — you’ve now already been fully approved.

You are a wonderful person to take care of all your dogs, and we’ll do everything we can to help you make decisions about Lucy. As I say, I’ll write more tomorrow, and once again — welcome to you!!

Marianne

Thank you mery much :)

I ll do my best to "study" as much as possible, its quite a new and complicated thing for me.
So nice to find people that can understand and have a knowledge, I want to do the best for this poor girl someone left.

Alright, I’ve made it back once again! As I said yesterday, we’re so grateful to you for taking care of the stray dogs who have been abandoned — you are truly their guardian angel. Sadly, we know how overwhelming and expensive Cushing’s treatment can be in all countries. I’m sure Greece is no exception. If you could share Lucy’s numerical test results with us, that will help give us a clearer picture of her current situation. I’m not sure what diagnostic testing is done in Greece, or what medication options may be available. If you can tell us more about that, we’ll then do our best to help you find the best solutions for her care.

So please feel free to ask us any questions you may have. We’ll be so anxious to learn more about sweet Lucy!

Again, welcome to you both.
Marianne

Marianne, thanks again for your nice and encouraging words :)

From previous posts I read, I noticed things are quite the same. Except from the symptoms which she had most of them, she also had some anomalies in her check up blood test, like high ALT. So she did the LDDS test. I do not have the numbers etc of the LDDS test ( it was done by the towns shelter vets and its somehow complicated to have them in hand) . Vetoryl is also used here, as i understand its the only medicine suggested for Cushing's by greek vets.

Vet prescribed to start 30 mg vetoryl every morning, cause he said her cortisol is very high and her symptoms advanced. It seems so big dose for a such small girl (she is around 8 kgs.) and i am scared (in general overprescribing its usual here). An animal welfare organization donated her first box of medicine but i did not started yet, I am trying to get the papers/exams so I can take an opinion from a vet clinic I trust ,asap.

I hope i ll take the second opinion fast, cause her skin condition is worse in comparison with the first day she came here. Her panting is somehow better cause she is all day in a room with air condition and i take her small walks only late at night (Greek summers are very hot). I also think she has lost some weight and the belly looks smaller. She probably had a poor diet before, now i feed her 3 small meals, only cooked low fat meat with vegs and also grain free kibbles. I also started her milk thist , turmeric and probiotics to prepare her body as best as possible for all these meds.

My main concern at this time is the 30 mg dose, seems very high. I noticed dogs with the same weight in the forum usual started with 10 or maybe 15 mg.

Thank you, Matina

Dear Matina,

Thank you so much for all this additional information. I think you are doing all the right things in the way in which you are taking care of Lucy -- the air conditioner, the short walks, the meals, the supplements. Everything you are doing is so good, and such a gift to her after her life in the street.

I understand that it can be difficult to personally get test results from some vets, especially if they are working directly with shelters. We do know that conditions other than Cushing's can give "positive" results on the LDDS test, but from all the symptoms you've described, it does sound as though Cushing's is the likely cause of Lucy's problems. I'm especially sorry to hear that her skin condition is getting worse, because there is a particular kind of skin ailment called "Calcinosis Cutis" that can make life miserable for Cushing's dogs. If you do an internet search on that term, you can find some pictures that you can compare to what you're seeing with Lucy. If it looks the same, then it's true that you'll want to start Vetoryl treatment as soon as you can in order to try to keep it from getting even worse. It it's only the case that she is losing hair and having bald spots, it's not so important to be be speedy in starting treatment. In that case, it's mainly just her appearance. But if she is developing sores that look like the pictures of Calcinosis Cutis, then the problem is more serious.

It's so good of the welfare organization to have donated a first box of medication. However, like you, I wish so very much that the shelter vet had prescribed a lower dose to begin with. I'm afraid many vets make the same mistake of thinking that, if the symptoms are bad and the case seems advanced, the dog should be given a higher dose. But everything we've been told by researchers and even the company that makes Vetoryl is that initial dosing should be based solely on weight and not severity of symptoms. So you're right, a safer starting dose for Lucy would be 10-15 mg. Every dog metabolizes the drug differently, and it may well be the case that she might end up needing to take a larger dose such as the 30 mg. daily. But in order to avoid risky side effects, you want to start with a lower dose, and see how the dog does both in terms of symptom relief and bloodwork results. After you see how the dog handles the medication, then it is safer to increase the dose at that later time if it seems necessary.

In Lucy's case, though, especially if it looks as though she has Calcinosis Cutis, I really don't know what I'd do if she were mine and it looks as though it will take a long time to be able to get a smaller dose. I might risk going ahead and starting the medication, while watching her very closely for any ill effects and stopping the medicine if anything worries you. You can see that I am placing a lot of importance on her skin, though. So if you can describe her skin in more detail, that can help us make some decisions about whether or not to wait to start treatment.

Marianne

I searched about calcinosis cutis, I think she is not so bad, seems an awful thing.

Lucy has some sores in her back legs and tail and her belly seems to have some kind of mild infection, the skin is very thin i can see her veins and not so elastic, i can also see 2 large round spots that seem infected and she has some small bumps . She also has some darkened spots that seem a little dry. Her nose is crusty and dry also and her ears seem a little dirty.

The main skin problem is around her throat, when she came here she had already lost her hair and had some dark patches but now it seems like some kind of dermatitis or bad infection, has sores, its greasy and has developed a weird odor.

I expect to have the exams tomorrow and get her to another vet for a second opinion , especially about the dose. I ll try to talk again to first vet also , maybe he will agree to a smaller dose.

Thank you.

PS. I send the vet the Dechra protocol about Cushing's treatment , where is is clearly suggested to start with the smaller dose of 2 mg/kgr and i am waiting an answer.

You are doing such a great job for Lucy! I know I keep repeating this, but it is *so* true! Good for you that you sent the Dechra info to the first vet, and that you've set up the new exam as well. Thanks also for the thorough description of Lucy's skin problems. I agree with you -- it sounds more like she may be suffering from skin infections rather than the Calcinosis Cutis. Skin infections of all kinds are pretty common in untreated Cushing's dogs because their immune systems are weakened by the disease. Low thyroid levels can also be associated with Cushing's, and that can also make dogs more vulnerable to skin problems. If Cushing's is causing low thyroid, the thyroid levels should improve on their own once the Cushing's is treated. However, sometimes dogs end up needing thyroid supplementation if their levels are low and Cushing's is not the cause. I just mention the thyroid because that may be a blood level that you'd want to have checked by the new vet if it wasn't already done by the shelter vet.

No matter what, we'll be anxious to hear how the new exam goes tomorrow.

Me again! I had one more thought to add. After posting a similar reply to another member, it occurs to me to also suggest to you to request a “rescue” dose of prednisone from one of your vets in the event that you do decide to start her off with that higher 30 mg. dose of Vetoryl. Having prednisone on hand could give you some extra peace of mind, because you would be able to quickly supplement Lucy’s corticosteroid level in the event that the medication were to drive her natural cortisol level too low. Hopefully you will be able to start off with a lower dose of Vetoryl to begin with. But I just wanted to suggest the prednisone as a backup if the lower dose is not available. The necessary dose of prednisone would be very small for a dog of Lucy’s size — I’m very annoyed with myself that I can’t remember the exact formula! But it is just one more thought that I had before your vet visit tomorrow.

Its a good thought, I have always predinasone at home, saved my dog once when he had a bad allergic reaction, so that will not be a problem. I ll ask the vet about the dosage.

Tomorrow Ill probably have the numbers of the LDDS test and her blood work so I can ask a more experienced with Cushing's vet about the 30 mg dose.
I hope I ll get an answer until Monday and can finally start with the treatment.

Lucy is now enjoying her new cooling mat, seems to work for her. ;)

Ηι , I have a good update, I went to the second vet, way more experienced. He agreed that 30 mg is too high , also he commented that her cortisol levels are too high. He suggested that she starts with a 15 mg a day. I am feeling better about this dosage and more willing to start the treatment.
Also thinking of start even lower at 10 mg , the cost of 10 and 5 mg medicine will be too much and we rely on donations for her meds.

I m thinking of starting at Monday, that doctor will be easy available in case something will go wrong.

I’m so glad to hear this news! I think that’s a good idea to wait until Monday to start the medication. And given the expense, I also understand why starting off with 10 mg. may work out the best — both in terms of cost and safety. I’ll be thinking of you and Lucy on Monday, and hoping all goes well!

Hi, we finally did not start the medicine yet, as it seems currently there is a problem with finding the 10 mg meds in Greece. After calling many pharmasists I found just one box available and we will have it tomorrow.

Also i found a pharmacist that splits the 30 mg, makes new capsules and can make them the right amount. Will be that safe? I met 2 people that did that in the past in the same pharmacist and everything went well. I ll start now with the 10 mg meds, but i kept the 30 mg also, so in case i can't find the 10 mg in future i ll continue with the split capsules in the dosage that Lucy will require after the first month.

Thank you

Yes, I think that should be fine to have the pharmacist repackage the 30 mg. capsules for you. We caution against people opening capsules and sprinkling out portions of the powder themselves, because it’s likely that the individual doses that they end up with can vary quite a bit. But I would think a professional pharmacist should be able to repackage all the capsules safely. There may still be a little variation in each individual dose, but far better than if any of us tried to do it ourselves. Good for you for finding these options, and hopefully you’ll already have the new 10 mg. capsules tomorrow.

hi! We finally managed to get the meds yesterday! Today Lucy took her first pill, i decided to start with 10 mg. She seems ok for now.

I arranged her test for 17 august, 13 days from now.

Hope everything will go well, Lucy is a tough girl.:o

Just want to make sure you're aware that the Vetoryl has to be given with a meal to be properly absorbed. Also, those ACTH stimulation tests have to be performed 4-6 hours after the Vetoryl was administered with food...Good luck!!

Lori

Thank you Lori.
Yes I already read that in the forum, also the vet told me about the meal and that the test must be done 4-6 hours after the pill. I give her the pill with wet food , I believe it must be better than kibbles.

Lucy seems ok today, hope the meds will help with her appetite and thirst/urination , last days she is even more aggressive around food.

Hi. Lucy is now taking the meds for 6 days, I think the drinking/urination is less already. Yesterday I came back from work and for the first time the water bowls were half full.

I finally got the LDDS numbers also

there are 3 numbers
26.2 μg/dl [ref. 0.7-8.0]
11.8 μg/dl
8.2 μg/dl

(maybe this is not the correct order, i took printscreens:eek:)

So sorry for the delay in replying to you, but I’m so glad that Lucy is already doing better! And thank you for the test results. This result is indeed consistent with Cushing’s, and the form of the disease that is caused by a pituitary tumor. This is the most common form of Cushing’s. I hope that perhaps you’re seeing even more improvement by now. We’ll be anxious to hear :-).

Marianne

Hi, I was away for vacation, so Lucy spend her last 20 days in another foster house. She did her 14th day test, her cortisol levels are still high 11.4 μg/dl [ref. 0.7-8.0], but she seems to have some improvement. They told me her belly seems better and her drinking /urination is less. Tomorrow she will come back here so i can see on my own eyes, if there is a real improvement.

I'm currently looking for another doctor near me to continue her treatment, cause with the shelter vets its difficult to be sure that the test was done in the correct time (I have a strong belief that with so many strays and work, they didn't test her in the 4-6 hours frame), and we can't in general agree with the treatment plan, they don't agree with the smaller 10 mg dose. They also wanted to give her an even bigger dose before the 30 day period.

Thanks again for this new update. Like you, I surely hope you'll be able to find a new vet who will be more knowledgeable about Cushing's treatment and protocols. I'm especially glad that Lucy didn't get the increased dose at the 14 day mark. It's possible that her cortisol may have been running even higher at that time due to stress over being in a new foster house. So it will be good to get her settled back down in your own house, and then to go from there. Once again, thanks for letting us know what is going on!

Marianne

Ηι! lucy is back here with us and she seems well. I visited another vet also, not quite satisfied again, they all just told me , take vetoryl, come back for exams every 2 months, i had to make all the questions and suggestions again.
At least the new vet agreed that the right dose to start was 10mg, he is next door and i can arrange to make the test in the right time frame, and in a very good price. (And i will be able to communicate easy and ask questions, in the shelter clinic that was difficult)

I got the results of her 14th day test ( shelter clinic), they just gave me a number 11.4 μg/dl[ref. 0.7-8.0], No explanation nothing


After almost one month on vetoryl I noticed some changes

The belly seems quite smaller.
She has no new hair lose and the smelly bad spot in her throat is somehow heeled now.
Drinking/urination is better , she still urinates frequently but i need fewer bed pads.
Her apetite is still huge!
She is more energetic and sassy, she is the boss here!
Panting is better, but the weather is not so hot any more.


The new vet also suggested that i skip the one month test , give her vetoryl another 2 weeks and then take the test. Not sure about that, although she seems to have no bad effects from the meds.

Is the 11.4 ug/dl result a post number? I'm thinking it is and if so I believe waiting a month for a recheck is fine as long as she's acting normally.

Ηι! Just here to inform you about Lucy. She seems to do well with the 10 mg meds, no bad symptoms .

Panting is much better , her belly is smaller also and the skin is better, not thin anymore.
She still pees many times a day ( around 8-10) but much less than before (before was 25-30 times a day).
She is still hungry all time also, but somehow better, at least she stopped licking the floor for hours.
Her hind legs also seem to be stronger, the last 3 days she can stand on them to reach things ot jump happy around

She is going to have a test in 2 days. They told me they take just one sample, wondering if you ever heard about that. I thought they take 2 samples for the retesting..

Thanks for the update and I'm happy to hear that Lucy's symptoms are doing better. Regarding the one sample collection, your vet may be doing the pre-Vetoryl method, I'd definitely ask the vet if this is what they are doing. Here's a link about that: .https://www.k9cushings.com/forum/sho...TH-Stimulation
Good luck and let us know those results, please

Thanks again for another update! I’m glad to hear you’re seeing some improvement, but realize you would like to see even more. As far as the testing, one monitoring protocol with which we’re familiar does involve only one blood draw. This testing protocol involves taking a blood sample right *before* giving the morning dose of trilostane. Here’s a link that describes how the test is done and how the results are analyzed:

https://www.k9cushings.com/forum/att...2&d=1659215520

Traditionally, the ACTH stimulation test has been the most commonly used monitoring test, and it does involve taking two blood samples one hour apart. However, during the last couple of years, the pre-Vetoryl monitoring test that I’ve described above has become common, especially in Europe. It’s less expensive because it doesn’t require the injection of a stimulating agent. As long as dogs appear to be generally well, this may now be preferred in many places. However, the ACTH stimulation test remains a valuable testing tool when more information about a dog’s adrenal function is wanted due to a poor medication response or the fear that a dog may be overdosed.

Hopefully, the pre-Vetoryl cortisol level is what your new vet is talking about. A single baseline cortisol level taken randomly throughout the day does not provide the same monitoring value as a level taken right before the daily dose of medication. So I’m hoping this is what he/she has in mind.

Marianne

P.S. I see that Lori and I have the same thought ;-)

I am not sure about the pre vetoryl test, cause he told me to bring her 5-6 hours after the dose, so i maybe did not understand well. I have to clarify that.

By the way the sores around her neck and head area was in fact the beginning of calcinosis cutis, she also has a smaller spot in her back. They seem to remain the same after the meds and have not progressed more. I also noticed that her legs must feel itchy, she licks them all time. I bath her with chlorhexidine shampoo once a week and use some aloe vera gel to help her with the itching.


I am glad she started the meds, she is already better, her mood also is different, she seems younger and more energetic. Sometimes i am thinking she is lucky her previous family abandoned her, she was probably left untreated for much time.

I'm glad to hear your dog is doing better on the medication. Don't forget to clarify the pre-vetoryl test timing with your vet. Lucy is lucky to have found a loving home with you!

Hey medusa, I just wanted to tell you that I am following you and that I greatly admire your compassion for Lucy.

Thank you all for your nice words and support.

I decided not to risk it with the next door vet and I rescheduled the test with the big clinic , the one that visited for a second opinion and I trust the vets, they have an experience with Cushing's. They prefer the ACTH and not the pre-vetoryl test.

In general i have the feeling that she maybe needs a bigger dose, the urination and drinking are better but yet not seem very controlled and i have the feeling that the last days she pees more again. Her hunger also is huge.

I'm relieved to hear that you have decided to go to the big clinic and will be having the full ACTH stimulation test done, I do believe this is the best choice. Please do let us know those results when you get them...thanks!

Alright, do let us know how it goes. We're here to support

Best wishes!

Hi all. Hope you are all ok.

We have some, not so good, news.

Before some days i noticed a big lump in lucy's chest (under her leg) firm to the touch, irregularly shaped.
Today we had arranged a visit to the vet clinic. She finally had a prevotoryl test (vet suggested that results can be safe as far as she still has the cushing's symptoms) and also took a sample of the lump to examine. He seemed more worried about the lump than the cushing's progress at this moment.
We ll have the results in few days.

Lucy is still energetic and happy and does not seem to be in any pain. I ll inform you about the results in few days.

Yes, please do keep us updated when you can and know you are not alone. You and Lucy are family now and we stick with our family no matter what. We may not have answers or experiences to share in every circumstance but we always have strong shoulders and gentle hugs to offer.

Ηι again and thank you for the support! It's nice and so helpful to talk with people that have been there and understand the situation.

The results came, and we have good news the lump was not malignant! She will take antibiotics and we will check it again in 15 days.

Her cortisol levels were still too high (I have not the paper yet) and fact is that her symptoms especially urination, drinking, polyphagia are not controlled at all so the vet suggested we go to 15 mg dose per day. I am also very satisfied with the new vet, he was very informed about the updates in protocol and everything i read here, and he is very caring and understanding, he even charge me a special much lower price cause she is a stray foster dog.

As i told in past I found a pharmacist that divides the 30 mg capsules into new of 15 mg and i ll go with that cause the cost is less.
Hope we ll see some progress soon!

Ηι, Its the 4th day on new dosage and i already saw an improvement in urination and drinking, much better now. She used to pee 12-15 times a day and now around 8.

Vet described Lucy antibiotics for the lump and skin infections, do you think it will be ok to have antibiotics while on vetoryl? Maybe its better to give her also probiotics or is there something else i should consider?

Thank you in advance.

Although I am not a vet, I do believe it is fine to give antibiotics while on Vetoryl. Dogs with Cushing's are more likely to get infections, especially UTI's, so antibiotics are prescribed often. Glad to hear that the symptoms have improved and I hope they will continue to do so.

Hi all, just an update

Lucy is about the same. At the beginning with the new dosage (15 mg) i saw an improvement but as days pass i feel we are back in the same... peeing around 12-14 times a day again, drinking a lot of water , hungry all time.
The skin seems to have no improvement also and as i was bathing her last week i saw some new spots that seem like CC, especially around her genital area and neck area. She is also more easily irritated and seems more anxious, even growling to the cats and other dogs.
I spoke to the vet and we decided to test her again in 15 days. ( 45 days from last test).


Hope you are all ok!
Matina

Thanks for the update and I'm sorry her symptoms have gotten worse. It does seem that an increase may be needed and the ACTH stimulation test will let us know. Please do post those results when you get them.

Lori

Ηι all ! Just an update about Lucy.

We are still on 15 μg vetoryl and last days i saw a big improvement in her drinking urination.

The biggest problem this last month is the huge lumps with fluids that they develope suddently ( sometimes on just 1-2 days) in her belly and chest area. This time it was a huge one (size of an orange) and it burst under the skin and become a huge wound so she is again on antibiotics. Vet told me that its something he sees often at Cushing pups. I feel very sorry for her cause it seems bad, but she seems happy and energetic as always!

Hope you are all ok and wish you all a happy new year.