Advice wanted 12 y/o female Staffordshire bull terrier (update: Tia has passed)

[Mel-Tia]

I need some advice about conditions which can develop as a result of cushings

Tia was diagnosed feb 2010 after she developed Calcinosis cutis and has been treated with vetoryl relatively successfully for the last two years we have had to change the dose up and down a few times and give her 30 mg twice a day which seemed to be working, however over the course of the last few months her skin condition has returned despite the fact her ACTH has been normal (last two results post: 143 and 110)

Her cholesterol and alkp have remained high throughout this time

I took her to a specialist who said we should do a CT to see if her tumour has grown however we couldn't afford to do that as her insurance has nearly run out and I could be made redundant this week, she isn't showing neurological signs in my opinion more like discomfort of some description.

She has all the symptoms of pancreatitis (shaking after eating, really thirsty, loss of appetite some days) but that test has just come back normal, while we were waiting for that I cut out all fat apart from chicken and that has seemed to help her behaviour settle down but I am at loss as to where to go now as I am sure she has something tummy related which is impacting how she metabolises her tablets

She always seems to have a dry mouth and i didnt know if that means anything, she was 16.5kg when this all started and she is now 14.5

Any advice anyone could give me on where to go or who to talk to or what I should be testing for as i am at my wits end

Thank you

Mel and Tia

[lulusmom]

Hi and welcome to the forum.

Was the last acth stimulation test done after Tia's symptoms returned? If not, that is the first thing that should be done. Did your specialist do a full blood chemistry and urinalysis to rule out other possible conditions? In my opinion, the symptoms you posted are not screaming uncontrolled. UC Davis, a renown veterinary teaching hospital, has done their own extensive studies on Vetoryl (trilsotane) and they admittedly have dogs whose excessive drinking and peeing never resolved, despite satisfactory control of cortisol. Dr. David Bruyette, a renown veterinary endocrine much prefers treating his patients over Lysodren but he readily admits that they have had poor results in seeing resolution of calcinosis cutis in dogs being treated with Vetoryl.

I agree with you on not incurring the cost of a CT scan at this point. If a dog on twice daily dosing has well controlled cortisol and is not showing neuro signs consistent with an expanding macro tumor, I'm not making a connection between the symptoms you are seeing and and the size of a pituitary tumor.

It is known that Vetoryl can and does increase one or more of the intermediate adrenal/sex hormones and these hormones can cause identical symptoms to those associated with excess cortisol. My dog had sky high elevations in all of the intermediate hormones yet showed no outward symptoms. That's not to say that every dog tolerates those elevations well so it's possible that it is this that is causing Tia's problems.

Glynda

P.S. I forgot to ask how soon after eating does Tia start shaking? Is this like a muscle tremor or does it appear that she is really weak for a while and then comes out of it? How long does the shaking last?

[Sabre's Mum]

Welcome Mel and Tia!

I just wanted to touch base whilst I am trying to research a few things for you .... google just will not bring up all the articles which years ago I read so diligently. My dear Hungarian Vizsla, Sabre, had calcinosis cutis and was treated with Lydsodren for approximately two years before he passed away. You are the second owner who is treated with Vetoryl, had previously had the calcinosis cutis clear up and now has it re-occurring (Ugga is the other dog). I am currently trying to research to see what I can find out ... but have not been able to successfully find anything that has been helpful.

There are comments made by various vets ... Ellen Behrend, , VMD, PhD, Diplomate ACVIM, Auburn University who says that calcinosis cutis may never fully resolve with treatment with Vetoryl .... also David Bruyette (if I recall correctly) has not had good results with Vetoryl and calcinosis cutis.

What I am trying to get my head around is why, over time, after a resolution of the calcinosis cutis under treatment, it rears it head when numbers are in range? Firstly, my gut feeling with Vetoryl and calcinosis cutis you need to be on twice daily dosing ... this is my personal opinion ... I am not a vet but my thought is that you need total control and no fluctuations. You are doing this. I know with Sabre, although treated with Lysodren, he needed things to be reasonably constant ... in a range or the calcinosis cutis plates would be "itchy". I should add that this was his healed plates with hair on. Sabre's calcinosis cutis was always there ... it healed over but was on the surface of the skin with hair. When he went low and went on a Lysodren holiday for 4 months we noticed that his calcinosis cutis annoyed him more than usual although his cortisol levels took four months to reach levels we could recommence treatment (between 2 and 3 post ACTH if I recall correctly .... multiply by 27.59 to get the numbers you are used to).

Has Tia had any recent bloodwork done? I wonder whether her serum calcium levels or phosphate levels are elevated. However, from the Merck Veterinary manual "The mineral deposits occur despite normal blood calcium and phosphorus levels probably because of the gluconeogenic and protein catabolic actions of cortisol". In humans there are different types of calcinosis cutis some have elevated levels of calcium and phosphorous whilst other types are normal. I did read ... and now I cannot find the reference that elevated calcium causes increase thirst and increased urination.

So I am at a loss why we now have two cases on this forum. Perhaps the Tia needs to have a certain range and have some consistency. With the last ACTH result of 110 (3.98 ug/dL) do you see the calcinosis cutis getting worse, better or the same?

I am sorry that I do not have the answers for you. Perhaps you could contact Dechra directly and see if you can get any answers from them.

Angela and Flynn

[Mel-Tia]

Hi Glynda

Thanks for replying. The last test was after her skin condition reappeared. I usually do their in house test the one which checks the kidneys etc every 3 months when she has her ACTH test. I am not sure what the blood chemistry test covers?

I know she has always had high cholesterol and alkp over the last two years despite controlled ACTH results. She had a liver function test last year as her levels were low after our summer holiday but that all came back ok

The shaking comes on straight after eating usually just her back legs and not uncontrollably but it lasts around 20 mins, I wonder if it was her tablet so I left it out tonight and gave it a little later but the shaking still happened, it's like she is waiting for the food to make her feel bad

Periodically Tia's doesnt seem to be able to control her temperature so i have to put a fan on overnight to keep her comfortable which her brother does not appreciate now it's winter!

She also seems to be more uncomfortable going big jobs and has to run around to kick start the process which has never been the case ( this has started just recently)

We did a urine anaylsis when i did the last ACTH and that was ok slightly dilute but within range

I am going to get some of her results to post here tomorrow as any guidance or thoughts from people with experience of this condition would be very much appreciated as I feel so helpless as present

Thank you again

Mel and Tia x

[Mel-Tia]

Hi Angela

Thank you for taking the time answer and to research I don't feel like my vet has done that much although she has spoken to the vetoryl manufacturer in the uk and they didnt have much in the way of advice to offer, they suggested the referral

The internal medicine vet said she was 85% sure it was a macro and not really willing to discuss what the other 15% was, I really didn't feel like she had looked at Tias info as she gave me a fact sheet for dogs just diagnosed and we have been dealing with this ok for 2 years so that wasn't very appropriate imo. We did have her blood pressure checked at that visit and it was normal

Her drinking and urination seem more under control since I stopped the high fat bits and she can go through the night without asking to go out which is good but I just feel whatever it is comes back every few days to upset her

I will ask about whether they have tested her Serum calcium and phosphorous levels when I get her other results tomorrow.

I think her skin is getting worse, I have cortavance to treat it to stop it itching her so much while we try and figure this out, she had it down her whole back from her neck to her bum last time and it breaks my heart to think it could come back like that

Thanks again

Mel and Tia x

[molly muffin]

Hello and Welcome. Did the Internal Medicine Specialist say Why she thought it was a macro tumor? None of the symptoms you have mentioned specifically cry out macro just reading them. Is there any sort of neurological abnormal happenings? Head tilt, rubbing at head, circling, dementia type symptoms, stuck in corners, hiding away, lost in the house that sort of thing?

Sharlene

[Mel-Tia]

Hi Sharlene

Tia wandered around the room the whole time she was at the consult and I think this is what made her suspect it plus her liver and cholesterol have never been managed.

Whenever she wanders around its for a purpose cause she is thirsty or hungry or needs a toilet, she doesn't seem to like to drink water from her bowl anymore she asks and I give it to her from a bottle, like her eyes aren't seeing the bowl right but she eats her food from a bowl at the same height!

Tia definitely isn't right as tonight again she is whining for no reason and her belly was gurgling like crazy and the shakes started

I wish I knew what was going on I feel so bad for her, it's not her time yet and I need to get a handle on this

Mel and Tia x

[molly muffin]

I see what you mean, wondering around the office doesn't really seem to indicate a macro, unless was also bumping into stuff and getting stuck in corners.
This does seem to be something internal, perhaps digestive system. You said the pacreatic test came back negative? the Spec cPL?

Do you have copies of all recent testing that you could post here? High/Low abnormals with ranges, include if it is nmol or ug ? That would help alot as everything is a combination of clinical testing and symptoms.

Sharlene

[Mel-Tia]

Ok her last results before I noticed the skin:27th sep

Biochemistry

Protein 64.9 g/l ref range 55.0-75.0
Albumin 31.9 g/l ref range 25.0-40.0
Globulin 33.0 g/l ref range 20.0 -45.0
Ag ratio 0.97 ref range 0.60 - 1.50
Urea 5.2 mmol/l ref range 2.5 - 6.7
Creatine 58.4 unmol/L ref range 20.0 -150
Alt 219.4 U/L ref range 5.0-60.0
Alk phosphatase 2463.1 ref range U/L <=130.0
Cholesterol 8.10 mmol/L ref range 3.20 -6.20
Sodium 143.8 mmol/L ref range 135.0-155.0
Potassium 4.5 mmol/L ref range 3.60 -5.60
Sodium potassium ratio 31.96 ref range 28.80-40.00
Chloride 107.1 mmol/L ref range 100-116.0

Pre ACTH 59.9 ref range 25.0 - 125.0 nmol/l
Post 148 ref range 125.0-520

After skin condition appeared: 30th oct

Pre 76.1
Post 115.0

they didnt do a bio test then not sure why as I always say to do all the tests they can, I have results back to the beginning now if anybody has any ideas or wants me to look at something

Spec PL 161 ug/L ref range <=200

Thank you to you all for any advice you can give me and my little girl Tia this is slowly breaking my heart and I can't stop getting upset as I don't think they are doing enough for her

Mel and Tia

[Sabre's Mum]

Mel ... there isn't unusually high for a cushings dog. The ALP is very high and so is the ALT and cholesterol. Have you every had a bile test done? (sorry trying to read quickly before the kids get out of bed and couldn't see it).

I am trying to rack my brain as to possibilities ... none of them may be right but .... things that come to mind. The trembling after eating could indicate a digestion or "gas" issue, or an upset stomach from the Trilostane. Has Tia's diet changed in anyway recently?

I also agree that it is unlikely the wandering around the consult room is indication of a macro tumour and Sharlene has given you symptoms where macros are the case.

All the best
Angela and Flynn