French bulldog w calcinosis cutis - Qs on Cushings diagnosis & treatment

[lola's mom]

Thank you, all. Glynda - perhaps that's why the Lysodren range was listed on the lab results instead of Dechra's range???

I finally heard back from the IMS just now and based on his experience he is standing very firm on keeping Lola at 30mg until our next ACTH test, with me keeping a very close eye on her in the meantime (I work from home for the most part right now thankfully). It's already been one week since the last ACTH test, so 3 more weeks to go. I'm very nervous...I don't know what the right answer is here - keep her at 30mg or insist she be decreased. OR, keep her at 30mg and get the next ACTH test sooner?

Other things to note:
- Lola is still having those shakes/shivers as I shared in that video from before, but now they are becoming more frequent. The IMS confirmed that does happen to some dogs on Trilostane, and he'll be calling someone from Dechra today to see if they can provide anymore detail on that. Apparently Dechra staff is offsite for all of today & tomorrow for some training, so it will take a few days to receive a response, which I'll post here once received.

- Over the last week I've noticed Lola drinking slightly less water than the gargantuan amounts she used to drink. I don't think it's at her normal rate yet, but definitely a bit of a decrease.

- Sometimes when I take her out now, she won't pee at all, whereas she used to pee every single time I took her outside, even if it was only an hour in between trips. I assume this is because of the slight decrease in drinking...but she's still drinking a lot so I'm feeling like this might be a little bit weird? The vet said they didn't think it was anything to be worried about since her urgency to urinate might be less now...

- Her appetite is still great.

- Her energy is still up (periodic bouts of play and speed walking) and down (moments of looking miserable) throughout the day.

[Renee]

Okay, I can see how you are kind of stuck between a rock and a hard place, trying to decide between going with the IMS or dropping back a bit on the dosing.

My personal instinct would be to drop back to 20mg, but in place of that, I would at least want another ACTH done within 2 weeks of the last. Waiting a month is too long, as the cortisol may continue dropping. I just fear she may drop too low, and waiting an entire month to find out would make me crazy.

If you are home with her most of the time, and vigilant, as we know you are, you will be able to immediately stop the medication if she displays any adverse reactions.

Remember with cushings, the peeing causes the drinking, not the other way around. My pug decreased on peeing before she did on the drinking. she still drinks more than what I would consider 'normal', but her peeing is greatly reduced.

[goldengirl88]

Good job by Renee as that is also what I would do. The numbers are getting low lets face it. From others going thru Addisons crisis on here it scares me to death so much I will avoid it at all costs. I therefore would also drop back to the 20 mg. I have no time to read what your vet said, but please this forum has the experience where many of the vets sadly do not. This will not hurt your dog, but help to ensure it's safety which is the paramount objective here. Blessings
Patti

[lola's mom]

Hi All,

Please pardon the lag in my posts! I hope everyone's babies are doing ok.

Here's the recap and latest with Lola (FYI, she weighs 23 lbs):

• Severe and rapidly spreading bloody and pussey CC in March was the first indication of potential Cushings, which was then confirmed via various tests in March & April.
• She started on 30mg vetoryl for 3 wks and while her numbers went down, a tinsy bit less drinking/urination, bit more energy, her skin dried up (still looked terrible but no more blood/puss), and no more spreading of CC, she was unfortunately experiencing the shakes (Dechra confirmed this happens to some dogs) and blood in her stool so we decided to decrease her to 20mg (the bloody stool is still a mystery, but now it's gone).
• After about 2.5wks at 20mg, it was clear that that was the wrong choice for Lola - her energy went WAY down, the CC began to spread again (thankfully still dry though), very very weak and shaky in her hind legs and she had a few accidents in the house. Her ACTH test at 3 wks on 20mg showed her post number increase to 5.2, whereas it had gotten down to 3.4 after 2 wks at 30mg.
• Given the severe spread of the CC and everything else, we put her back on 30mg and it's now been 3 weeks since we've done that. Starting about 10 days ago, I noticed a huge increase in her energy, less shaky in her hind legs, and her urination has nearly normalized, which is awesome. Also no shakes (she had minimal blood in her stool at the beginning, but no more). Unfortunately though, her CC has continued to spread very very rapidly. She's due to have her next ACTH test in one week.

Here's the dilemma:
Despite the dramatic improvements in her energy, urination, being less shaky in her hind limbs, and no shakes/bloody stool, the dermatologist is so concerned with her CC and believes that Lysodren may be better for the CC than the vetoryl. I also saw this mentioned on a few posts here, particularly one from Gladys. The dermatologist has been debating this switch with the IMS (who has experience with both vetoryl & Lysodren) and he is open to switching her over to Lysodren. Given the severity of her CC he would want her to do a quick washout period of only 6-7 days. I've seen the posts on here and elsewhere about providing 30 days washout, but we don't think we have that amount of time here at all given how rapidly her CC is spreading. The dermatologist's concern is that it could spread to spots where it will make her have difficulty walking (paws), urinating/pooping, etc - basic function. The IMS feels confident that if Lola develops Addison's then we'll just switch over to begin treating that which he is very experienced in as well...not sure how I feel about that.

Over the last 3-4 weeks, I've seen existing CC spots expand or new ones pop up nearly every day. However, I don't believe I've seen any new ones/expansion over the last 3-4 days. So, given this and my nervousness about switching to Lysodren in general and with such a short washout period as well, we talked about giving her another 2-7 days to see if the vetoryl will kick in to stop any new CC growth. We're fighting against time in either scenario and I feel very uncomfortable with either scenario...what are your thoughts on these or options?

I will post pix of her CC over time shortly...

[lola's mom]

Here is a link to a photo album showing her CC progression over time. Despite how scary it looks, and her being a bit itchy, she doesn't seem to be in pain (except for when I need to apply her antibiotic ointments in certain spots). She is such a sweet and forgiving trooper.
http://www.k9cushings.com/forum/album.php?albumid=889

On another note, I wanted to mention that she has lost one or two teeth and the IMS specialist said that can happen due to weakened ligaments as a result of the Cushings. Has anyone else experienced tooth loss in their dogs?

I also failed to mention that about a week ago the IMS specialist recommended that we also give her lignan and melatonin supplements as those have also been shown to help with various Cushings symptoms according to a study from the University of Tennessee...She's been on those for a few days now. Has anyone seen any positive/negative results from those supplements?

[molly muffin]

The pictures in Buttercups album was before and after her radiation therapy for the macro tumor. As the cortisol went down it did improve and continues to improve last we heard.

CC is one of the hardest things to get rid of. I think they used a triacholor spray (not sure if I spelled that right) Didn't give her very many baths as you're trying to dry it out, wipes I think were used quite often.

Yes, Dechra does recommend a longer wash out period, but it sounds like they are very concerned about the cc continuing to spread. It is of course in the end up to you, we did have one dog I think do a week or two week wash between vetroyl/trilostane and lysodren, which went okay. I'd want the IMS to be very experienced with both, which it sounds like yours is.

I don't know that I have heard of tooth loss specifically due to cushings, but yes the ligaments do become weaker.

I do hope that you can get this under control. Some of our more experiences hopefully will be by soon or tomorrow even.

hang in there
Sharlene and molly muffin

[lola's mom]

Thank you, Sharlene! Yes, we've been using the trizchlor spray and shampoo too.

[goldengirl88]

Here is my suggestion. If it were my dog I would take her to a laser therapist, it has done wonders for Tipper's leg. I was told by the laser therapist that cold laser can be used to heal skin problems. I would try that. The next thing I would do is go to 15mg of trilostane. You said 20 was too low and 30 seems to have helped. Have you had an ACTH on the 30 mg yet? I would do that first. Then I would get 20 mg Vetoryl and a 5mg of trilostane from Diamondback Drugs. I would use the 25mg dose. You can ask you vet to order you some 2mg trilostane also. The reason I say this is from experience with Tipper. She can no longer take 30 mg as it makes her pre number go low. 25 mg is not enough to control her symptoms so I added 2 mg of trilostane. So she now gets a dose of 27mg. When you have the trilostane in 2mg increments it is easy to go up or down a few. I do not want to give Tipper 1mg more than she needs of this stuff so that is how I work it. There are others that combine Vetoryl with Trilostane. I like the comb as I know Vetoryl is true to the dosage where compounding is not as true. Hope this helps you somehow. I would definitely want to know about the blood in the stool though. Blessings
Patti

[Renee]

Even as things come under control - the CC will go through a period where it is working it's way out. You may be seeing parts coming up and through the skin that were there long, long before, and are just now erupting. If they aren't as angry, and they are staying relatively dry.... I wouldn't be so quick to jump to lyso. If you read my thread, you'll see that Tobey continued to have CC come up for months, she still has a few spots, but the nature and character of the spots was quite different once her cortisol was under control.

I think it sounds like 30mg is working very well.

I don't know about the cold laser therapy, as no one here has personal experience using it on CC, so it's a shot in the dark.

[goldengirl88]

It would never hurt your dog. In fact you may get a whole session and your dog will feel like a puppy after a few times. It helps their arthritis, and any musculoskeletal issues going on as Tipper had those in her back and it helped her.