3/5 Summers Amps=140,110+4,62+6,48+8,50+8.5,46+9,48+9.5,47+10,48+10.5,69+11,Pmps=72,102+2

Summer has been dropping all day. Gave HC gravy several times with no change so at +10.5 i gave her 1 tablespoon of hc gravy with a couple drops of karo and she came up to 69. Summers skin is tearing again and its bad. She had a small place on her back yesterday morning and when i went back to check on her she had pulled her fur and skin out and the place now is as big as my hand and all the way across!! Its so upsetting to see her like this. I put a layer of vaseline on it because i read that it protects it and allows it to heal and it has helped her other places as well. Antibiotics worked ok but didnt let it heal as well. So i ended up putting her baby onesie back on her. I also had some collidial silver spray and i just put that on her today and put her onesie back on her with some feminine pads inside the onesie to keep her shirt from becoming wet or bloody. It looks bad but the vet told me it will just keep happening and being her skin is paper thin, there is no sewing that will hold it. Plus where she pulled her fur/skin off, it is a gap from fur to fur so there is nothing to sew to if we wanted to try. I feel so bad for her. It has got to be painful because it hurts me to look at it. I just dont know anymore. Summer went low earlier and she didnt want to come up in her numbers even with hc gravy several times. It worries me. Please pray for summer....

 

Your poor kitty! Has she been tested for Cushing's? Thin skin that tears easily can be one of the symptoms.

 

I’m so sorry, poor you and Summer. You’re doing all you can and sure you’ll keep her comfortable. Loads of vines and prayers

 

No i haven't actually gotten her tested but my vet highly suspects it. Just haven't had a chance to make an appointment and take her into town. It is so upsetting to see her in this condition.

 

Debra So sorry Summer's skin is tearing, and giving you the numbers drama too. All this poking can't be so easy on her skin. Maybe you should try keeping her in a little bit higher numbers for a while, so you don't have to poke as much. Maybe a 2 unit decrease down to 4 units for a bit? It's way larger than a normal increase, but for any lurkers, Summer is very special circumstances.

 

Did you shoot tonight? A skip is also a possibility.

 

I was going to skip but she went up to 72 so I did. I know she earned another reduction today with all those lime greens. So Idk if I will take her down 1 or 2 units. I'll see how she does tonight and go from that. Even if I knew she has Cushing disease, there is nothing that can change her thin skin, right? My God, I feel really bad. I'm so upset about this. I just want to help her and make this nightmare go away.

 

I like Wendy's suggestion. If BG numbers were kept a bit higher it would mean less testing would be required.

Less testing = less handling.

Less handling *could* mean a little less skin tearing.

It might be worth trying...

 

((((((Debra))))) sending you major hugs. I can only imagine the stress of seeing her like this. I hope that something can be done to help her heal.

 

I don't know enough about it, but do know that trisolane is a treatment for Cushings that is caused by a pituitary tumour. Not sure how it impacts the skin though. Might be worth a conversation with the vet. There is also surgery, hypophysectomy as a treatment, if it's a pituitary tumour. Same as treatment for acromegaly. Unfortunately only one vet surgeon in the US doing this surgery.

 

Do you know or anyone on here know if there is a group for Cushings kitties on fb? I am going to call my vet in the morning and talk to him again and go from there. I just feel so helpless. She hasmgot to be in pain. I mean she is RAW. It is horrible. I can't stop crying.....

 

@Tuxedo Mom Mary-Ann's Tuxie was Cushings. I don't know of any others active and current here now. There is a high dose FB group. Last time I asked someone I know on there, there weren't Cushings kitties active, but that was a while ago so could have changed.

 

Sending Prayers

 

Sorry to hear that Summer is having the tearing skin. This is a red flag for Cushing's. The easiest and least invasive test is the UCCR (urine cortisol-creatinine ratio) which is done by collecting a urine sample at home so there is no stress affecting the results. This is taken to your vet and sent to an outside lab that can do the test, such as IDEEX. If the results are positive or borderline, then other tests, such as the HDDS (high dose dex suppression) and ACTH stimulation test can be done to determine whether it is pituitary based (PDH) or adrenal based (ADH) . An ultrasound will usually show enlarged pancreas, liver and both adrenals with the PDH (pituitary) and only one enlarged adrenal, usually with evidence of a tumour or growth with the adrenal based. With PDH trilostane (vetoryl) has been used with some success. The trilostane helps to reduce the effects of the excess cortisol the Cushing's causes. When a kitty is on trilostane regular ACTH testing is necessary to find the right dose without giving too much which can reversalyl cause Addison's. With ADH this drug will not help and surgical removal of the adrenal is the usual approach.

IDEXX information on ACTH and HDDS:
https://www.idexx.eu/globalassets/d...ry/protocols/acth_stimulation_test_feline.pdf

With Cushing's glucose levels are hard to control because the body is over-producing cortisol and the usual 'controls' in the body are not working to keep the production in check. As with acro, the effects can wax and wane which will affect insulin requirements. If you need more information tag me and I will try to fill in the information.

Some basic information on the UCCR test. This site refers to dogs but the test is the same for kitties:
https://vcahospitals.com/know-your-pet/urine-cortisol

 

Thank you so much Mary Ann for all the info you gave me. I called my vet to talk to him and told him what i needed test wise and it was such a let down. I may have to call my other vet that is more up to date and see what he says. But the vet i called today said that he didn't know anything about cat's and cushings and that he knows dogs can take vetoryl but he didn't know about cats. I said i heard cats can take it as well but you have to have them tested regular to get the dose right or they can get Addisons. His response to that was well you would surely want a cat with cushings over Addisons!! Like that is suppose to make me feel better!! And when i mentioned the UCCR test, he said well we could but we are talking about a cat here not a dog. He really didn't seem very concerned about Summer at all. He said i will see what i can find out but he never has been one to do "research" for the patient and i have always had to be the one to call him back just to hear he hasn't had the time. I am so upset. If he does blow summer off like i think he will, i am done with him. He is the actual vet that dx summer's diabetes but NEVER even bothered talking to me about it other than trying to get me to but vetsullin and i told him i would be using Lantus. He never talked about testing, shots, how to do anything. So today with asking the vet about testing for Summer was a No Go. Will call my other vet tomorrow. Mary Ann, i have heard with people that have cushings their skin condition can be reversed. Do you know anything about it with animals? I am trying to find out if summer was treated if it would help her thin skin. Thank you again Mary Ann. I am trying to gather as much info as i can about someting that i know nothing about. It is just so terrifying. i want to do what is best for Summer. i just don't know at the moment what that is.

 

@Summers Mom

Most vets do not know anything about Cushing's in kitties, since it is considered so 'rare'. My personal opinion is that is not as rare as thought but simply under recognized and under-diagnosed. Many years ago acromegaly was considered rare in kitties and now more current studies have shown that as many as 1 in 4 kitties may suffer from it. The literature on Cushing's is mostly aimed at dogs, but there are some articles that discuss Cushing's kitties. My own vet (second one) is a good vet and she was skeptical about Cushing's until I went through the testing steps and she became a believer. I originally had an ultrasound done and the board certified vet gave his subjective opinion that it was PDH based on the organomegaly involved. My vet did not think it was possible so I waited another couple of months and started doing the other tests.

One thing the vet is correct about is that Addison's is more dangerous than Cushing's. A comparison would be a kitty who is hyperglycemic compared to a kitty who is hypoglycemic. A hyper wears the body out but a serious hypo can be very dangerous or fatal. Addison's causes a very very low production of cortisol ( like a hypo cortisol) and cortisol is necessary for the entire body to function well. This is an emergency situation. That is why a kitty using vetoryl (trilostane) must be monitored carefully, especially the first weeks/months to make sure the dose is not too high.

I never used the vetoryl with my Tuxie. It was my personal choice based on how upset he would get when I had to do vet visits and the constant monitoring would have caused him extreme distress and the additional stress would quite probably have triggered more pancreatic attacks as in the past with vet visits. Tuxie had the very thin skin but did not get the tearing the way Summer has. There was another gal on here a few years ago that had similar tearing and she did try the vetoryl. Unfortunately other complications came up and her kitty did not live long enough to see if the skin tearing would improve. Cortisol, which is over-produced with Cushing's causes the skin to become thin, fragile and prone to tearing, so the thought is that if the effects of the cortisol can be countered with vetoryl it should help with the skin conditions. I have not been able to find any studies or papers that prove this, but there has been so little research done on Cushing's kitties.


ETA Some information on using vetoryl in kitties. In this article improvement in the skin and thickness was shown as the treatment progressed

https://endocrinevet.blogspot.ca/2013/10/trilostane-treatment-of-cats-with.html

 

Thank you for weighing in Mary Ann.

Ugh on your vet Debra.

Neko's acupuncture vet ( also a regular vet) had seen a Cushings kitty and Neko wa her first acro, or at least that's what she thought til I educated her. Turns out she had a stray adopt her that was probably acro. These conditions are more common than most vet's think. Dr. Richard Nelson, first vet to do hypophysectoomy in the US (pituitary removal that is a treatment for acro and PDH Cushings) has a presentation where he said it's 17% of diabetic cats. Seems high, but who knows these days.

I knew a Cushings dog from our shelter, adopted by a friend. He developed Addisons, not good for dogs either.

 

Most vets are familiar with canine Cushing's. Cushing's is fairly "common" in dogs and there are a number of medications that work well for them. Unfortunately most of the medications other than vetoryl (trilostane) are poisonous for kitties. Hopefully some days the veterinarian community will recognize the higher incidence of feline Cushing's and develop other meds/treatments that will help. Other than a hypophysectoomy there is no "cure" for Cushing's.

 

Thank you so much Mary Ann for your great info and for taking the time for Summer. It truly is appreciated. I am going to read up on all the info you sent me and call another vet tomorrow. I will stay in touch and let you know how it goes. Thanks again so so much!!!

 

I am posting a few links to studies and info on Cushing's. Some are only abstracts since I don't have paid rights to the whole article.I can look up more if you like but if you want some insight these articles may be helpful...or confusing.

https://www.ncbi.nlm.nih.gov/pubmed/17542194

https://www.ncbi.nlm.nih.gov/pubmed/24011349

http://www.academia.edu/8229127/Urine_Cortisol_Creatinine_Ratio_in_Healthy_and_Sick_Cats

https://www.vin.com/VINDBPub/SearchPB/Proceedings/PR05000/PR00106.htm


http://www.pdsinc.ca/Portals/0/Adrenal Function Testing Protocols.pdf

https://books.google.ca/books?id=elPuvsucuY8C&pg=PA368&lpg=PA368&dq=cat Cushing's symptoms wax and wane&source=bl&ots=gq_y1nUuaH&sig=6K1bglDFByMKOt-OoL1y-mNk7Po&hl=en&sa=X&ved=0CCsQ6AEwAmoVChMIpcmKirHYyAIVQi2ICh0IEw-B#v=onepage&q=cat Cushing's symptoms wax and wane&f=false


ETA This one has various feline testing protocols:

http://www.veterinarypartner.com/Content.plx?A=636&

 

Thank you Mary Ann!! You are Amazing!!