Vet is stumped but considering Cushing's

Hello,

My vet was completely stumped when I took Mira in today but is testing for Cushing's, cancer, and a few other things with blood and urine tests. I've been trying to find out more information about Cushing's and what treatment options are like.

Her symptoms are: diabetes (controlled but still on the high end at 5u), thin skin, bruising, redness, bumps/wartlike things that bleed and eventually fall off and scab over with a bit of a darkening of the skin around them, one large scabbed patch, potbelly, hunger, medium thirst/peeing, slow healing (the darkest bump appeared in August, still not healed)

I took her to the vet in December for the same skin issues and we tried an Omega-3 supplement and a sebum oil that I forget the proper name of but it was supposed to help the flaking/dandruff.

I put some photos of her skin and scabs in an imgur album (tw: potentially gross/upsetting): https://imgur.com/a/fz0K3Ti

Does this seem like Cushing's to you? I'm too anxious to patiently wait the 2-3 days for the vet to get back to me. If it is Cushing's, what are the treatment options? From what I can see online it's medicine + majorly invasive surgery.

 

You might want to take a look at this post. http://www.felinediabetes.com/FDMB/threads/how-to-diagnose-cushings.207776/

To me it sounds like something to be considered. Tagging @Ana & Frosty (GA) and @Tuxedo Mom who both had Cushings kitties and are very knowledgeable about it. Frosty was treated with medication. There is a surgery, hypophysectomy or removal of the pituitary, and yes it is brain surgery. Where are you located? The surgery is only done in a few places.

 

I'm located in Toronto, Canada. The articles I read suggested that medication isn't very effective, it's nice to hear it helped one kitty at least.

 

The only surgery sites I know of in North America are New York City and Washington State.

Here is the link to a research paper on a Cushings kitty go into remission on Vetoryl, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5912277/pdf/10.1177_2055116918767708.pdf
Of course diagnosing type of Cushings, if that, is the first step cause not all are treated the same. We also had one member whose Cushings kitty went into remission on her own. If caused by a pituitary tumour, the tumou can pulse up and down. My girl had a different type of pituitary tumour that caused her acromegaly.

 

If it's a tumor, will it eventually metastasize and spread? Vet websites say the prognosis is "guarded to poor"!

 

They are benign tumours. My girl had acromegaly at least 5 years. I did get her treated with radiation though, which helped.

 

Just weighing in on this conversation. As a petparent of a (GA) Cushing's kitty, I would say that there is a definite possibility that Cushing's may be at play. The combination of the thin skin, easy bruising, potbelly and hard to regulate glucose levels are certainly a red flag. I never did treat my kitty with the vetoryl, but @Ana & Frosty (GA) did as well as another lady a number of years ago. Both people had some good responses to the skin issues and glucose issues, but unfortunately both kitties passed from complications

Which test is your vet doing? The UCCR urine test is the cheapest and least invasive and involves you collecting a sample of urine at home and having your vet send it for analysis. In Canada this is usually sent to IDEXX for testing. A negative is considered a negative, although IDEXX does not have ranges related to felines, only those for canines. My kitty had a slight positive/borderline result from this. Other test such as the ACTH stimulation test and/or HDDS test are used to determine if this is pituitary based or adrenal based. The most common is the PDH or pituitary based Cushing's. This is caused by a benign tumour on the pituitary which in turn affects the regulation of naturally produced cortisol. Cortisol acts as a steroid which will cause higher glucose levels that are difficult to regulate. Usually the liver, pancreas and both adrenals are enlarged (as shown with an ultrasound) since they are constantly working overtime because of the excess cortisol. As Wendy said, the effects of a pituitary tumour can wax and wane which is why a good testing regime (which you are already doing) is important. ETA Actually when I rechecked your chart I noticed that you are only testing sporadically...it would be best to test before each shot and during each cycle to get a better picture on how the insulin is actually working. My Tuxie was very prone to big glucose swings and would go from blacks to low greens within a cycle. The highest level of Levemir that he reached was 6 units twice a day. My kitty lived over 2 years with Cushing's with no drug treatment and it was suspected that he had cancer at the end.

Ana can give you great information on the vetoryl treatment fro Cushing's.

 

Thank you so much for your response. What did you do to manage your cat's Cushing's without drug treatment?

 

Basically I would give extra supplements such as B12, milk thistle ( liver support) B complex, vit E, taurine etc and be very vigilant about pancreatitis. Luckily Tuxie only had about 3 milder episodes of pancreatits which were easily treated with fluids, pain relief and anti-nausea meds. This really didn't address the Cushing's but dealt with symptomatic relief from conditions. The only meds for treating feline Cushing's tht seem to work is vetoryl ( also known as trilostane). Hopefully @Ana & Frosty (GA) will be on the site shortly and she can give you information on that.

Wendy posted above this link to a study on a kitty reated with vetoryl ( trilostane)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5912277/pdf/10.1177_2055116918767708.pdf

 

Sorry guys, I am extremely busy with work and will try to come online this weekend and read everything. Just don’t have the time right now.

Since I’m not on the site lately I often don’t see tags. PMing me goes to my email though. Just throwing it out there since I haven’t had time to come online lately much.

 

Just catching up now, my apologies. We were in France for a week snowboarding in the Alps, and then I had a busy week of work and just catching up on all the house work/errands. I meant to come here last week and write, but guess I guess I was putting it off because it can be difficult to talk about Frosty sometimes. (@Sleafy , I lost him this past October.) However, I am happy to share our experience with the medication and help any cat and parent that may be going through the same thing.

Any news about the workup results of your kitty, by the way?

I think Mary Ann and Wendy gave you a good overview of Cushing's so I won't repeat what they have said. They both shared very helpful articles with me when Frosty was first getting worked up for it. You may scroll down to my posts on this forum from last April/May. Reading them was very helpful for me.

I also agree that it does sound like your kitty likely has Cushing's. I looked at your pictures and some of them do look like like the skin tears Frosty had. Also, I noticed your kitty has the characteristic "unkept" appearance to the coat. It looks just like Frosty's did.

Once Cushings was suspected, I took Frosty to an Internal Medicine (IM) veterinarian about an hour away for a thorough workup. To test for Cushing's, Frosty had the ACTH stimulation test, which is a blood test that is done at the vet's office. He also had the IGF-1 test as well for Acromegaly, although I think the vet was thinking wishfully when she ordered it, because she kept telling me how much success she had treating acromegaly cats with radiation. The other possibility was cancer and that the skin tears cased by paraneoplastic syndrome. Frosty's blood work came back positive for Cushing's, and due to the severity of his skin tears and poor diabetes control, we decided to treat with Vetoryl.

He was started on 10 mg of Vetoryl in May I believe, and he did very well on it. His blood sugar became under control and we were able to wean down his insulin requirements. But perhaps most importantly, his skin tear healed, although the hair there never grew back. He also put on more muscle and his fur looked a lot less "unkept-like," and his belly seemed a little smaller. I kept Frosty in a special cat onesie after his first skin tear in order to prevent him from tearing out patches of skin while grooming. I will attach some pictures for you, and a link to where you can purchase it.

Unfortunately, Frosty had other serious medical problems that I did not know about in addition to Cushing's. I adopted him last January as a 9 year old stray, and only knew about his diabetes. In September, he suddenly got very ill, and from then on, the more we did to try help him, the more problems we would discover other organ systems. I will not go into detail about all of that (unless you really want to know). However, I do believe Vetoryl allowed him to have a good additional 5 months with us, and allowed him to heal and prevent more painful skin tearing.

Another member here, @Rardito also has a kitty with Cushing's, Mitsy. In her case, the kitty has unequal pupils (from the brain tumor pushing on the optic nerve), muscle weakness, hair loss, and a pot belly. However, her kitty's diabetes was well controlled with insulin and she had no skin tears, so her vet opted not to give Vetoryl. Mitsy was able to go into remission, and is still in remission and seems to be doing well! (I follow her on Instagram. She's very cute). Her hair is still thinning, but even some of her muscle weakness improved after her diabetes went into remission and she was able to jump on the couch again. Rosa may be able to tell you more.

If your kitty does get confirmed to have Cushing's, I highly recommend seeing an Internal Medicine vet, as they are likely to be more familiar with cat Cushings as well as medication dosing, because cats are dosed differently than dogs. Their dosing should not be as aggressive or they can go into an Addison's crisis. Also, I recommend purchasing the medicine online, as it is cheaper. Your vet can just fax a script to the pharmacy. Since your kitty has skin tears, I would not recommend not treating, or treating holistically. Skin tears are very painful and she will keep getting more unless she is treated with medication.

Please feel free to ask any questions you may have. I apologize for the delayed response, and I will be available for any questions.

 

Frosty in his clothes.






Here's the link for the onesie. I think Frosty wore a Large. He was a big cat (not fat), about 14-15 lb.