12/6 Shishi Unable to regulate, skin lesion pics

Hello all at lantus land

I was away on hiatus from FDMB for about a half year, I apologize for this. I do not have a good reason for why I did that. I understand that this severely complicates the support of fellow members, for this I am sorry. Its rather difficult for me to make a post everyday.

During this half year, I have been unable to regulate Shishi's BG well, you will see this on her spreadsheet. Sometimes I have broken protocol due to hospitalization, boarding, or knowing that I would be unable to keep a close eye on her when her BG is low.

Shishi has been hospitalized 2 times of which were both pancreatitis flare ups, onset of diarrhea and dehydration and leading to not eating. 3-4 days of fluids and pain killers and antibiotics made her well again. After the hospitalization, she rejects Merricks wet and other wet foods, but will eat Hill's M/D. I don't like the crappy vet food but better than not eating at all.

The financial upkeep for shishi has been extremely difficult, I am unable to perform as much BG's tests as I would like to. She has not been tested for pancreatitis via Fpli, she has not had acro or IAA test done either. Regulation is rather difficult with no good pattern in sight.

She has a new onset of symptoms which involve hair loss and skin lesions, extremely thin skin and lots of thirst for water and peeing lots, even more than she was unregulated. I am rather convinced that it could be cushings, but the vet suggest that it is so rare, and testing for it is not 100%. I will upload pictures for your opinions, they are not the best quality photos but should tell the story.

I do not want to spend a fortune to test for cushings if I feel that it will not be conclusive. As I am at a point where I am almost unable to care for Shishi's vet bills

Should you guys have any other opinions on as to what can cause this, please let me know. Shishi is strictly a indoor cat, single cat in home with no other animals. Her appetite is still voracious as always, stools are formed now. Coat is terrible, she dosen't purr or play. Pee's alot.




I thank you all for your endless support, and I hope to stop by here as often as I can.

no need to apologize, Will...
life is busy!

and all I can offer is hopes that she gets better regulated,
and sympathy on those sores...
Ouch, Shishi!

celi

Hi Will - no need to apologize - I think most of us have been through the financial end of this with our kitties. We all do understand. I have no idea on the lesions- it is out of my realm of experience, but thought I'd post so this so at least you will be bumped up in cue. I hope that someone will come along soon who would know. have you posted this on Health? maybe someone on that forum can help. I hope ShiShi becomes better regulated - there is improvement over all, but do understand your concern. I hope that maybe sometime soon you can have Shishi tested for IAA or Acro - with a high dose on board I would wonder. Good luck - I wish you the best.

(((will))) you must be so worried! don't worry about not posting, it's fine. i looked at shishi's ss - you have really been through the mill. she's got numbers all over the place and you've covered a large range of doses. i am surprised to see the dose around 12 in july and back down to 5-6 now. do you have any idea why she needed such a high dose last summer - ie, was there an infection at that time? i saw the pancreatitis, but that wouldn't necessarily develop while on a high dose of insulin and having lower numbers, would it? or maybe it would. i don't have experience with pancreatitis.

punkin has acro, but i don't know much about cushings, other than the skin is very fragile.

glad you included the pictures. hopefully someone will see that who can suggest if that looks like cushings or not.

Having said this disclaimer:

I am not a vet and tend to be a bit of a virtual medical moron (I have worked for lawyers most of my life & understand a lot of that legalize, but even the simplest medical terminology is so totally "Greek" to me that I tend to glaze over at about the third medical reference -- I do learn fast tho as I think many here might attest to -- even tho I do have to read this stuff over and over b4 I finally get it!). Tinkerbell had what in my simple layman's terms I called a rash early last Spring which looked very similar to what Shishi has in those pix, so I will share the info I got from her vet here & let you digest it for what it may or may not be worth (uhuh, you can definitely tell I've always worked for lawyers after all that, can't you?)

Tinkerbell went OTJ in December 2010. In late Feb or early March 2011 (and I am not saying there is any correlation here at all whatsoever but it does seem a little curious to me) she started getting this "rash." Her BGs were still OTJ fine but she kept getting this "rash". It was on her face between her brow and her hear towards her eye, worse on the left side than the right usually, and all around her neck.

The vet actually said "I hope it's just fleas or a flea allergy" but checked her over and it wasn't, so she dx'd it as "Eosinophilic Granuloma Complex", more commonly referred to as "rodent ulcers". She said normally this is treated w/steroids, put b/c Tink is diabetic she wanted to try ABs first (& I was so grateful to have Dr. Penton on board there), and we decided on 14 days of Clavamox twice a day. By the second day Tinkerbell has stopped digging at her face and neck & it started to clear up.

This has been a long journey. Tinkerbell would clear up for a few wks, then "break out" again. We did a couple more 14-day courses of Clav over the next few months & every time Tink would clear up right away & then 6 or 8 wks later after going off the Clav start breaking out again. I think it was about the 3rd time this happened Dr. P said to do the Clav for 30 days, and this time it really seemed to work. Tink didn't break out for months, and then about the last time she started to break out just a little over her eye again was about the same time she came back from the Falls. The weird thing is I didn't start her back on the Clav for a couple days while I watched this lesion, but as soon as she went back on insulin the thing dried up on its own.

I'm not saying that insulin had anything to do with this, it just seems curious. Maybe it has s/thg to do with her immune system, maybe it's just a coincidence. She came back from the Falls about the time Tawny got really sick the 1st time in November, too, so who knows.

So sorry for the long story but you might want to ask your vet about "rodent ulcers"?

I remember posting some pix of the lesion the first time and I will try to find the link and post them here later.

Good luck with this. Dr. P did say that these rodent ulcers break out around the face and neck. Edited to Add: ...and mouth.

Desi

The symptoms you describe sound like they could be Cushings disease. Hair loss, poor unkempt hair coat, skin fragile skin, pot belly, and muscle wasting are physical signs. I am not sure about the first photo. The second photo looks like it could be a skin tear, which would be highly suggestive of Cushings disease.

My Bear Man had iatrogenic Cushings from steroid use. He did not undergo testing. There were some members with Cushings cats who had the diagnostics, and pursued treatment. Cheryl and Whiskers (GA) was one of those. If you PM her, she may be able to help more with those. The one medication for Cushings seems to be Trilostane.

Ditto on the no apologies needed.

I agree about posting on Health -- or linking to your post here -- to get more input.

Has allergy been ruled out? Are the lesions the result of scratching or do they just appear?
Have you tried something like Allerderm? It's a topical that is good for itchy or dry skin.
You mentioned Shishi not wanting to eat canned foods. Has food allergy been ruled out?
Has the vet gotten any kind of skin sample to test?
Can your vet consult with a veterinary dermatologist?
Has a blood disorder been ruled out?

If this is allergy or inflammation related, it could be effecting Shishi's numbers.

Good evening, guys!

Do Shishi's lesions get crusty at all, and are they symmetrical on both sides of the body? I ask because those are two hallmarks of pemphigus, an auto-immune disorder from which Willie suffers. I hate saying this because I know money is tight for you right now, but a skin biopsy will give you a definitive answer. For pemphigus, some vets treat with steroids, but Willie gets cycolosporine, which is an immune suppressant. When all is going well, he takes about a dose per week. If the vet cooperates, you can get it from a human pharmacy for much cheaper.

You can look at Willie's spreadsheet... until we started treatment for him, regulation was impossible (granted, he was also grieving the loss of his kitty companion of 12 years) and when he started the medication, his numbers improved in a very dramatic way very quickly. It is likely that the skin condition, whatever it is, is contributing to Shishi's high numbers... likely from discomfort and stress.

I'd google both the rodent thing and pemphigus and see if you can find pics. Might help you in figuring out what it is. Please feel free to PM me if you have any questions!!

Here's the link to the pix of Tink's "Owie" back in Feb 2011: Tinkerbell Rodent Ulcers 2/2011

Welcome back, we all know about life getting in the way. So sorry about Shishi's skin problems. Discomfort from that and infection could be what is play in havoc w/ her numbers too. I hope you find an answer soon. You might ask Tracy, Leo's bean. He has hsd an ongoing skin problem. That I think started w/ a food allergy. Has that been considered?

have you seen the very small amount of info there is on cushings in the high dose ISG? i pm'd someone with cushing's experience to see if they could come and check in with you.

Cushing's disease:

http://www.cat-health-guide.org/felinecushingsdisease.html
http://www.cat-lovers-only.com/cushings-disease-in-cats.html

Cushing’s disease is caused by a tumor of either the pituitary or adrenal glands, causing the production of excess cortisol. Cortisol is a naturally-occurring chemical in the body, which helps the body respond to stress such as infection or pain. With Cushing’s disease, however, the body continues producing cortisol even when the stressor has been removed. This causes a number of problems one of which is insulin resistant diabetes.

One particular symptom that helps differentiate this disease from acromegaly so quickly is that Cushing’s causes very thin fragile skin that may tear easily and/or not heal well. Females are most often the target.

Click to expand...

Thanks for the healing vines and input guys. And its great to be back with such a warm welcome.

Last summer around July 24th 2011 when Shishi was hospitalized, I believe she was on 12 units of lantus due to a kidney infection. I did not include this detail on her Spreadsheet, and has since been updated. It was diagnosed via ultrasound, while looking for signs of pancreatitis.

She went in today for a skin scraping and some surface cytology. Came back negative for demodex. Bacteria and yeast was present. Blood and urine was also taken. Vet showed me Shishi's blood serum and it was visually milky, he suggested that normally it should be clear and that milky serum is not a good sign.

Vet also mentioned that she has a skin infection, and that skin infection is rare in cats. For this to happen she would have to have contracted some-kind of bacteria that's resistant to antibiotics, or there is a underlying condition that's making her immune system weak.

As far as a food allergy, I have suggested this to the vet but he quickly dismissed it. Shishi was on M/D for a few months prior to these symptoms, and he was quick to dismiss food allergies from M/D. I like to think otherwise.

Shishi has always been a high dose kitty, and I have yet to find out what is the source of this. Her eating schedule and injection times are very consistent, and contraband is far and few in between.

Rodent ulcers I will mention to my vet, it seems that hes just ordering test after test now, and even considering biopsies...... which is why I am trying to figure out what's actually necessary or not.

Regarding the pemphigus, her lesions are only on the right side of shoulder and between the shoulder blades. None have appeared on the left side yet. The lesions have taken over 2 weeks to crust up and heal. Fresh lesions pop up here and there now.

I was thinking that she was licking herself to bleed, until I saw the lesion that appeared on the back between she shoulder blades, there is no way she can lick that part or scratch herself there.

Shishi has never been on steroids, but I know that cushings can also come from tumors of the pituitary or adrenal glands. I will definitely try to find out if other members have similar symptoms.

Will make a post on health, and link this post here for additional input.

Hi,

My cat Cole has cushings and he has skin lesions that look similar to the photos you posted. If your cat does have cushings, these skin lesions are part of the disease that you deal with. He can make the lesions worse by just cleaning himself and they take a long time to heal. Cole has also had several bouts of pancreatitis, he has been anemic, has had kidney failure, and other complications. plus his BG has been tough to regulate. I believe you said your cat is always hungry and this is also part of the disease. They feel as if they are starving despite the amount of food they are fed. it's a side effect of too much steroid in their system.

An ACTH test can determine if your cat has cushings and the treatment is Trilostane which Cole has been able to tolerate, some cats may have trouble with it. Dealing with this disease is a constant struggle for me financially, and as a caretaker I am challenged as its more than just a matter of regulating BG and giving him Trilostane. I use a lot of holistic care for him in addition to the meds, preferring to keep him on as little pharmaceuticals as possible. I don't feed Cole anything but raw food as he had trouble keeping the prescription diet down, he was on a kidney diet tried KD from Hills as well as others. He was vomiting every other day but with this new diet he is able to keep his food in!

What I do for his skin is not much. When it happens I clean it with salt water, 2 tablespoons water and 1/4 tsp salt, and then put him in a shirt so he doesn't lick it and make it worse. You can put some neosporin on the wound to help heal. They do seem to heal slowly and Coles hair grows back slowly as well.He has opened up some pretty large sores that are frightening how quickly and easily they get worse but I have been lucky that none have gotten infected. Lately he wears his shirts all the time. The shirts, basically dog clothes, are a better solution than the cone so he can move easily and I don't worry while I am working or away from home. plus he looks cute. he doesn't love the shirts he tolerates them and it does give his skin time to heal. I realize you said Shishi can't reach wear the sores are but she could have started them by simply scratching. This is a heartbreaking part of this disease, if that is what she has. It's hard to see your beautiful friend loose their coat and their common actions of bathing and scratching make it worse. cole had a gorgeous coat before this disease, and now it is pretty shabby and thin.

Cushings is a tough disease but Cole still enjoys life and is not in constant pain, and he is used to wearing his shirts. He is an amazing resilient guy despite the many challenges. I thought he was going towards the inevitable multiple times but he continues to rally. He has a strong will to live. I hope your Shishi doesn't have it but if you do get tested and she does test positive she can be ok and happy. I am willing to share as much as I know about living with the disease. I don't post a lot but will answer posts and questions by letting you know what my experiences have been in hopes that you can help Shishi.

Please let me know if you have a specific question and cole and I hope for the best for you and Shishi.

Re: 12/6 Shishi Unable to regulate, skin lesion pics update

Hello All

Thanks again for the input, I have spoke with the vet regarding the additional possible diagnosis and the blood and urine results have came back.

Another detail I did not include was that Shishi has lost a large amount of weight in the last 6 months. She was close to 6kgs a year ago, 5.5kg's 6 months ago, and now shes at 4.24kgs. Her meal amount has not changed in the last year, only the type of food. She gets roughly 226 calories a day, no matter the type of food I give her, I have been staying around this value.

Her thyroid level came back extremely low, vet said that this is a indication of her being very sick on the inside. He recommended a ultrasound to look for tumors in the pancreas, and possible tumors in the adrenal glands.

He also suggested a skin biopsy to look for additional skin diseases.

Her livers came back normal and kidneys functions are normal aswell, urine is very diluted which suggests kidney infection.

Having said this, I mentioned food allergies, it could be he replied but it would still not explain why her thyroid levels are very low.

Regarding pemphigus, it usually starts from the claws although this is not always the case, in Shishi's case, her claws are all fine and clean.

With rodent ulcers, he mentioned that the rest of her thats not affected by the lesions would be ok, but in shishi's case, her whole skin and coat is affected.

Shishi has since been licking herself close to where the hair is falling out, tearing out her own skin in the process. I have put a cone on her but she was licking all night. I will attach another picture.

Vet prescribed some surolan for the wound, as to why shes licking herself so vigorously is a mystery at this point. Not sure if I am able to go ahead with any further tests, and even if I can, don't know which would be the best diagnosis tool.

This is a pretty good summary of what goes on with hypothyroidism. It seems to describe Shishi's skin and coat issues. The only thing that doesn't fit is the weight loss. However, hypo-T is easy to treat!

Those skin tears look extremely suspicious for Cushings. If you are going back for more diagnostics with your vet, I would urge you to ask him about tests for Cushings. One is the ACTH test that was mentioned above. Another is the Low Dose Dexamethasone Suppression test, which I think is the one recommended by Dr. Lisa on this board. There is also a UC:CR (urine cortisol:creatinine ratio) which can screen, but not return a definitive diagnosis. I am sorry that I do not have the details. Your vet may have to research this on VIN, as it is quite rare, and the vet may not have even seen a case.

If you look at this link, the lesions pictured are extremely similar to Shishi's.

http://www.fabcats.org/owners/cushings/info.html

eta: If you are administering sub Q fluids at home at all, please use extreme caution, as this can put more stress on the skin. My vet never wanted me to give sub Q fluids to Bear Man due to the potential for injury to his very fragile skin.

Hi Will,

I'm sorry you and Shishi are going thru this. Miss Witty (Whiskers) was diagnosed with cushings. First our Internal Medicine vet at the U of Minnesota did an abdominal ultrasound, which confirmed the diagnosis of a tumor on one of her adrenal glands. He than did the ACHT test which confirmed cushings. We did use the medication Trilostane mentioned above. We lost Witty one month later. Trilostane is used off label for cats (more commonly used in dogs) and you must monitor your kitty very closely for any changes and going right away to the vet if this were the case. Lisa and Cole have much more experiance that I and I concur with all of the information in her post. Linda and Bear man are also very knowledgable as well.
Cats with more than one health condition make tight regulation diffcult, so no apology necessary. That said the people here are extremely helpful. Also work closely with your vet (within your budget constraints, I also know how difficult this can be)
Next post in the IAA/Acro/cushings board (these are three types of high dose kitties) so the peope there can be very helpful as well. Also there is a facebook group called feline acromegaly (acro is the acronym for acromegaly), people with high dose kitties post there as well. I wish we would have had more time to work with the facebook feline acromegaly group, they are really knowedgleable and have more activity there than the FDMB IAA/Acro/cushings board, however posting on the IAA/Acro/cushings board here at FDMB got me hooked up with the facebook group. I'm really terrible at how to join the feline acromegaly group on facebook, but I will post a link to your condo and someone should pop over here for you as members usually belong to both groups.
Lastly breath....I know this is difficult but you are doing great in caring for Shishi and the people in the groups will offer a lot of support. Some good advice I have gotten when dealing with my pets multiple health conditions was try "to do one thing at a time and then move on to the next" I know its hard when you want answers, but it helped me from getting to overwhelmed.
If you have any other questions or need to know anything feel free to PM me.
Sincerely

Will,

Oh my goodness, I just went to the feline acromegaly facebook group and see you are already there :lol: :lol: :lol: .

What wonderful groups of people on both groups, so quickly they are to get in and help when need!

Hey all

Trying to find answers is the most difficult part, the course of action now is Shishi is on clavamox to clear up her kidney infection and to see is it helps with her skin problem.

Vet is more suspecting cancer or cushings and is suggesting a abdominal ultrasound or the low dose dexamethasone suppression test and using canine high dose.

He first wants to have the antibiotics clear her up for 2 weeks, then use the Urine Cortisol:Creatinine Ratio to see if its a possible sign of cushings although not a definitive test.

He mentioned that hypothyroidism would cause her to gain weight as you said aswell Sienne, and quickly dismissed that diagnosis. He wouldn't want me to treat just for hypothyroidism with meds due to the fact that there seems to be another underlying issue with her causing the low thyroid levels.

Her poop came back negative for parasites, and her urine culture came back negative aswell, he also ruled out feline leukemia because shishi was tested for it 2 years ago and was negative. Since then shishi has not came in contact with other cats directly nor shared litter boxes or food with other animals. He also dismissed FIV because of this aswell.

Her hair usually fall out in clumps, about a 1/8 to a 1/4 inch in size, after bare spots show, the skin turns from pink to a darker pink then to purple and with red spots. Sometimes this is made worse by her licking bare skin and tearing out the topical layer of skin and which is what happened with the above picture.

I appreciate the advice regarding the sub Q fluids, this did not even occur to me. She has not gotten sub Q fluids since her new onset of skin problems. Last time it was administered was around mid October.

Would acromegaly or IAA cause these symptoms? should I even test her for them at this point?

It seems that the 2 biggest important factors here is the low thyroid levels and the significant weight loss.

punkin has acro and has none of these symptoms except an increasing need for insulin. other than the high dose, no, i don't hear any of the same symptoms as acro.

Hey Will,

That last photo looks exactly like what Cole has done to himself. The more you describe her symptoms the more attributes she shares with Cole. He used to be a big guy about18 lbs. now he is 11. And 18 was a normal weight for him. The dog shirts do help with the licking. like Linda, I think Cushings is a strong possibility. And if the diagnosis is Cushings I am happy to share what I do for Cole if you are interested.

Lisa and Cole

Hey Lisa and Cole

wow, I am glad to hear that there are similar symptoms that are exhibited by cushings from another kitty that Shishi is showing. I am very inclined to get the cushings test done.

I am trying the Dog clothes but will do so after dressing and the healing of her existing wounds, her cone is temporary stopping her from licking herself but does not stop the scratching with the rear legs.

I will definitely be in touch with you more if Shishi is diagnosed with cushings, at this point I am unsure of if I can even get this test done. But thats something I myself have to take care of.

These symptoms are not usually evident with cats with acro, how about IAA though?

It sounds like Shishi has a lot of issues. I have no experience with acro or IAA, but I do not think that acro or IAA would cause the skin lesions.

Your higher dose of insulin could be suspicious for either acro or IAA. I believe that Cushings could also be responsible for that.

The skin lesions are a big quality of life issue for her, so once the antibiotic treatment is finished, I am sure that you and your vet will want to discuss the next diagnostic steps to find the cause for those.

I'm so sorry for poor Shishi's continued problems. Another alternative to the dog clothes are simply using infant t-shirts. Much easier to find and less expensive.

I also don't know about IAA

Linda and Bear Man said:

It sounds like Shishi has a lot of issues. I have no experience with acro or IAA, but I do not think that acro or IAA would cause the skin lesions.

Your higher dose of insulin could be suspicious for either acro or IAA. I believe that Cushings could also be responsible for that.

The skin lesions are a big quality of life issue for her, so once the antibiotic treatment is finished, I am sure that you and your vet will want to discuss the next diagnostic steps to find the cause for those.

Click to expand...

Cole's insulin can be all over the map. Depends in how much he eats and if he can keep it down.

The skin lessons are tough. The shirts can help keep the bandages on as well. I think the ACTH test was around $350 us dollars. Trilostane helps with regulating the insulin and the skin but some cats don't react well so close monitoring is necessary. I also support Cole with vitamins and supplements

I will monitor this thread but a PM may be quicker to get a response from me. Please take good care of Shishi and yourself. This is tough to deal with but not impossible. Let me know when you want more info.

Good luck!