Bruiser-What meds to use (9.5 y/o bulldog) calcinosis cutis

[Bruiser]

Hi, my buddy was just diagnosed with Cushings. Bruiser is a 9 1/2 year old bulldog and he's my best friend. He's been in my life it seems forever and been through every up and down I've been through. I can't imagine not having him snoring at my feet.

We initially took him in to the vet when my very awesome dog started going to the bathroom in the house and a quarter sized sore appeared on his shoulder blades. On top of Cushings it turns out he also has a very severe case of calcinosis cutis that now goes from his ears to the middle of his back which came on insanely fast and it breaks my heart because he shivers from pain unless on pain medicine. The dermatologist put him on a DMSO immediately after his biopsy which confiirmed the cutis (from the way it looks it was originally thought to be a burn it was so bad). He's on antibiotics now to fight off infections and we had an ultrasound Friday which confirmed that there were no tumors on his adrenal glands, so tomorrow he is going for a LDDS test to determine treatment for cushings.

What treatment works best for Cushings? The dermatologist keeps telling me that the treatments are "scary." From everything I read on the posts on this forum everyone seems to have success when treating. Any tips on why you chose the treatment you put your dog on is helpful and what that treatment is called.

Also, has anyone had the calcinosis cutis go away? Will the cushings treatment help the cutis? My poor man is bleeding everywhere and in pain. When I ask the vets...3 of them so far...none of them will give me a real answer. They say we need to see what we can do. I don't really know what that means and makes me think the answer is no. Is the DMSO the best bet to get it under control? I ask this because again my awesome bulldog has one favorite past time-swimming-and he can't go in the bay with the sores on his back. He has really no interest in doing anything, but when he sees that water he tries to go for it! I would love to have him back in the water.

I hate seeing him in pain. That's the hardest part of this whole thing. Will it go away? I don't want to make him stay in pain if I can't fix him. Thanks for any information or ideas on how to make this guy feel better.

[StarDeb55]

Welcome to you & Bruiser! I'm certainly sorry for the reasons that brought you here, but really glad that you found us. I'm really sorry that your big guy is suffering so at that moment. It's my understanding that calcinosis cutis is pretty much diagnostic for Cushing's. The LDDS will not tell you what med to use to treat, but it may be able to tell you what type of Cushing's, adrenal or pituitary. Now, when it come to the ultrasound that was done, even though you say no tumors were found on the adrenals, were there any specific comments on the size of the adrenals. No tumors tells me that this is probably no adrenal based Cushing's, but pit cushing's. In pit cushing's, the adrenals are usually bilaterally enlarged or may even be normal in size. I'm curious why your vet team still wants a low dose dex done since calcinosis, along with the ultrasound should make the diagnosis.

When it comes to treatment, both lysodren & trilostane are effective meds. Yes, they are very strong meds, but they are life-saving for our babies. Where the "scary" part comes in, is when a vet who has little experience in treating Cushing's, does not follow standard loading, dosing, & monitoring protocols for either drug, starts "flying by the seat of their pants", & the pup pays the price. This is where you as Bruiser's parent are going to play a critical role, you will need to get yourself up to speed on everything cushing's, including diagnostic testing, medications, what adverse reactions may occur with medication, just the whole nine yards, since you are Bruiser's only voice & advocate. This is where our important information section comes in, you will find a huge number of links that will take you to anything you need to know about Cushing's.

I really can't help with the calcinosis, but we have a member in New Zealand who dealt with CC on her Viszla for a great period of time, & she is our expert. I'm going to shoot her a PM, & hopefully she will stop by tonight. Now, on to drugs. I have successfully treated 2 pups with lysodren. (Yes, I have been blessed to have 2 dogs with cushing's). My first boy, Barkley, was successfully treated with lysodren for nearly 8 years with a great quality of life. He crossed the bridge at 15 from medical causes unrelated to his Cushing's

One last suggestion, & then I will close this out as I know this post is getting pretty long. I would suggest that you get copies of all testing results that have been done on Bruiser until now, & request copies of all results in the future. Most members do this, so they can keep a file on their pups at home. That file can come in handy if you end up at a strange vet in the middle of the night.

Please keep us posted. We are here to help in anyway we can.

Debbie

[lulusmom]

Hi and welcome to you and your awesome Bulldog, Bruiser.

Debbie has covered just about everything I would have said but I want to add a bit of information on the choice treatment. Dr. David Bruyette is a reknown and widely published endocrinologist/specialist whose treatment of choice for his patients is usually Vetoryl (Trilostane); however, he readily admitted on an audio of one of his lectures that his clinic has not had good luck in seeing improvements in calcinosis cutis with Vetoryl. I believe this could be because Vetoryl does not address the other adrenal hormones, which probably contribute to skin issues. Because of Lysodren mode of action, it almost always takes care of all of the adrenal hormones. Dr. Bruyette is the Medical Director at VCA West Los Angeles and because Calcinosis Cutis is so difficult to get the upper hand on, your vet may want to consider contacting Dr. Bruyette to get his opinion.

http://www.vcahospitals.com/west-los-angeles

I'm very familiar with both drugs as my two cushdogs have treated with both. Knowing what I know, if Bruiser were my dog, I would opt for Lysodren. Most people are scared of both drugs but as Debbie mentioned, adverse effects are a lot more likely if the vet is inexperienced, plus the pet owner has to their part and educate themselves. It's a joint partnership and both vet and pet owner need to follow protocol to the letter. You can find treatment protocol for both drugs in our Helpful Resources section.

It is a vet's responsibility to counsel the pet owner on the seriousness of the drugs necessary to treat cushing's. My way of thinking is that if a vet scares a pet owner enough, they'll pay attention and monitor their dog. The good news is that no matter what choice you make, we'll be here to help you both in any way we can.

I'll be looking forward to your posting the results of the LDDS.

Glynda

[Sabre's Mum]

Welcome to you and Bruiser! (and thanks for the PM Debbie)

I can truly empathise with the current state of your dear buddy Bruiser. I am also at a quandry as to why your vet team want to do a LDDS when an ultrasound was done and more important is that through all of my research ... calcinosis cutis is pretty much a diagnosis for cushings. There are a few rare cases which have other factors have been the cause but I the last time I looked there only about four reported cases.

Just out of curiosity ... was the original sore started at an injection site? This is what happened with our Hungarian Vizsla - Sabre.

Given your description of the calcinosis cutis on Bruiser I would personally want to start medications ASAP. This is the only true way of getting calcinosis cutis under control. Some think that the meds are scary but I believe that the best way is to educate yourself about cushings and the treatment and then your pups treatment is really a "team" effort. I must warn you that when you start treatment it is likely that the calcinosis cutis is likely to get worse before it does get better, but in Sabre's case it did get better.

Our Sabre had calcinosis cutis around the ear , around his anus, plates from the back of his neck to the end of his tail. Due to money constraints (we had already spent $1700 treating his pyoderma around his anus - really the second site of his calcinosis cutis) that our diagnosis consisted of his symptoms and an ACTH. I would have loved to have done an ultrasound but we could not afford it along with the meds so we just treated. Sabre was on Lysodren and it took about 4 - 6 months before his hair grew back and we finally had the calcinosis cutis under control. You are very lucky in the US that you are able to source DSMO. When I suggested this to my vet she said it was something was used in the past for horses in NZ but not nowadays. So ... we used medicated shampoos, betadine, antibiotics when any areas looked as though they were becoming infected. We also placed a T-Shirt on him (in the summer) and a jacket (on him in the winter) to stop him from nibbling at any spots. Some of the areas (very few though) rose to the surface and eventually disappeared but the majority remained as thickened, hardened plates. They were always there but never caused an issue except when his cortisol levels went low and he would get itchy - rolling on his back.

If you have any further queries ... ask away.

Take care
Angela

[Bruiser]

Thanks for the notes. I have requested the history from all three of the vets that I have been working with. Thanks for the suggestion. I am also taking to heart the advice that I need to be in control and learn the very most I can. I get scared away from a lot of the technical terms and feel a bit overwhelmed, but taking the time to read and research will hopefully help me make the right choices.

The ultrasound showed abnormally large adrenal glands. The notes say "the adrenal gland changes and mild hepatomegaly are consistent with pituitary dependent hyperadrenocorticism. A ldds test should be considered for confirmation.

The original sore was not at an injection site. They originally suspected Front Line as the cause of the first sore, then moved to thinking it was possibly the burn when it became severly inflammed which led me to ask for a byopsy when it kept growing and getting worse.

Lysodren sounds like a good option. Thanks Glynda for the information. I really REALLY want to work on getting the cutis under control, so it's good to read a bit about the Trilostane.

Angela-was your pups calcinosis cutis very raw and angry looking? Bruiser's bleeds non-stop and is bright red and seems to grow a few inches every few days. The vet said it's the very worst she has ever seen. I too use t-shirts on him since he can now scratch it on the sides of his ears.

I agree, I need to get him on treatment immediately, but both the Radiologist and Derm said that they wanted one more test to verfiy his cushings type. Does that sound right that I am having so many tests to prove something that seems to be already diagnosed? Again, thanks for all the notes. It's really nice to talk to folks that have been through this and I have hope I can get Bruiser swimming again.

[labblab]

Welcome from me, too, and I have to join the group who is questioning the need for an LDDS in relation to a dog who has been diagnosed with calcinosis cutis and has an abdominal ultrasound that is consistent with pituitary Cushings. In your dog's case, I would think that the calcinosis cutis would actually be a more reliable indicator of Cushing's than the LDDS, because the LDDS is vulnerable to "false positive" results in the face of nonadrenal illness or severe inflammatory conditions. I would think that the inflammation from Bruiser's skin condition would be enough, in and of itself, to affect the LDDS testing results. Plus, even when accurately diagnosing Cushing's, the LDDS does not always help differentiate between the adrenal or pituitary forms of the disease -- for that, you usually look to an abdominal ultrasound which you have now already done.

One suggestion: before proceeding any further, I really would follow Glynda's suggestion and ask your vet to try to consult with Dr. Bruyette. He really is an expert in this regard, and can provide guidance re: further testing and treatment. He may end up suggesting an ACTH blood test instead of the LDDS, because the ACTH will tell you what Bruiser's pretreatment cortisol level looks like. Or he may just advise you that no additional testing is necessary at this point. Either way, I think his input could be very valuable.

Good luck, though, in whatever you decide!
Marianne

[Sabre's Mum]

Sabre's was only weepy and bloody in certain areas .... the area around his anus was terrible. What we tried to do was to get it to be dry ... hence the use of betadine. We really did not see any improvement with three months of antibiotics (two different types) ... and initially prednisone to control the inflammation (we did not know what was causing it at this stage!), then we got the confirmed cushings diagnosis and started the lysodren.