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

Hi Everyone,

The info here has been very informative, I'm still sifting through a lot of it. I'm sure I'll have some more questions beyond today...thank you to everyone who created this forum and to those who are active in it.

A few days ago my frenchie was diagnosed with calcinosis cutis - she has CC patches in several spots on her body and unfortunately one of them (just above her shoulder blades) is oozing and severely infected which we are trying to get under control - it is very scary-looking. She is on Zeniquin, Chloramphenicol, Mupirocin, Silvadene, and Trizchlor shampoo & spray. She doesn't seem to be in pain except for certain spots when I apply the ointment, and she doesn't try to itch too much - she's such a good-natured dog.

They gave her the ACTH Stimulation test to confirm Cushing's and it came back negative. The vet is certain that she has Cushing's and so she wants to run the Low Dose Dexamethasone Suppression Test to see if it returns positive for Cushing's. Given that CC pretty much is synonymous with Cushing's, is it even worth running this additional test?

Either way, it sounds like an ultrasound would be beneficial to help determine pituitary vs adrenal cushing's?

As for treatment, it sounds like there are really three options to choose from, is that right?:
- DMSO (that's what my vet is already leaning towards for some reason)
- Vetoryl (Trilostane)
- Lysodren

Is the choice between these dependent on whether the Cushing's is pituitary vs. adrenal? What other factors impact which treatment to choose?

FYI, my Lola is about 8 years old. I adopted her from a rescue group about one year ago, so I don't know if she's had prednisone in the past - definitely not in the last year. Since she is a frenchie, she is also very prone to skin allergies.

Thank you in advance for your advice and caring concern,
Lola's mom

Oh dear, yes, the dreaded CC can be quite painful to look at and hard to control. If it causes her pain, definitely see about getting her some tramadol. Please tell us how the CC was diagnosed? Biopsy? Does she have any other symptoms that would lead you to suspect cushings?

Can you please post the ACTH results including the reference ranges and any other bloodwork results? I know you said the ACTH was negative, but they may be dependent upon the lab. For example, the normal range for my lab is up to 22 for the post cortisol, but in many other people's results, their labs use a max of 18... so, you may be just on the border line for the ACTH results.

An LDDS is a good idea, as is the ultrasound. I would not say either of those are a waste, in my opinion.

As an aside, with her being on so many abx, I would urge you to add some probiotics to her diet. That much medication can really get her system out of whack.

Thanks for your note, Renee! I was sent to a dermatologist for the weird growths that the specialist immediately recognized as CC and confirmed via biopsy. Lola has also been drinking much more recently and having increased accidents inside which isn't like her. She has also battled UTIs for the last few months, thinned skin and weakened hind legs which I thought was the beginning of arthritis. Also a slight decrease in energy.

I will post the ACTH numbers when I'm able to receive them from the vet, and yes Lola has been on probiotics for a few weeks now. Her liver/kidney (?) values were slightly elevated - nothing that my two regular vets flagged, but the specialist really put all the puzzle pieces together.

Unfortunately Lola had a terrible reaction when I gave her tramadol combined with her other meds a few days ago (all require to be given with food and some are required three times a day, so I can't give her any more food!). She was shaking about 30 min after I gave it to her, I had never seen her do that before, so the vet recommended I omit the tramadol since she generally didn't seem to be in pain...

Poor girl. :( I am so sorry the tramadol gave her a reaction.

It sounds like you are on the right path. And, I am glad you saw a specialist about the CC.

There are a number of us (my pug included) that are dealing with CC. Please find our threads and read them. You can get some good information on how we have been treating them. Of course, the only true 'cure' for CC is lowering the cortisol. Everything else is just management.

I look forward to seeing the test results and seeing what the LDDS and ultrasound reveal.

Renee - I just read your entire thread about Tobey from early December through to your latest post. It has really helped me set expectations for the long and winding road ahead, thank you so much for all of that documentation (and for everyone else's care and advice!). It sounds like things have been improving for Tobey, how is she doing now?

Thanks again to everyone who is active in this forum - I hope to return the favor over time as I gain more knowledge and hopefully as Lola gets better.

Bless you for reading my thread! I remember when I first came here, I was reading threads from start to finish too. Its helps to not feel alone, and it is reaffirming to see that all of us have gone through similar experiences from the very start to wherever we are now.

It is a long and winding road, but the path gets easier and easier for many of us.

Symptom wise, Tobey is doing very well. I think we have hit her perfect dose, but I have not gotten an ACTH done yet, and that will tell some of the story. I was supposed to do it last week, so I thought I would do it this week, but her vet is out of town, so.... I have put it off another week. I know it's a break with protocol, but I feel okay with it at this point.

Her personality is still a bit off, but I am just giving that some time.

It really does feel better to know that others are going through this with their pets and that things can and do get better over time.

That's great to hear about Tobey, fingers crossed the numbers are positive.

Hope that you can get the cortisol lowered and then you should see things start to improve with the cc too. Eventually, it takes time.

Not all dogs react well to tramadol, sounds like Lola is one of them. They can maybe have it in a very, very small dose, if you need to try that.

Sharlene and molly muffin

Thanks so much Molly Muffin and Renee!

We had the LDDS test yesterday, so I'm hoping to receive the results today or tomorrow which I'll post here. In the meantime, here are the ACTH results:
Pre: 2.5 ug/dL (Reference range = 1.0-5.0)
Post 15.2 ug/dL (Reference range = 8.0-17.0)

I've read mixed things about DMSO and the risks associated with it - Lola is a french bulldog with a sensitive system so I'm conflicted on whether to try it out or not...thoughts?

Also, I'm having trouble finding the thread on here - is the general thought that Lysodren is better for resolving CC, or is it Trilostene? I just read that there were some sudden death cases with Trilostene, which is alarming.

Okay, the ACTH results do rule out cushings.. but, again, we know those can be wrong, so other diagnostics and analysis of symptoms will help lead to the diagnosis.

I personally had zero success with DMSO, and the smell of it was just horrible. It is often prescribed, and some dogs (Cosmo on here, who has passed) did have success with using it, in conjunction with vetoryl. If you are already on abx and using trizchlor spray, then I would not waste time with the DMSO.

Some people say that vetoryl is not as effective at controlling CC, while others (my Tobey included), are doing well using vetoryl.

Don't get scared away by the side effects of vetoryl vs. lysodren. They both are equally as effective and equally as 'dangerous'. You won't be able to choose one over the other based on which is safer. Neither one is safer than the other.