Attila-Calcinosis cutis, starting treatment w/ Lysodren..(Attila has passed on)

I am very, very new to this forum, but wanted to let you know that for years I have fed my boxers a raw diet. I stopped for the last few years because I got lazy. Working full time and being the taxi cab for my boys , was making it difficult to make the pick up times from my meat supplier. So I went to high quality grain free kibble. Since Barkley has been drinking and peeing so much( couldnt leave him alone for more than 2-3 hrs) I thought going back to a raw diet would be the best. I have to say that I am amazed at the decrease in his water consumption. It's almost back to normal, which means he doesnt have to go out side so often!

I know people have mixed feelings about a raw diet, but I have really found it helpful with my dogs. Either way, good luck with the lysodren. I will hopefully be starting on the same thing soon.

Raw, wet (canned) and home cooked diets have a much higher moisture content than kibble (dry feed) so it is to be expected to see a rise in water consumption when going to kibble from any of those three type feeds. ;)

Hi - I know this thread is old, but hopefully someone will get this. My French Bulldog, Attila has Cushings, has been on Vetoryl for a little over a month (under Dr. Bruyette's care) and has had the calcinosis for about a month. 2 days ago his hair started coming out in chunks on the back of his neck (w/ some blood from the skin attached). I have been cleaning the area daily, putting antibiotic ointment and have bandages and a t-shirt if we go out (as it looks pretty scary). It seems from the posts from Sabre's mom that it gets worse at first when meds are started but naturally clears up? Is there anything else I should be doing for him to help this heal? Can we expect the hair to ever grow back? I will consult with the vet, but I've found everyone on this forum to be the best consultants on the day to day issues in dealing with Cushings. Thanks for any input. Laura

Hi Laura,

There has been no activity on Bruiser' thread for over 2 years so I moved you post to Attila's original thread in order to keep all responses and history concerning your baby's journey in one place. I will also change the title of this thread to reflect the CC so those who deal with this will know and be more apt to chat about it. ;)

Hugs,
Leslie and the gang

Thank you so much Leslie - I couldn't figure out how to start a new thread with a new subject, so you have taken care of it all! Much appreciated.

Hi Laura,
My Boston has the dreaded CC. We tried a lot of things to help it, including over the counter ( human) antifungals and antibiotics, and various medicated shampoos.
I think what helped the most was an product called Dermarest, which is a (human) product for psoriasis that is 3% Salicylic acid that I got at the drugstore. It dries up the outer crusty shell part and just leaves a smoother bump.

I am following your thread because we are getting ready to start Lucy on Lysodren. Vetoryl did not work for her. She too has had issues with loose and or bloody stools in the past, so we are planning to give Pepcid before each dose.

Shelly and Lucy

Thanks Shelly - I will look into Dermarest. I have looked at many of the posts on CC, but can't find too much advice on how to best care for it. I imagine antibiotics are good to keep on it to avoid infection? It would figure that Attila's American cousin (a Boston) would have similar GI issues. For us, Flagyl always seemed to work and we have only been feeding Attila sweet potatoes, oatmeal and white fish- very bland. Good luck with the Lysodren - Unfortunately, Attila's body rejected it, but there's good information on here about dosing and administration.

Hello my fellow Cushings parents! Attila (9yr old Frenchie) has been on 30 mg. daily Vetoryl for over a year now. The results of his ACTH stimulation test last week were very good, however he has been drinking water excessively over the past month. He can hold his pee through the night, but he does pee more often in the day. His urine is sometimes yellow and sometimes clear. Has anyone had this happen?
Our vet (Dr Bruyette at VCA West LA) said that he could take an MRI to see if their is pressure on the "pituitary mass"(?). I said that before we go through that big procedure Id like to check his blood and organ function. He recommended a "plan panel" and urinalysis. As you can all probably understand, Id like to be proactive about this symptom in case it is linked to something more serious. Thank You for any input on this.

It's been a while since we heard from you, welcome back! Over a year that Attila's been in treatment for Cushing's! Wow time goes by so fast!

I see that an urinalysis has been done, what were those findings? Did the results come back for the plan panel, and if so, could you post them? Diabetes can come on suddenly, has this been ruled out? Also, would you post those recent ACTH stimulation test results for us?

Hopefully the reason for Attila's increased water/urinating will be figured out soon, you're doing such a great job with dear Attila!

Hugs, Lori

Welcome back to you and Attila! I, too, am glad to hear that you have had a very good year, but sorry to read about this new issue. I know you are in very good hands with Dr. Bruyette, and I hope that you will soon get to the bottom of things. I do not know what a "plan panel" is, however. Is it some type of special blood panel?

Marianne

Hi Lori and Marriane - (I guess the posts don't show up immediately in my email anymore) Thank you for responding. Yes, time has flown by! I am thankful that Attila has been stable during one of the busiest periods of my life this past year. I have never gotten the numbers from the ACTH stim tests, I have just trusted the doctors read on them because of his experience, but I can ask for them. We have not yet done the urinalysis or the blood "plan panel". I don't know what that is specifically, but thats the blood tests the doctor suggested in order to tell if anything is off. Good to know about the Diabetes. I would assume that would come up very quickly in any test. Its alarming that Im not alarmed at the $250 cost of the blood tests…at this point I say I could have sent Attila to college with all his vet bills. - I am probably in good company on here.

Forgot to remind you of my name -"Laura"

Good to hear from you again, Laura, and to know that Attila has been doing well the last couple of years. A thought on the urination, DI, a form of diabetes that has nothing to do with blood sugar but rather with how the body processes water. You might as Doc B if this is a possibility...and if he says yes, don't let him do the water deprivation test. It is risky. Most vets just start the med (an eyedrop) and if that works, there you have the diagnosis with minimal risk to the pup. ;)

Let us know and don't be a stranger!
Hugs,
Leslie and the gang

Hi Leslie - I appreciate the heads up on the DI since I have never heard of it. I will definitely communicate with Dr. D regarding the potential water deprivation test. I will post the results of his tests - another medical mystery to be solved! Thank You once again for your wisdom. Staying in touch…Laura & Attila

Hello - We did the blood tests and urinalysis with Dr. B. He described the blood test results as "boring" since nothing was out of the ordinary and the liver enzymes look good. The urine was diluted as expected. He is suggesting the option of getting an MRI to see if there is a pituitary tumor and if we will treat it with radiation or surgery. He says if not, we can use a medication called DDAVP which is a hormone to help with the excessive drinking and urination issues secondary to diabetes insipidus. MRI's are very pricey ($1600) as is surgery &/ or radiation ($8000 each). Ee gads! I already could have put Attila through college with what Ive spent on him. Anyone had an MRI? Ill wait to see the results of MRI before I ask about the options of surgery and/or radiation if they are needed. His symptoms are not severe right now, just thinking of taking proactive steps. Hopefully we are just looking at Diabetes Insipidus - good call Leslie! I know a few people wanted me to post blood results. I trust the doctor that they are normal, but do some of you still want me to get them? Thanks

We definitely want to see the lab work. ;) I think I would try the eye drops first and see if they did the trick; if they helped I would take that to mean this is DI and not Cushing's. That would save you the money of an MRI right now and it may not be needed at all if the DDAVP works. :)

I second Leslie's thought of trying the eye drops for DI. On the off chance that is what it is, then you wouldn't have to fork out for the MRI.

Dr. B did say we could start with the DDAVP which he uses an oral version as the eye drops can be irritating. However, he did say that if Attila responds to the medicine it would argue that he does have Diabetes Insipidus and probably a large pituitary tumor. Although I'd save money on the MRI, Id like your thoughts about how important it may be to visually see the size and location of his tumor at this point with an MRI? Thanks

Okay I have read back through the entire thread Laura, and I don't see anything that would make Dr. B suspect a large pituitary tumor. There doesn't appear to be any neurological issues. Is he thinking that the peeing is a neuro issue rather than DI? or that a larger pituitary tumor causes DI? I'm not sure I get his thinking on that. Did he expand at all?

I don't know if an MRI is going to show a large tumor or not. They are done, often when a larger tumor is suspected though. My specialist told me that at this point with my dog having no neuro systems (diva doesn't count) that the tumor could be so small that an MRI wouldn't show it and she has found that to happen several times. If you want to know though and if it will give you peace of mind and you can afford to do it, then it might be worth it. I don't know that it is imperative to have it done right away though, unless Dr. B is adamant that he thinks a large tumor is in play.

That's my two cents worth of layman thoughts. LOL :)

Thanks Sharlene - Yes, Dr. B says that if the meds work for DI that there is likely to be a large pituitary tumor present. Even though Attila has no neurological issues at this time, Id like to get an MRI at some point to see what we are dealing with, as I don't want to be surprised. Dr. B said we can start the meds for now.

He did not expand on his reasoning, but initially said a tumor could be pressing on the part of the brain that controls the processing of water.

I'm curious about the Calcinosis cutis. Did it clear up on Vetoryl? If so, how long did it take? Did you try other treatments? If so, what? Kaibo has been diagnosed with Cushing's again and has CC. I would be thinking diabetes is happening, something Kaibo has as well. If you have questions about diabetes, just ask!

Hi Kaibos's Mom! The only thing that worked in the end was the DMSO gel. …and boy does it stink! I tried bandaging his sores with antibacterial ointment and other natural salves, but nothing worked. He also has an extremely clean diet and Ive tried skin supplements. I don't think that the Vetoryl was effective with the CC as the timing didn't seem to correlate. I have included a previous post on this site from "Lulu's mom" from 2009 that discusses some findings by Attila's Cushings vet Dr. Bruyette which might be helpful. Also, Attila's hair has not grown back and its been 2 years. We are lucky its on his neck and he can't see it since he's a proud Frenchie!;)

Quote:

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Originally Posted by lulusmom

I will be posting this on four members' threads, all of whom are dealing with calcinosis cutis. Kerry, Millie's Mama; Crystal, Annabelle's Mama; Shelly, Lucy's Mama and Pat, Peety's Mama.

I've seen too many dogs on Trilostane who have either had little to no effect on Calcinosis Cutis or a worsening effect while on the drug. Based on the frequency with which we've seen calcinosis cutis on this forum, there seems to be a correlation with the increased popularity of Trilostane for treatment of cushing's. I've had a gut feeling for a very long time that Trilostane is responsible for worsening calcinosis cutis due to it's effects on the sex hormones. Dr. Oliver, was the leading expert on adrenal steroids and he firmly believed that 11-deoxycortisol levels build-up in dogs being treated with Trilostane as did other intermediate steroid such as androstenedione, 17-hydroxyprogesterone, estradiol and progesterone. I've never been able to find anything in layman's terms that explains the affect, if any, these steroids have on calcium metabolism. While searching for that connection, I stumbled upon something even better. It was an abstract of a study entitled, "Canine hyperadrenocorticism: effects of trilostane on parathyroid hormone, calcium and phosphate concentrations". The last sentence of that abstract was eye opening.



It looks to me that cortisol isn't the only adrenal steroid that can cause elevations in blood calcium levels. Dr. David Bruyette, a renown endocrine expert, readily admits that he has had bad luck in resolving cc with trilostane. That's pretty telling coming from a high profile specialist who is a contributor to Dechra's continuing education program for veterinarians. This is not a new study. As a matter of fact, I believe it may have been published before Vetoryl was approved by the FDA.

You can find the complete abstract here: http://onlinelibrary.wiley.com/doi/1...283.x/abstract

I'm just sharing my thoughts with those of you who may want to start asking more questions of your vets....or you may even consider calling Dechra, the manufacture of Vetoryl (Trilostane). I'd be very interested to hear what they have to say about this study.

Glynda

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Not to hijack the thread, but just wanted to say I had a much different experience managing CC. I was able to resolve it with the use of vetoryl, and I had zero success with DMSO. But, as each dog reacts differently to things, I am sure that what works for some will not work for others.

Hi, just wanted to comment on that post of lulusmom (Glynda), because we actually subsequently started a whole thread on our Everything Else forum that offered some clarification to that post as well as additional case studies. Since the time that thread was started, we have seen several more dogs here who have had CC resolve while being treated with trilostane. That's why I think the picture is much more positive than at the time of Glynda's first post.

http://www.k9cushings.com/forum/showthread.php?t=5509

Marianne

Thanks everyone! I will check that post out Marianne.

I also did not have any success with the DMSO and I could not get the smell out of the house for WEEKS! Jed had a pretty bad case, I have some pics in his album. I believe the only thing that helped was managing his cushings and at the time Jed was on vetoryl. Jed's hair did grow back and you would never know he had a skin issue. It just takes time.

CC can be the hardest thing to get rid of, but we have seen success with both lysodren and trilostane now. The key is getting the cortisol to a low point (post) that it stays controlled.
Any hard little deposits that are already there, will have to come out completely before it is all done with and have the cortisol low enough that no further ones develop.
It is well worth checking out the cc thread in Everything Else section that Marianne linked to.

Here is the most recent ACTH Stim test results from 1/17/15: Let me know if you want to see other specific results of the blood panel which Dr. B said were all very normal
Cortisol Sample 1: <1.0 (Low) Reference Range: 1.0-5.0 ug/dL
Cortisol Sample 2: 3.4 (Low) Reference Range: 8.0-17.0 ug/dL

He started on the DDAVP about 5 days ago. Not seeing a change yet, but I don't know how long it takes…

Quote:

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Originally Posted by Squirt's Mom

We definitely want to see the lab work. ;) I think I would try the eye drops first and see if they did the trick; if they helped I would take that to mean this is DI and not Cushing's. That would save you the money of an MRI right now and it may not be needed at all if the DDAVP works. :)

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Hi again Laura! I'm sorry you are not yet seeing any improvement in Atilla's drinking, but I really do not know how quickly the drops are supposed to help if they are going to do so.

Regarding Atilla's ACTH results: did Dr. Bruyette say anything at all about that low "pre" that was <1? Some specialists seem to be concerned about low "pre" numbers, but other specialists -- not so much. As a result, I have a hard time knowing how big an issue to make of it myself. Atilla's post of 3.4 was really perfect for a dog being treated for CC. So I don't know whether you want to risk increasing the "post" number by lowering the trilostane dose. Apparently Dr. B did not, but I am just wondering whether he discussed any concerns about the very low "pre." (By the way, the listed "post" norms are for a dog who does not have Cushing's at all. They are not relevant to a dog being treated with trilostane).

Marianne

To: Marianne - Dr. B has not mentioned the low "pre" levels. He's been pleased with the past blood levels.
Update on possible Diabetes Insipidus:
We have been on the Desmopressin (DDAVP) for a month now and seeing some reduction in Attila's drinking and peeing, but we still have to provide a pee pad for him on the balcony since he may not be able to hold his urine until the next time we are able to take him out. So we are not out of the woods here. Dr. B is considering raising the dose. We are on .1 mg 2 x a day right now. Hmm...

Hello Everyone - Attila started showing strange behavioral symptoms last night (i.e. barking, disorientation) and we rushed him to the ER. He got an MRI which indicates a large, aggressive tumor that started bleeding (which led to the sudden onset of symptoms). Dr. B says it is inoperable, but we can try radiation - 10 minutes a day for 16 days while pup under anesthesia. This may prolong his life for 9 mos.- 1year. We will see how he responds to his anti-swelling meds tomorrow morning which will indicate whether there has been any permanent damage. I will have to make a decision whether radiating is in his best interest. Has anyone gone through this?!

having trouble finding old posts on radiating tumors...

Oh gosh. I am so sorry to hear this has happened to Attila.

I don't know that we have had one that has started bleeding. Maybe one the others will know about that. We have had several with macro tumors that have gotten radiation treatment.

It sounds like Attila's though has become unstable. So I think you have to rely a great deal on what they tell you about prognosis with the radiation if it is too late to be able to help him. The brain damage aspect. Can he go under anesthesia safely. Many factors to think about.

Do let us know how he is doing and we of course are hoping for the best but honestly I just don't know enough about what happens if they start to bleed into the brain to give you any real answers. Hopefully one of the others will know more.

Hugs

Look up radiation. Jed was our last one who went through radiation. The surgical knife one I think it was called.
http://www.k9cushings.com/forum/show...ight=radiation

Buttercup also http://www.k9cushings.com/forum/show...ight=Buttercup

Then we have the macro tumor thread. http://www.k9cushings.com/forum/show...ht=Macro+tumor

Hopefully these will help you

Thank You Sharlene - Dr. B said Attila did well with the anesthesia during the MRI. He will be sedated through the night and they will gradually wake him tomorrow and see if he is back to being his alert self which would mean he responded well to the anti- swelling meds and doesn't have permanent brain damage. I keep thinking I should have done the MRI a few months ago, but I wanted to see if he'd respond to Desmopressin from his excessive drinking and peeing - who knew the tumor was so aggressive?

We have seen some pretty aggressive tumors lately. I don't know why that is but they can sometimes grow quickly if they are the type to do so.
That is good that he handled the anesthesia okay. That is always a worry too.
Hopefully there is no permanent damage. It is just all so very scary to know they are going through so much and not know what you can do to help them.

I visited Attila at the vet tonight even though he was sedated. The doctor on duty showed me the MRI of the tumor. The largest point of the circumference is 2.3 cm (almost an inch!). For the tiny brain of a French Bulldog, this is a large tumor….and it bled. More to be revealed tomorrow morning as he comes out of sedation, then I will try to make the best decision possible based on a projected quality of life.

Our thoughts and prayers are with you hoping for the best possible outcome.

Just read through your thread. Gosh our dogs are lucky we love them like our kids. That is a large tumor for your little guy. Please keep us posted. Your guy is much like my Jed I think...hard time handling the cushings meds, the CC and now the large tumor and they are about the same age. It's so hard to watch them suffer through all of this...

xoxo
Lisa and Jed