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

Hi all - Here's what I learned during my appointments with the derm specialist and the IMS yesterday:
- The mild left renolithiasis is so minor, and she presents no clinical symptoms so I just need to keep a lookout to see if she strains while she urinates.
- Apparently the high blood cholesterol is also related to the Cushings.
- She has clostridium bacteria in her poop so they gave me panacur granules to sprinkle over her food for 5 days, plus metronidazole for 7 days (in addition to all the many other meds she's on!).

As for her CC, the derm would like us to continue with the mupiricin and silver sulfadexine (sp?) ointments and trizcolor spray on the infected area on her neck, plus continuing with the oral antibiotics (zeniquin & chloramphenocol), plus the trilostane. For the new CC spots that have popped up (they're just red and puffy at this point, no discharge or infection) - they want me to begin to apply DMSO on those to prevent further spread/worsening of those new spots and hopefully some begin to reabsorb with the DMSO and the trilostane over time. So far, the DMSO isn't too smelly.

I'm worried about having ALL of this stuff in her system, frenchies in particular are typically very sensitive to meds. We'll see how all this goes, fingers crossed!

I can't remember if I asked this or not? Do you have her on some good probiotics? With so many different meds, especially the abx, her good bacterias can get out of whack. A good probiotic can help keep things healthier.

Yes, she's been on probiotics for at least 3 months now :-)

Hi All,

Just wanted to post an update on Lola. Her CC has continued to spread, however here are her ACTH test results after being on 30mg of Trilostane for 2 weeks:
pre:1.3 ug/dL
post: 3.4 ug/dL
(Desired(?) pre and post range on Trilostane treatment is 1.5 - 9.1 ug/dL based on what was listed in her first test results)

Unfortunately they listed the desired range on the lab results for Lysodren treatment (1-5 ug/dL ), and she's not on Lysodren! I'm waiting to hear back from the IMS on this issue and his interpretation.

You may recall that her initial ACTH results didn't indicate that she had Cushings, however the LDDS test confirmed that she does, plus she has the CC. For reference, her initial ACTH test results were as follows:
Pre: 2.5 ug/dL (Reference range = 1.0-5.0)
Post 15.2 ug/dL (Reference range = 8.0-17.0)

Any initial thoughts on her 2-wk pretest level being at 1.3 ug/dL?

Thank you!
Merove

If it's only been two weeks, then I would caution you to watch her very, very close over the next 2 weeks, as the cortisol can continue to drift down for the first 30 days. With her post figure already being so low, at 3.4, she could be at risk of going too low in the next few weeks.

Honestly - you may consider dropping back to 20mg to be safe.

The range you are in however, is a good range, I just worry about the cortisol continuing to drop.

The CC will continue to spread, as the sores underneath the surface of the skin still need to bust out (they were there long before they appeared above the skin surface). You'll know it's improving when the oldest sores start to heal, and the newer ones aren't as angry as the original sores. My pug continued to get lesions coming up for a few months after starting vetoryl, but none of them ever got as bad as the original lesions from before treatment. They still have to run their course though.

Thanks so much, Renee. I'll also let you know what the IMS says once I hear back from him.

The range for vetroyl is 1.5 - 5.0ug or up to 9.0ug if symptoms are controlled, so where she is now is doable, you don't want to go any lower on the pre though, as 1.5 is optimal. You could easily increase I meant decrease! a tad with room as Renee mentioned and stop immediately if she goes too low. As far as the cc, Renee is right about that too and she too is going through it, so hopefully the worst is over now and you'll see improvement, but cc and hair, usually the hardest ones to get over. Just keep an eye on her that she doesn't go too low.

Sharlene and molly muffin

Sharlene - I was actually thinking a potential decrease in the vetoryl, as she has already dropped down to 3.4 in just the first two weeks. I worry that with such low numbers, while in an ideal range, she does not have much room to drop any lower and still be safe within the next two weeks. That cortisol may continue to drop down, and it could get too low.

I meant decrease, not increase! :eek:
Good catch Renee!! I edited :)

Sharlene

I agree 100% with Renee's assessment. You don't have a lot of wiggle room and it's only been two weeks. While Dechra says a post stim of 9 is okay as long as all symptoms are resolved, I don't believe calcinosis cutis is included in the usual symptoms. Unless he's changed his opinion, Dr. Edward Feldman of UC Davis does not use the Dechra guidelines and uses a therapeutic range similar to Lysodren. I listened to one of his lectures and he states that if a post stim is above 6 or 7, the dog may have resolution of all symptoms but it will never be normal. To achieve normal, you have to get the post stim in the same range as the basal (resting) cortisol. Most labs show this range as 1 to 6 ug/dl. If I had a dog with cc, that would certainly be my goal so as to ensure resolution. Just my two cents.

Glynda