Miss Millie Mayhem (Eng Bulldog) - NEW Dx: Cushings PDH and AWFUL Calcinosis Cutis

What a wonderful forum I have had the chance to scour for endless information as my baby girl went through lots and lots of testing to receive a final diagnosis of Cushings (PDH) and Calcinosis Cutis (AWFUL!!!). I can’t thank everyone enough for all of the posts that have helped me to become more informed and a better mama for my girl. Millie Louise (almost 10 yr old English Bulldog), was diagnosed on 6/28/13 with Cushings (PDH) after an ultrasound was performed. She weighs 55 lbs and started on Trilostane 6/29 – 60 mg every morning with food. What is just visually awful is her calcinosis cutis – I have such sympathy to all of you out there who are also dealing with this horrific skin issue as well as Cushings itself. Miss Mille has had open, oozing wounds and scabs from her neck all the way down her trunk (a good 8-12 inches wide) and on her cheeks – face cheeks that is. I pray that this quickly gets under control and am treating with DMSO and an antibacterial mousse in addition to Clindamycin and Rilexine due to staph and strep infection. This was the most aggressive skin disease I have ever seen and at the very onset took her to a dermatology specialist (went from a couple spots to the entire neck/trunk and sides of face in 2 weeks). So I thought I would post what seems to be protocol as it relates to symptoms and test results and would appreciate any thoughts or things I should be asking/looking for…I want to be the best I can for my girl. She is also taking Previcox, Phenobarbital and Tramadol (and yes, I have a spreadsheet to manage her meds and as recommended by a couple of you out there, a journal outlining any irregularities). Oh – poor thing also has an interdigital cyst that likes to keep re-appearing as well.
Symptoms:

•Excessive drinking
•Heavy urination but no accidents in house
•Big appetite
•Thinning hair coat turning into awful calcinosis cutis (determined by biopsies) – open oozing soars
•Weakness in rear legs – no more jumping up favorite “low chair”
•Little bit of a pot-belly
•Lack of desire to go on even short walks

Testing Done:

Urinalysis: Sp. Gr. 1018 (?), Color: lt. yellow, PH: 6.5, Protien: Trace – Reading handwriting so hope I got this correct…no other values noted.

LDDS: Pre-Dex: 2.5 ug/dL, 4Hr: 2.4 ug/dL, 8Hr: 2.3 ug/dL – I thought it was strange her baseline was within the normal range, but both vets said that it can fluctuate through the day. Also thought since baseline was somewhat normal, I was surprised her calcinosis cutis was SO EXTREME.

Bacterial/Skin Test: I cannot decipher these results, but it was determined she had staph and strep infections.

Biopsy: Clinical Summary – Three week history of erosions, dorsal neck, spreading along the back. Lesions are surrounded by erythematous plaques. White irregular serpiginous plaques on lateral neck. Two punch biopsies of erythematous plaques and one of white plaque. History of allergic disease. Suspect calcinosis cutis. Skin scrapings negative. Cocci seen on cytology. Patient is PU/PD with increased appetite. Gross Description - One container labeled “Millie,” three specimens, six sections in one cassette. 3 skin punch biopsies, bisected and totally submitted as six sections in one cassette, specimens inked blue, yellow, unlinked identification of halves. Diagnosis – Skin biopsies, dorsal plaques: calcinosis cutis, multifocal. The epidermis is acanthotic and suffers multifocal edema and vacuolar degeneration. There is a thick layer of loose orthokeratotic keratin on skin surface. Somewhat cystic follicular keratosis with follicular casts is also evident. The dermis is becoming mineralized. This has incited a granulomatous response and fibrosis. There are also small fragments of mineralized bone in the affected tissue (SHOULD I BE CONCERNED ABOUT THIS…BONE IN TISSUE??). Comment – Clinical Diagnosis of Calcinosis Cutis is confirmed…

ACTH: Time 1: 3, Time 2: 4, Cortisol Sample 1: 2.1 ug/dL, Cortisol Sample 2: 8.5 ug/dL (I believe the vet said this test was inconclusive?)

Superchem: Just reporting “abnormal” – Albumin: 2.1 (LOW), A/G Ration: 0.7 (LOW), Alk Phosphatase: 1704 (HIGH – this seems off the charts to me…normal is 5-131 U/L), Magnesium: 1.4 (LOW), Potassium: 5.6 (HIGH)

CBC: Just reporting “abnormal” – Platelet Count: 595 (HIGH), Differential Neutrophils: 11097, 81% (HIGH)

OK - so wow, I know this is a lot, but I just don’t know what else I should be looking for, what additional questions I should be asking. You all have helped me wipe away my tears over the past few weeks as I feel you are all an amazing support group. This has been very difficult and I just hope to do my best for my little girl. THANK YOU ALL in advance for and words of wisdom you can offer, I know I am in good hands with all the wonderful support I see flowing through this forum. Sorry to be so long-winded but didn’t want to miss anything! ACTH Test scheduled in 9 more days to see how she is doing on the 60 mg

P.S. We call her “Millie Mayhem” cause she has such an attitude and such sass! She is so stubborn and I look forward to helping her get back to her old crazy self!

Sincerely,
Millie's Mama (Kerry)

Hello and welcome :)
I am sorry for the reason that brought you here, but so glad you found us. You have come to the right place! There are many K9Cushing's angels standing by to help and stay with you every step of the way. They love details, test results, any information you can get your hands on. It looks like you've already made a good start with that.:) We will do all we can to help. Others will be popping in to welcome you also. Be ready for lots of questions. :)So again welcome to you and Millie,

Hugs,
Kathy

Love her name, my angel Tia had some sass of her own so your comment made me smile.

I don't know lots about the test results but I do know our experts like the reference ranges against the results to determine what that lab classes as normal range (you can edit the original post save typing it again)

I do have first hand experience of Calcinosis cutis as my little girl suffered from it too, I am so sorry she has it on her face, Tia got it down her whole back panel and it is wickedly bad to look at.

We shaved her back in the end so we coud keep it clean. We also used salt water from the sea and sudocream to help the itch and soreness. One of our members is also using manuka honey with success.

Big hug to you and kisses to Millie Mayhem

Mel
Xxxxxx

Ps I love her picture she looks like she is wondering what the heck you are doing!

Thanks Mel and Kathy,
Appreciate the welcome, and of course as I write this, Miss Millie managed to rip the scabs off the side of her face...arghhh...just opens up again. She certainly does not have a beauty pageant title in her near future, but she will always be the best looking girl to her dad and I. I appreciate the recommendations as my goal is to help use something that may soothe her and prevent itching. The one thing we have going for us is her bulldog body, so she can't really bite at things, but she can paw her face (can't wear cone cause of sores on neck). I just wish she could talk to me and tell my if it itches bad, and then if I put something on her, I just don't want it to sting or burn and I want her to say "oh mama that feels good" or "hey, get the heck away from me with that stuff." I will research the items you noted below. What kind of pup is Tia? I will also edit my response with refernce ranges per your recommendation

PS - Millie is always wondering what the heck I am doing...this pic was pre-disease. The dermatologist said it is the worst case of CC she has ever seen, and I have not even shared pics with family and friends because I fear it would horrify them :eek:.

Thanks much!

Kerry and Millie

Hi Kerry,

Welcome to you and Millie from me as well! I am so sorry for the circumstances that brought you to us but so glad you found your way here.

Sorry, again, but I have no experience with calcinosis cutis but there are members here that do and I am sure they will be along soon. One of Moderators, Angela, is very knowledgeable about calcinosis cutis since her beloved Vizsla, Sabre, had it too, I will shoot her a PM and let her know you are here. ;) In the meantime here are some links to other member's Threads regarding calcinosis cutis: http://www.k9cushings.com/forum/showthread.php?t=5108

http://www.k9cushings.com/forum/showthread.php?t=5316

http://www.k9cushings.com/forum/showthread.php?t=3956

Quote:

---

Originally Posted by khockman

ACTH: Time 1: 3, Time 2: 4, Cortisol Sample 1: 2.1 ug/dL, Cortisol Sample 2: 8.5 ug/dL (I believe the vet said this test was inconclusive?)

Sincerely,
Millie's Mama (Kerry)

---

One question I have is, when this ACTH stim test was done was Millie on Trilostane or was this done before treatment started?

Please know we will help in any way we can so do not hesitate to ask any and all questions, ok?

Love and hugs, Lori

Thanks Lori!

The ACTH Test and all other tests were done prior to Trilostane (we just started her on this yesterday – the day after the ultrasound ruled out adrenal tumors). Still need to get full blown ultrasound report faxed to me tomorrow from IMS, but adrenal glands were both enlarged, no tumors appeared present and narrowed it down to PDH. Is there some concern you have with the ACTH :confused:? I very much appreciate your welcome and your input and am also thankful for the links you provided! I hope you never have to deal with CC...Cushings is tough enough With everything that comes along with that...

xoxo,
Kerry

I must admit that I am quite baffled that Cushing's is suspected for the CC. According to those ACTH stim results Millie's cortisol is not elevated at all.

Cushing's is when the cortisol is way higher than normal. So I am a bit concerned with Millie taking 60 mg of Trilostane because Trilostane will lower her cortisol more and if it lowers it too much it could create an Addison's crisis.

Staffie...

When she had it around her neck I got the stretchy bandage and cotton wool stuff for underneath and put sudocream on before but it can stick if it dries out so needs changing a fairly regular otherwise the scabs can come off before they are ready.

It starts out like stretch marks then bumps then scabs which will fall off and then when the medicine starts working it will be new skin. Tia did get all her hair back, we had to shave her from her neck to her bum, get the vet to be very careful if you do get her clipped cause Tia defo found that uncomfortable but I think it helped me keep it clean and infection free

Big hug

Mel
Xxxxx

I did bring up the same concern you had as when I looked at both the LDDS and ACTH results it seemed that baseline cortisol levels fell normal. With the LDDS it appeared that even though baseline fell in normal range, she was unable to suppress at 4 and 8 hrs, but with the ACTH, I was told the results were inconclusive. Both vets said that cortisol have hit peaks and valley throughout the day depending on when the baseline is taken? I also brought up my concern of Addison’s given too high of a dose. Understanding both UC Davis and Dechra protocol (because of this GREAT forum), it looks like the 60 mg falls at the low end of Dechra given her weight of 55 lbs. What else can CC be caused from…any thoughts :confused::confused::confused:?

So possibly Petey and now maybe Millie....

I thought cushings was the only thing to cause CC. Might have to do some reasearch....

I think I read once diabetes but can't remember, will look!