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

[khockman]

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)