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

[lola's mom]

Thank you so much, Marianne, this is very helpful info!

Based on what I've read on this forum, lysodren requires a loading time with ongoing maintenance after. Presumably that is dosed via weight as well? Any recommendations on what that would be if we took the lysodren route? Once again, Lola weighs 22-23 pounds.

My regular vet isn't familiar with lysodren and my dermatology specialist didn't feel too strongly about going with either vetoryl or lysodren - she just recommended that whichever vet I go with should be well-versed in the treatment they prescribe and test often. Reading through an overwhelming (and helpful!) number of threads here, it seems that on the whole, lysodren has been more helpful in clearing up CC than vetoryl for most dogs, so I'm more inclined to go that route.

My regular vet has been wonderful and has gone well out of her way to help diagnose Lola, and while she has been reading up on Cushing's treatment to ensure she is taking the correct route I am feeling like she isn't as well-versed in treating Cushing's as I'd like her to be, so I've found an internal medicine specialist (one who works closely with and is in the same building as the dermatologist) who treats many Cushing's cases and is equally familiar with both vetoryl and lysodren. I was able to get an appointment with him tomorrow, so we'll see exactly what he recommends - I'll report back on that here, stay tuned!

[Renee]

Thank you so much, Marianne, this is very helpful info!

Based on what I've read on this forum, lysodren requires a loading time with ongoing maintenance after. Presumably that is dosed via weight as well? Any recommendations on what that would be if we took the lysodren route? Once again, Lola weighs 22-23 pounds.

My regular vet isn't familiar with lysodren and my dermatology specialist didn't feel too strongly about going with either vetoryl or lysodren - she just recommended that whichever vet I go with should be well-versed in the treatment they prescribe and test often. Reading through an overwhelming (and helpful!) number of threads here, it seems that on the whole, lysodren has been more helpful in clearing up CC than vetoryl for most dogs, so I'm more inclined to go that route.

My regular vet has been wonderful and has gone well out of her way to help diagnose Lola, and while she has been reading up on Cushing's treatment to ensure she is taking the correct route I am feeling like she isn't as well-versed in treating Cushing's as I'd like her to be, so I've found an internal medicine specialist (one who works closely with and is in the same building as the dermatologist) who treats many Cushing's cases and is equally familiar with both vetoryl and lysodren. I was able to get an appointment with him tomorrow, so we'll see exactly what he recommends - I'll report back on that here, stay tuned!

Awesome job mom! You are doing everything right so far. Lola is very lucky to have you. I look forward to hearing what the IMS has to say.

[lola's mom]

Thank you, Renee :-)

The IMS felt strongly about an ultrasound to rule out any adrenal growths, so Lola had that done today and the adrenals were all clear. He felt that vetoryl was the best route to begin with since he feels it's easier to adjust as needed and is FDA-approved for Cushing's, whereas he feels lysodren is a bit trickier when adjustments are needed (and apparently not FDA-approved for canine Cushing's even though it's used widely for that). He's used both for Cushing's patients and typically prefers to start with vetoryl as the first approach unless there are other hormonal issues going on, in which case he said lysodren would be the better one to start with. He said that if the vetoryl isn't working over a period of time, we can always switch to lysodren and feels the unmedicated time in between that switch doesn't need to stretch out to 30 days, but can be 10-14 days...let's hope that vetoryl just works for her and no switch is needed!

While he wants to start out dosing low and slow, since Lola has such severe CC which is spreading quickly, he wants to start her out at 30mg and he wants me to bring her back in within 2 weeks for the ACTH test to see how things are going. I'm a bit nervous about starting at 30mg instead of 20mg but he feels very confident about that amount and he has many Cushing's patients...We start her first dose tomorrow AM and I'll be keeping a close eye on her and logging everything. I'm nervous but cautiously hopeful that she'll begin to turn around in time.

We go back to the dermatologist in one week, and at that time if her infection is much improved they want to take Lola off the antibiotics and put her on DMSO so that the calcifications can begin to reabsorb into her skin (antibiotics won't do that presumably). The IMS agrees with that approach. I'm nervous about all that too, but we'll see.

Does all this sound kosher to you all? Thanks for your thoughts!

[labblab]

I'm glad you've had the ultrasound performed and are receiving the benefit of additional consultation. Yes, for the most part, things sound kosher to me and given Lola's rapidly spreading CC, I do understand why he is wanting to be a bit more aggressive with the dosing. Since you are starting at about 1.5 mg. per pound, I'm glad that he is recommending ACTH testing at that initial two-week mark. I know you will be watching her really closely and will be poised to nip any problems in the bud. I'll be watching anxiously for updates!

Marianne

[Harley PoMMom]

I agree with Marianne, Lola's treatment plan sounds right to me, however; I do disagree with his statement below:

He said that if the vetoryl isn't working over a period of time, we can always switch to lysodren and feels the unmedicated time in between that switch doesn't need to stretch out to 30 days, but can be 10-14 days...let's hope that vetoryl just works for her and no switch is needed!

On the dvm 360 (veterinary medical information) website they have a Q&A Cushing's article with Dr. Feldman. Dr. Feldman is a renown Cushing's expert who has published in many peer-reviewed, high-quality journals, he had this to say about switching from one drug to another:

Any dog switched from one to the other should receive no medication for at least six weeks.

Full article can be found here: Cushing's disease and other adrenal gland disorders

I am sure Lola's vet has heard of Dr. Feldman and I bet has read many of his published articles.

Will be watching for updates about Lola, and I am sure you'll do an excellent job, and remember we are here to help.

Hugs, Lori

[lola's mom]

Thank you so much, Marianne and Lori! I will be sure to share the link to the Dr. Feldman Q&A with the IMS.

I have to say the more I think about it, I'm waffling on the 30mg vs 20mg start given the potentially scary side effects...The capsules I was given to start tomorrow AM are 30mg capsules.

[Harley PoMMom]

Trilostane, which is the active ingredient in Vetoryl, has a short half life, so if Lola would start having any adverse effects, stopping the Vetoryl should perk her back up. Adverse effects to watch for (although I really don't think this will happen) are: vomiting, diarrhea, lethargy, or Lola just not acting like herself. Remember too, when in doubt don't give the Vetoryl, and we are here to help.

[doxiesrock912]

Some of the ladies here have used a spray that is quite effective in treating CC. Maybe your IMS would consider a combination of 20mg Vetoryl and the spray. Trizchlor spray conditioner(smells nice) and mupirocin ointment for spots that crack open.

[labblab]

Val, Terry tells us that Lola is already being treated with these medications, as well as some others, but control has been difficult.

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.

Terry, I surely understand your concerns about the trilostane dosing, and without that handy crystal ball that I already mentioned , it's impossible to know what will end up being the best dose for Lola. However, I also understand your vet's sense of urgency as far as getting her cortisol down relatively quickly. CC is a terrible condition that can explode when untreated or undertreated. Sadly, during our years here, we have had a couple of owners who were faced with end-of-life decisions for their dogs when unmanageable CC rendered quality of life unbearable. I do not tell you this to scare you unnecessarily, but to offer a bit more context for your IMS's recommendation. I cannot tell you what the "right" dose will end up being for Lola, but as Lori says, if you do opt for the 30 mg. you can simply stop giving the drug if Lola seems to be reacting badly. Plus, the fourteen-day ACTH will give you valuable info re: the drug's effect on Lola's system and I'm sure your vet would decrease the dose at that time if it seems to be higher than is optimal.

Marianne

[goldengirl88]

I don't have any experience with CC thank God, but know many on here struggle with it, and I just wanted you to know you can lean on us for support to get thru this. Blessings
Patti