Daisy - Boston Terrier on Trilostane

[cferna01]

Hi everyone,

Wow. I am amazed at the level of support on these threads. I just confirmed that my Daisy (a 10 year old boston terrier who I got in Oct 2010 from a rescue) has Cushing's disease. I started her treatment on Saturday. She is taking 5 mg of Trilostane (2x per day- 7AM and 7PM). She had the signs of increased urination and thirst and I took her to the vet in July 2011, but after bloodwork and tests, I was told that she prob had a low-grade uti or that she may have difficulty holding her pee as she was spayed right before she came to me. Needless to say, i switched vets and now I am working with an IMV who specializes in endocrinology.

My biggest concern at the moment is daisy's calcinosis cutis. It developed rather rapidly (within 2 weeks) and although she just started treatment, it is getting worse and spreading. I am washing her with specific shampoo and I am giving her antibiotics (simplecef), but it is spreading a bit (although the original location appears to getting a tad bit better). Any recommendations on how to manage her skin condition? I keep it aired when I am with her, but I put a clean towel around her neck when I go to work because I came home and she scratched her scabs and was full of blood. I want to do everything to avoid an infection or it worsening so any advisement is greatly appreciated.

Please let me know if you would like any additional info on my part. I have copies of her most recent tests (except the ACTH Stim that was done on Monday... this test confirmed cushing's disease). Also, our ultrasound suggests that it is Pituitary dependent Cushing's.

Thank you so much for the support of this site. I am so thankful to find all of you. I keep going back to my vet and inquiring more.

Have a nice day,
Claudia & Daisy

Moderator's Note: I have moved your post so that you may have your own thread for Daisy and others may respond to you queries. Sabre's Mum

[jmac]

Hi Claudia & Daisy,

Welcome to the forum. I believe someone will come along and create your own thread so we can find you and Daisy easily.

I am sorry to hear that Daisy is struggling, but I am certain that the wonderful people here will be able to help you out. You are correct that you have found a wonderful and informative site with fabulous, caring people. We usually ask you to start out by posting as much information as possible. You told us some of the symptoms Daisy was having, but can you also post the tests she had done with the abnormal results? That will help people advise you the best they can.

Now that you have found us, you and Daisy will not be alone. We'll be here to help you out on your Cushing's journey.

Julie & Hannah

[Sabre's Mum]

Welcome Claudia and Daisy,

As you can see I have moved your first post over to your own thread.

Our Hungarian Vizsla - Sabre had calcinosis cutis so I can truly understand what you are going through at the moment. You are on the right track at the moment with your management of it ... "management" being the emphasis here. Sabre was treated with Lysodren and we initially used antibiotics along with medicated shampoos (every three days) .... the shampoo only made it worse so we tried oatmeal for some time then gave on that eventually as well. We used betadine to try and dry up the areas. Eventually we only used antibiotics if we thought areas were becoming infected. We also used jackets or T-Shirts to stop him from nibbling at any spots.

Once his cortisol levels came down ... and were within the therapeutic range for a "cushings treated" dog .... things became better. Warning ... they did initially become worse before they came better! BUT once his hair grew back in and the skin healed in the calcinosis cutis areas it was "just there". Sabre had large plates of calcinosis cutis on many parts of his body but were never really an issue to him.

Here is a thread which calcinosis cutis was discussed http://www.k9cushings.com/forum/showthread.php?t=3765

If you have any further queries please ask away.

Angela and Flynn

[addy]

Hi and Welcome from me as well,

I am so glad you found us. The skin problems tend to get worse before they get better. Often times they are the last to resolve. Since you just started treatment we do not yet know wherre Daisy's cortisol is.

My Zoe has mild start of calcinosis cutis and it seemed the small plaque deposits started to clear up rather quickly but the large bumps on her tail are being slow to start to open and heal.

Hopefully others will be along to give you their experiences. We seem to have had more members recently with this problem.

When is the ACTH test scheduled?

Glad you found us. Hang in there.

hugs,
addy

[beachwalkerz]

Hi Claudia and Daisy
I am new to this forum with my recently diagnosed French Bulldog (calcinosis cutis, awaiting one more result, hopefully starting treatment for Cushings early this week). Like Daisy, Izzy's calcinosis came on QUICK and within two months her entire back, bottom, around her ears, and her neck are covered in hard plates and/or bald (the majority of it in the first two weeks).
We have tried: antibiotic creams and medicated shampoos. Nothing seems to help. It is still spreading and my vet says that it really is a losing battle until the Cushings is brought under control. That being said, I am really worried that these hard areas of deposits will remain. They seem to itch her a lot but she doesn't have the mobility in her back legs to scratch and irritate them.

Has anyone taken any holistic approaches to topical treatment for the plaque deposits?

Sabre's Mom: Thanks for sharing what you tried.

Hugs to you, Claudia, and Daisy
jodi

[Nikki]

Hi Claudia and Daisy!!!
I'm fairly new to this forum, but I wanted to say hello!! I also have a boston terrier who is also suffering from the calcinosis cutis. He seems to be doing okay so far with treatment with all of his symptoms, but we have noticed the calcinosis cutis is still slowly spreading (Although it is looking MUCH better in its original location). We were doing DMSO applications on it daily, then the vet told us to stop completely, and now she said we can start again with doing it every other day or so. Anyways, just wanted to say hello and welcome :)

Nikki&Max

[cferna01]

Nikki & Max, Jodi & Izzy, Addy & Zoe, Angela & Flynn and Julie & Hannah:

Thank you for your responses! Ok, here are the results:

3/24/2012 Severe deep pyoderma

Presenting Complaint: Skin rash on neck

Diagnosis: Severe deep bacterial and yeast infection. Suspect underlying skin abnormality.

Case Summary:
Daisy presented through the Emergency Service for evaluation of a skin rash that had been getting progressively
worse over the past 2 weeks. The rash has not seemed to bother her at home, but did start to bleed after cleaning today. Daisy has also been drinking and urinating more. On physical exam, the skin of her dorsal neck was found to be severely thickened and firm with large areas of full thickness ulceration and scabbing. Skin cytology revealed abundant bacteria (rods and cocci) and yeast indicating an severe infection. Daisy also had a “pot-belly”, mild muscle wasting and cranial organomegaly (enlargement of her internal organs).
Based on her combination of clinical signs, we are suspicious that Daisy could have an endocrinopathy such as Cushing’s disease. Her skin disease could be secondary to an endocrinopathy. Cushing’s disease has been associated with a condition known as calcinosis cutis (calcification of the skin). It is also possible, given the
severity of the skin changes that Daisy could have a form a skin cancer. A skin biopsy may be needed to further
characterize Daisy’s skin lesions.

Medications:
• Cephalexin 250 mg capsules: Please give 1 capsule by mouth twice daily for at least 30 days. This
is an antibiotic for Daisy’s bacterial skin infection. She should be treated for at least 2 weeks beyond
resolution of the skin infection. Please give this medication with food; it can cause some GI upset.
• KetoChlor Shampoo: Please bathe Daisy twice weekly with the shampoo. Lather and allow to set for
at least 5 minutes to allow adequate contact time of shampoo with skin. Rinse thoroughly.

Follow up:
We recommended follow-up with the Internal Medicine Service as soon as possible. You have a scheduled appointment with Internal Medicine A on Thursday 3/29/12 at 4pm. Please do not feed Daisy after 6am that day in case she needs sedation for her appointment; she can have access to water. Daisy may also need a dermatology appointment or consult. Internal Medicine A will give you further
instructions regarding additional follow-up for Daisy.

I thought that I had the test results, but I do not. I will get them from the vet. We had an ultrasound, CBC, Chem, U/A, UCS, and first ACTH Stim. We are due for our 2nd ACTH Stim on 4/28/2012 (2 weeks after treatment). The doctor recommended that I feed Daisy/give her her medicine then bring her in 4 hours later.

Typically, how long does it take for the a cushing's dog to respond to treatment? I feel terrible watching her and I can only imagine how uncomfortable she is feeling.

If I understand correctly, the calcinosis cutis calcium deposits never heal. Is this correct? Any recommendations on how to better manage it for her? It just looks so painful. How long does that typically take to clear up. I also worry because it is getting hotter and I worry that she will sweat under the t-shirt and it will cause an infection. Oye.

Anyway, always open for feedback. Thanks for listening.

Love,
Claudia & Daisy

[cferna01]

Hi again,

I just read the post about calcinosis cutis being treated more effectively with lysodren as oppose to trilostane. Has everyone had this experience? I just started Daisy on the trilostane (10mg at 5mg in AM/PM). Also, is lysodren the pill where you give it to your dog once per week?

Ok... Daisy and I are relaxing on the couch. She is such a little trooper. I hope we get this cleared soon. :-(

Thanks again,
C & D

[StarDeb55]

I really can't offer much input about the CC doing better with lysodren except the articles I have read seem to point in that direction.

I can tell you bunches about lysodren since I have used it to treat 2 pups. With lyso, you initially go through a loading or induction phase where the medication is given daily, split into 2 doses. The loading dose is calculated based on the pup's weight in kilos, & should be in the range of 25-50mg/kg, preferably as close to 50 mgs., as possiblem For example, let's use a pup who weighs 40 lbs. which is 18.2 kg..(divide weight by 2.2). For this pup, a 50 mg/kg loading dose would be 910 mg. daily. Lysodren normally comes in 500 mg tabs, so the easiest thing to do for this pup is give 1 3/4 tab daily for a dose of 875 mg, which is 48 mg/kg. During loading, the pup is monitored carefully for any change in behavior, especially eating/appetite. This change can be something as simple as simply pausing briefly while eating, where normally, the pup would inhale the whole dish of food without stopping, & clean the crumbs off the floor. At this point, an ACTH would be done to see if the pup is loaded, results would need to 1-5. Let's assume that the pup is, indeed, loaded. Now, the loading dose instead of being given daily is now broken up into several doses over the week. Using this example, 1/2 tab on Mon. & Weds., 3/4 tab on Fri. Most experts agree that maintenance dosing needs to be broken down into multiple doses over the week. Weekly maintenance dosing usually will not work. This is because of how lyso works. Lyso causes the adrenal cortex tissue where cortisol is produced to necrose or die. The trick is you want to necrose enough of the adrenal cortex to get the cortisol within treatment range, without destroying so much of the tissue the pup is at risk of Addison's The adrenal cortex needs to be consistently dosed with the med to prevent the tissue from regenerating & start overproducing cortisol. Some pup's will regenerate the adrenal cortex in the blink of an eye almost, others may regenerate this tissue much slower.

This is probably more info than you wanted about how lysodren works, but I wanted to give you the big picture.

Debbie

[Sabre's Mum]

Hi Claudia,

I truly understand what you are going through with your dear Daisy. I remember back to when Sabre was going through exactly what Daisy is going through now and just wondering how his skin condition was ever going to sort itself out. BUT ... it did BUT ... it does take time!

Sabre was treated with Lysodren but it took him about four to six months before the calcinosis cutis was no longer an issue. In the early stages of treatment it did get worse but then things got better. As I explained in and earlier post we "managed" his condition in the initial stages trying to prevent infections but eventually his hair regrew (little fluffy bits which you gain so much satisfaction from) and eventally back to normal length. Once his hair regrew fully we never had to worry about infections again and it was "just there". Sometimes the calcinosis cutis does "erupt" and disappears but in Sabre's case this only happened on one spot. All the other calcinosis cutis remained as plates.

If you have any further queries please ask away.

Angela and Flynn

[cferna01]

Hi!

Thank you, Angela, Flynn, and Debbie!

I have been keeping a tshirt or jacket on Daisy and her cc looks better than last week. My goodness. It was gross. Oozing. She is one week in to the trilostane and appears to be taking it well. We have another ACTH Stim scheduled for 4/29.

A couple of questions:

1. I have her on Prescription Hills Diet (w/d formula). Do you recommend any specific foods that are best for cushingoid dogs? I also feed her quite a bit of pb. She loves it and I will put some treats in her kong with pb.

2. She is on 5mg of trilostane in AM/PM (10mg per day). Is this too little? I ve read mostly that vets start with 20 mg per day (10 mg in AM/PM). Daisy is +/- 20 lbs. Should I recommend a higher dose to see results? Or is it best to start with a lower dose?

3. For our 21 capsules of 5 mg, it cost $39.99 (this will last 10.5 days). It will probably be approx $150 per month if I stay with this compound pet pharmacy (i think it is best pet rx). That is very expensive for me! Are there any reliable pet med locations where I can purchase 5 mg capsules at a much cheaper cost?

Thank you everyone for your help! Daisy and I just returned from a walk. She is still her chipper self. Such a sweet baby! It saddens me that in her brief life of 10.5 years, she has experienced so much pain (from neglect in a back yard breeding site to cushings). I really hope that we are on the road to recovery. She deserves to live her last 5+ (hoping!) years happily. :)

Have a great day,
Claudia & Daisy

[lulusmom]

Hi Claudia,

The results of the acth stim test on the 29th will guide your vet as to whether a dosing change will be needed. Peanut butter is high in fat so you should buy the lower fat brand and give it to Daisy in moderation. I don't know of any dog who doesn't love peanut butter, my own included. What most people don't know is that dogs can be allergic to peanut butter and make them prone yeast infections and other skin issues. I discovered this when I was trying to figure out what one of my dogs was allergic too.

Call Diamondback Drugs in Arizona for a quote on 5mg trilostane. They are highly competitive and they are a trusted source for compounded meds. www.diamondbackdrugs.com Toll free number is 866-578-4420

[cferna01]

Thanks, Lulusmom! I do notice that her calcinosis cutis gets a bit inflamed when I give her a good amount of pb the day before... maybe it is correlated. Hmmm... thanks for the info. I will certainly give her it in moderation.

Any other advice on diet for cushingoid babies?

Thanks!

[lulusmom]

If you notice a definite change in Daisy's calcinosis cutis when you give Daisy peanut butter, you may want to discontinue giving it to her. Try healthy treats like green beans, apples and baby carrots. My dogs love these and that's what they get for treats. Here's a vet's site that includes information on peanut butter:

http://www.carepaw.com/2010/07/31/peanut-butter-and-food-allergies-in-pets/

As far as diet goes, cortisol is a catabolic steroid that messes with protein metabolism so it's best to have them on a good quality protein, low fat diet. I personally try to keep the carbs (grains) down too as most grains, especially soy, corn, wheat are high allergens and they make my dogs fat. They make me fat too. :D