Hercules 10 Year Old, Staffordshire Bull Terrier

[travis]

My 10 year old 54lbs Male Staffordshire Bull Terrier, angel has aged dramatically in the last 6-12 months. I thought it was because he was so fit and energetic when he was young.

Arthritis, really stiff legs and inability to jump on the bed anymore. Also nothing faster than a walk.
Pot Bellied,
Increased Urination,
He has always love to eat so no real indicator
Loss in muscle mass in the head. (Baboon Skull)

https://www.dropbox.com/s/i65yezaomm04wd1/2015-08-12%2007.52.39.jpg?dl=0

Dreaded Calcinosis cutis (looks like an acid burn on his shoulders, 8 inch by 4 inch)

https://www.dropbox.com/s/ebfi5brl09697pn/IMG_20150929_105205_01%20%281%29.jpeg?dl=0

Hard lumpy patch in the cheek that broke through to more Calcinosis Cutis



Went to the vet and he was mis-diagnosed with Skin infection twice. 2 rounds of antibiotics and $400 later.

Finally found this site(a God Send) and did lots of research. Went to the vet and did simple blood panels here are the results.
Here are the results
Alkaline phosphatase - 1114
Cortisol Creatinine Ratio - 55 Normal <34

The question to the forum is the following. I need your help
Based on symptoms and blood panel do I treat Hercules with Lysodren. (Calcinosis Cutis seems like this is the drug of choice based on the forum discussions)

Follow on, I do not want to go through endless testing and retesting at $200 a test. I know this may sound harsh and I love my boy but I do not feel that spending an additional $1000 on testing over the $700 is responsible or if it will truly impact his quality/length of life going forward.

My options are:
1. Start on a maintenance dosage of Lysodren 500mg 3 times a week. Monitor closely and see if there is any improvement drop to 500mg once a week after 3 weeks.
2. Do not proceed with any medication, use Glucosamine and MSM, stop infection in Calcinosis and enjoy my time with him.

All input will be greatly appreciated.

[Harley PoMMom]

I have manually approved your membership so now all your posts will be seen right away. Also, please just disregard the validation email that was sent to you from k9cushings.

Hi and welcome to you and Hercules!

I am sure sorry for the reasons that brought you here but so glad you found us, and we will help in any way we can.

Hercules sure is a beautiful boy! We totally understand about the cost with Cushing's, the initial expense is during the diagnostic phase, the cost of treating usually goes down significantly after you've got the diagnosis confirmed and the treatment underway.

Was Hercules on any kind of steroid recently for a period of time?

Both Vetoryl/Trilostane and Lysodren/Mitotane can be used when a cushdog has Calcinosis cutis (CC), on the forum we have found that when a cushdog can get that elevated cortisol down to the therapeutic range of 5 ug/dl or a bit lower the CC can be better controlled. With Lysodren treatment a dog goes through what is know as a "load." This loading phase is required so the Lysodren can erode a small part of the adrenal glands so that they are not producing excessive amounts of cortisol. Once a dog is loaded than the maintenance phase is started. I want to warn you, that CC gets worse before it gets better, and it will only get better with treatment. It is also very painful, dogs can be so stoic at times so pain meds are usually needed.

Renee is our resident expert on CC, which I will provide a link to her thread so that in the meantime you can read it, and I am sure she will stop by soon.

http://www.k9cushings.com/forum/showthread.php?t=5908&highlight=Calcinosis+Cutis

If you have any questions do not hesitate to ask them. Oh, I also want to provide you with links to info regarding Lysodren and Vetory: http://www.k9cushings.com/forum/showthread.php?t=181 and http://www.k9cushings.com/forum/showthread.php?t=185

Hugs, Lori

[Renee]

Hi there. I am so sorry your boy has the dreaded CC, but it can be managed and go into 'remission', as I like to say. I apologize in advance, this may be a long reply.

Without treatment at all, the cushings and CC will eventually ravage the body. We sadly have a member on this board that chose not to treat her pup and the CC took only a year to completely cover the vast majority of the dog's body. Quality of life can get very serious, very quickly when dealing with CC.

But, let's get something out of the way right off - cushings is NOT a death sentence. Successful treatment will allow the dog to live their normal lifespan. Treatment (or lack of) will absolutely impact quality and length of life!

There has been some debate over using lysodren versus vetoryl in managing CC. If you read my thread, you'll see I had success using vetoryl to manage it. I do believe, in the past, lysodren was more successful, simply because we were (are) still learning about vetoryl. The manufacturer states that cushings can be considered controlled with vetoryl when the post cortisol is below 9 ug/dl. I think where the confusion lies is that many people got close to that number but never got control of the CC. Whereas with lysodren treatment, the control range is post-cortisol below 5 ug/dl. With vetoryl to resolve CC, the post cortisol needs to drop below 5 ug/dl and stay in range long-term, which many people were not doing. I must be very blunt and clear here - there is no 'cure' or long-term treatment for CC other than controlling cortisol levels. No topical, antibiotic, shampoo, etc will control it.

I'm not familiar with the overall cost and monitoring when using lysodren, so I'll just speak to the cost and management of vetoryl. I will say though, that your post fails to take into account the necessary loading phase of using lysodren.

Please do not just reject vetoryl right off. It's a viable option. I will give you my opinion of how you should proceed, going forward, if you did choose to use vetoryl.

Firstly, I wouldn't waste money on an LDDS. I think it's safe to say (assuming no steroid use recently), that your pup has cushings (best to confirm first though). I'm not sure you are interested in finding out if it's PDH or ADH, unless you would consider surgery?

I would start with the ACTH so you can establish your 'baseline' reading before treatment begins. Then start treatment. If your guy is 54 pounds, then I would go with 60mg vetoryl. Run an ACTH in 2 weeks, then again 2 weeks after, and so on following the testing protocols. You may get lucky and stabilize at your first dose. The larger dogs, in my experience, tend not to need as much of the drug as the smaller dogs. Always exceptions of course.

Lysodren is definitely another option and I do hope that some of our lysodren people will stop by and give you an idea of cost and the proper protocols for management. I honestly do not know which is more expensive long-term. Vetoryl is a financial commitment in the beginning, but the costs do taper down.

Okay, enough for now. Sorry I've posted so much.

[labblab]

Hello and welcome from me, too. You've already been given some great thoughts and advice, but I do have a couple of thoughts that I would like to add, as well. In honesty, they are a couple of concerns. If I am understanding things correctly, you are essentially self-diagnosing Hercules and it sounds as though you are considering self-treating, as well. This involves making certain assumptions that may seem very reasonable, but they also may be very dangerous.

I am assuming that Hercules' skin condition has not actually been biopsied, but that it appears to resemble CC? Unfortunately, I just tried and was unable to download your Dropbox images. If you create a photo album here and add the images to your album, it might make it easier for the rest of us to see them. However, even in saying that, there can be a fair amount of confusion in making accurate diagnoses just from the visual appearance of skin problems and lesions. To compound my concern, it sounds as though Hercules has not had an ultrasound or any Cushing's-specific blood testing performed, either. So basically, you are arriving at your own diagnosis based upon your interpretation of symptoms alone. I understand that testing costs can seem overwhelming and that you personally feel convinced that Hercules has Cushing's, but I do believe that for his own safety, you need to obtain some additional corroboration before launching into treatment with drugs that can have serious, even lethal, consequences if they are misused.

In honesty, if it was me, I probably would be satisfied with either an ACTH stimulation test as Renee has suggested, or even just a skin biopsy. If CC is verified, then in conjunction with his other symptoms, I would agree that a Cushing's diagnosis seems almost certain.

But here comes the next sticky wicket -- it sounds as though you are planning to move forward with your own Lysodren treatment plan which does not correspond with standard protocol for a dog with CC in need of significantly lowered cortisol. Lysodren (as well as trilostane) is a very serious drug that requires monitoring blood testing, no matter what protocol you intend to follow. You cannot arbitrarily pick a dosage protocol and proceed without actual monitoring testing. In other words, you cannot safely monitor the medication's effect on adrenal function and blood chemistries just by eyeballing. If so, you are risking either a lack of therapeutic success as one extreme, or pushing Hercules into Addisonian crisis as the other. It's not clear to me whether or not you would intend to perform the monitoring blood testing, but if not, then I do not believe you should proceed in treating with either drug even in the event the Cushing's diagnosis is confirmed.

It may be the case that you will opt out of any additional testing whatsoever, and if so, that is entirely your decision and not one about which I would pass any judgement. But if you are seriously considering treatment with either Lysodren or trilostane, I think additional testing needs to be part of the deal. If not, you are risking making things even worse for Hercules rather than better.

Marianne

[Renee]

Marianne - I was able to view the images of the lesions. They do appear to be CC to me, but biopsy is the only true way to diagnose.

Also, just to back pedal a bit - Marianne is absolutely right that as of right now, you do not have a definitive diagnosis for cushings. Discussing treatment at this point is purely hypothetical. A confirmed diagnosis is imperative (although CC can make it presumptive).

[travis]

Thank you all for your thoughts, and detailed feedback and comments. I apologize for the delayed response I was not aware my post went live.

I was planning on going the un-monitored route regarding treatment and I do understand that this is a crazy notion in terms of the drugs and the power of the treatment. I am beginning to understand a little more now after reading the detailed responses.

The detailed response in terms of the Lysodren vs Vetoryl was definitely a huge help and I would opt for the Vetoryl before the Lysodren based on the comments above. Renee thank you for the time in the post, the CC is a bear. Management is impossible. He was not on any steroids except for the one injection received from the vet when he diagnosed the CC as some other skin disorder.

Hercules has not started any treatment.

The CC has no open wounds right now and is not half as inflamed as it was. He is in way better spirits...probably less pain and irritation. No new break outs of CC and if there are any my next move will be to begin treatment.

Marianne I have been to 2 vets and they concur that everything does point to Cushings but it is not definitive without a biopsy or blood test. I will post images to photos and follow up images for where he is today.

I do not want to make anything worse for Hercules and a week ago I felt they were pretty bad. I viewed treatment as a Hail Mary. Pervasive and spreading CC and general unhappy disposition did not look very promising...
This week is another week he has a pep in his step, CC is less inflamed and no new visible or calcium deposits in the skin so I am on a wait and see.

It is terrible to think of losing him but at the same time I am wrestling with a minimum of 3 ACTH Stim test ($199 each) and any additional testing the vet puts on the table on top of the $700 to date 2x antibiotics for "skin condition" and $200 for basic blood panels and vet visit. With no guarantee to how affected his overall system is and where he could be during treatment.

With that being said and where he was last week I felt that a Hail Mary may be justified. Right now he is doing better so on a wait an see. I apologize and I do not want to offend anyone by seeming callous, because of the way that I am looking at the numbers and cost, please believe me he is truly the love of my life and best friend.

I have found peace in knowing a diagnosis and being in a position that I can finally make decisions to help him. Watching a fit health energetic dog age overnight (3 months) was scary and I did not want to believe or know if there was anything systemic.

Thank you for your kind wishes and responses I will honor the forum and members by keeping everyone up to date on progress, and decisions.

[travis]

Thank you I read all the links, I appreciate the support and the forum.

[Harley PoMMom]

I apologize and I do not want to offend anyone by seeming callous, because of the way that I am looking at the numbers and cost, please believe me he is truly the love of my life and best friend.


Thank you for your kind wishes and responses I will honor the forum and members by keeping everyone up to date on progress, and decisions.

No apologies are necessary and I hope you know that we aren't here to judge any one but only to help in any way we can. ;)

Cushing's is definitely a expensive disease to treat, CareCredit is what has helped me and still does. It's a revolving credit line that allows you to pay large bills same as cash as long as they are paid within the promotional period. I'm providing you with is a link to a thread in our Resource Forum which may be able to help with costs: http://www.k9cushings.com/forum/showthread.php?t=212

Please do keep us updated ;)

Hugs, Lori