Bad case of calcinosis cutis

[Devin]

Hello, my dog Jackson was diagnosed in May of this year with IMHA( due to his Pro Heart Injection we think). He was started on high dose Prednisone, Azathioprine and Famotidine as well as a liver supplement. We have since slowly decreased his Prednisone to 10mg SID and his last PCV was 38%. He has some pretty bad side effects from the Pred, severe muscle wasting, bloated belly, etc. But by far the worst side effect he has had is the calcinosis cutis. He has multiple spots on his back, the first of which healed up rather nicely, but the newest one on his neck is now infected and purulent. I have been flushing it daily with saline on the veterinarians advice, he was on Cephalexin for about a month with no change so he was switched about a week ago to Baytril. The Baytril was also for a
UTI and seemed to help a little, but we need a refill now. We are also keeping the wound moist by applying Silvadene cream and keeping it wrapped when we aren’t home to help prevent scratching.

I am wondering if anyone has had any luck with other treatments? I know surgical removal is often recommended for large calcinosis cutis or areas of reoccurring infection, but I am not sure I would want to put him under anesthesia for something like this, he just seems so fragile still and his liver values are very high. Any recommendations would be very helpful, we are also going to be taking him to the vet soon to discuss it with her. Thanks so much!

[admin]

Hello Devin,
welcome to our group! I am sorry you had to find us but glad you did. It looks like Jackson is doing pretty good with a PCV of 38%. Unfortunately the side effects you describe are fairly common. The good thing is they will disappear once the prednisone and azathioprene are reduced or even cut out completely. I am sure you know that this has to be done very gradually.
My dog also had many side effects but Calcinosis Cutis was not one of them so I am not much help. I know however that this has been discussed in a thread calle “Hector” maybe you find some answers there. I also know that other people have dealt with it and I am sure they will make recommendations as soon as they read your post. I totally agree with you that it would not be a good idea to put Jackson under anesthesia for surgery at this point.
About Jackson’s liver values, there are many supplements that can help with that. Ask your vet about Sam-E, this is a product that helps the liver deal with all the toxins. You can also give him milkthistle to help the liver. Remember that the liver is a fantastic organ that can heal itself and the liver values will go down once the medications are reduced. The Sam-E would be a great supplement to help until then.

How old is Jackson, what breed? You could also post a picture so we have an idea what your special boy looks like.
Best wishes,
Brigitte

[Vally]

Hi Devin and welcome to the forum. I’m afraid I’m not much use on he issue of calcinosis either. It’s so unfair what these poor dogs go through. Someone else will pop on with more information, I’m sure. I agree that surgery would be too risky at this point. I know it can take a long time to cure.

I would certainly also recommend SAMe. Made a big difference with my boy. Liver values improved very quickly.

Regards, Vally & Bingo

[admin]

Hi Devin

Glad you’ve found us – a big welcome to you. My dog Worzel had some small problems with calcinosis cutis, but nothing like as bad as you have suffered. When he came off the pred altogether, these patches healed nicely & some lumps (like small stones) actually came out of them. His infected leg also healed up at last – it took a long time. He still has some cysts & lumpy bits though, but that’s a minor detail we don’t worry about! I used chlorhexadine on the non-infected areas (to prevent it getting worse) & antibiotic cream on his wounds, but it really was the drop in pred that made the difference. Chlorhexadine can’t be used near eyes/ears/mouths though. The azathioprine lowering made a big difference to his PCV – it went up each time we lowered it – probably because it is a bone marrow suppressant in the long term.

Poor Jackson – these side effects are truly horrible & he has been on these drugs for quite a time. Can you tell us what doses of each drug Jackson is on now? As Brigitte says, 38 is not a bad PCV, which is good news, but we all appreciate these reductions in drugs have to be done reasonably slowly in most cases to prevent a relapse. In my opinion, I would definitely avoid surgery at the moment – I think this would be difficult as they have trouble healing on these drugs & I personally wouldn’t risk it.

I’m sorry I don’t have much experience in dealing with the large patches of infected calcinosis. Worzel only had a few patches & his wounds were from the over-shaving (top layer of skin removed – ouch!) of his leg for the infusion (drip) & the bone marrow biopsy, but I hope we have helped a little.

Vally & Brigitte have mentioned Sam-E milk thistle – I totally agree – these are great for reducing liver enzymes. Worzel’s dropped back to normal within a couple of weeks, so these would good things to add for Jackson.

Here is a link to a human medical study on calcinosis cutis worth looking at as it has treatment ideas you could discuss with your vet:
http://www.ncbi.nlm.nih.gov/pubmed/22741938

We have a glossary of AIHA terms which you might find useful – some reading for you!
https://www.secondchanceaihadogs.com/AIHA_Terms/iatrogenic-cushings-disease/
https://www.secondchanceaihadogs.com/AIHA_Terms/calcinosis-cutis/
https://www.secondchanceaihadogs.com/AIHA_Terms/prednisone/

Look forward to hearing from you – I really think prednisone reduction will help the calcinosis, but you obviously have to do this slowly with your vet keeping an eye on things. Has Jackson had problems before with reductions, by the way?

All our best wishes, Sheena, Worzel (diagnosed Dec 2012) & Ollie too

[admin]

Hi Devin. Thank you for presenting your poor Jackson’s ordeal with AIHA and his ProHeart injection. It’s a conundrum – you try so hard to give them the best medical care and wam – this happens. This group was a life saver to both Sadie, my now five year old cocker spaniel, and myself. Sadie is one of those with AIHA that will never be vaccinated again. Her only preventative intake now, is oral TriHeart Plus, for heartworm, as we live in Florida, which I give her every 45 days.

Sadie had the same bloating (she look like a football on toothpicks!), incredible weight gain (8 pounds, from 32lbs to 40lbs) and really bad muscle atrophy with the needed high dosing prednisone (and cyclosporine). She is down to 3.5MG of prednisone a day now (thank goodness!!) and is finally starting to loose weight (my junk yard dog) and her barrel chest. It’s been a process of almost two years. But she’s here and a survivor. This horrific disease CAN be beat!!!

Like Vally and Brigitte, I have not dealt with calcinosis cutis with Sadie (her story, and others are under Our Stories), but I know others have here and they will respond in help, as Sheena has done already about her incredible Worzel (Sadie’s boyfriend).

I’m glad Jackson is on liver protection. It’s a must with these high doses of immune suppressants. Sadie too, as many others on this forum, takes SAM-e and Milk Thistle for liver protection.

It sounds as if Jackson’s PCV is rising. What was his pre-AIHA PCV?

Please stay with us. You are not alone.

Sending our love, Linda and Sadie

[Devin]

Thank you so much for all your advice! Jackson is an almost 2 year old Black Mouth Cur mix. He was a rescue we were fostering, found on the street covered in bumps and scabs and I just had to bring him home. We eventually became “foster failures” because we fell in love with him! I don’t remember what his PCV was before his diagnosis, but he was the picture of health a mere 2-3 months before his diagnosis, he was even a blood donor. During his first crisis, his PCV went down to 7% at the lowest and he needed 3 blood transfusions. He was started at 40mg Prednisone BID and has very slowly been lowered to his current dose of 10mg SID about every 3-4 weeks after (we do bloodwork before each lowering of the dose). He has had no bad reactions to lowering any of the medications thus far, and we are hoping to keep it that way!
We know the side effects are inevitable with the steroid and immune suppressants, but he seems to be having such a severe reaction. I can deal with all the side effects, I just feel so badly for him. He never seems painful, but I have to think that he is at least uncomfortable.

I will definitely look into the SAM-E, thank you so much for the advice. He is on Vetri Liver right now, has been since this whole thing started. I will see if I can get some Chlorhexadine from my vet hopefully that helps him. His whole back seems to be developing spots of the calcinosis cutis, I just hope they don’t get infected like his neck. He will also never be vaccinated again and I will be VERY careful with any medications I give him and research before hand. I am looking into which heartworm prevention to give him being in such a high risk state, Florida.

I really appreciate all the advice and kind words, it is great to have found a forum like this to get advice and support. I am thinking of all your babies and hoping they are doing well. Vally, you are so right. These sweet babies don’t deserve any of this, I think sometimes that is the hardest part of this whole thing.

[admin]

Hi again Devin

Goodness, poor Jackson has had a rough start – I had never heard of this breed (I’m from Britain, but live in France now) & looked them up – what a beautiful dog & no wonder you fell in love with him. I love to hear about people taking in rescues & you’re right – no dog deserves this horrible disease. Thank goodness there are people like you who care enough to look after them – you are certainly not “failures” in my eyes – you are successes!

I think the calcinosis is very itchy – humans say it is really irritating. I would imagine an infection would add to that & maybe make it bit sore too. Some of us used to be on an old forum & I remember one owner having very similar problems – I have been squeezing my brain trying to remember what they did. (Please anyone else that remembers Robert & Maggie, can you think of anything that would help Jackson?) I am trying to find more info for you & will post some more ideas as soon as I can find anything useful. Bear with me for now!

You are right to be very cautious with everything – I am also completely paranoid & I think you’ll find most of us are the same. Welcome to the club that we don’t really want to be in. We have to be happy that our dogs improve as far as the blood results are concerned & we deal with the side effects as well as we can.

Sending you all our very best wishes, Sheena & the boys xxxx

[admin]

Me again Devin
Apologies for the slow reply. Basically, I have been searching the back of my brain for what someone else did in the past. I am going to try & find that person’s e-mail address if I can. All I can remember is that their vet cleverly used DHEA transdermal cream to penetrate the skin barrier in order to use a drug which I cannot for the life of me think of. I normally have the memory of an elephant, but not this time! I was hoping someone else on here might remember. It must have been a drug normally given orally, but was considered better used topically for the calcinosis cutis.
The only help I can be is to provide these links which give you every type of treatment available to humans & dogs – at least you can discuss all the options with your vet to avoid surgery for now.
Calcinosis cutis
http://clinicaltrials.gov/show/NCT01918904
http://emedicine.medscape.com/article/1103137-treatment
http://www.ncbi.nlm.nih.gov/pubmed/21679811
http://jddonline.com/articles/dermatology/S1545961611P1042X/1#close Zinc oxide – a no no
http://books.google.co.uk/books?id=hRryAAAAQBAJ&pg=PA117&lpg=PA117&dq=calcinosis+cutis+new+treatments&source=bl&ots=1Ixvnieiuq&sig=9MO5vwvIK_TI72pgafCqsYbDnG0&hl=en&sa=X&ei=cywGVIPnJ8qVapeCguAD&ved=0CHUQ6AEwCTgK#v=onepage&q=calcinosis%20cutis%20new%20treatments&f=false