14 year-old Shih Tzu With Recent Cushing's Diagnosis

[Squirt's Mom]

Hi Julie,

I know very little about this other than when Crys was young her doc was always checking for what she called "knuckling" - she would take Crys' back feet, turn the toes so they were on the floor instead of the pads, and see if and how long it took Crys to put the foot right. They did this because of all her skeletal abnormalities to keep an eye on nerve damage that might occur...at least that is what they told me when I asked why they kept doing that. Then, that summer Squirt's pin came out of her knee, she would drag that foot from time to time upside down simply because it hurt too badly to put it right but she wasn't putting much weight on it either. Brick has one foot he drags a bit - the nails never quite clear the floor so he has a distinct gait and is easy to locate when he's on a hard surface. He does this as a result of the hydrocephalus...along with other oddities, but it sure doesn't slow him down! I can tell the days the pressure is greater than others based on his gait as well as other indicators. So, there are three who drug or drag a foot yet had no neurological issues that have taken their time away. Brick has neurological issues, but he's 13 going on 14 and just as happy as a lark, full of life and love.

You seem to understand what other implications this might, MIGHT, have so I won't go there. Just wanted you to know there are other reasons this could be happening and they could mean nothing.

I am with you in trying to prepare myself for that day - and I'm not doing a very good job of it at all. The very idea literally takes my breath and clinches my gut into knots. I draw from the courage of so many here in the hopes some of that will be accessible when needed. Also like you, I do my best to make each day one of happy memories for us both, cherishing every wag, every bark, every grin.

Hugs,
Leslie and the gang

[Jenny & Judi in MN]

oh Julie, this made me so sad. I think it would be a long shot but over on the diabetic forum some of the dogs with diabetic neuropathy got some of their back leg strength back by taking B12 vitamins.

I don't want to think of the limited time we have with our animals either. it is so hard.

lots of hugs, Judi

[addy]

Julie, Zoe does the knuckle dragging with her one back leg. I can hear the toenails scrape.

The only thing that helped Zoe was excerise, walk very slowly, one day on, one day off, very slowly build distance. It took a long time to accomplish it and now that she has been so house bound, she is knuckle dragging again.

The vet used to test for neurological problems by having her stand and then bending each paw down so her knucles were on the floor and wait to see if and/or how long it took her to correct the foot position.

If Hannah has back issues maybe the knuckle dragging is not neurological.

Is Hannah happy today? Is she smiling at you? Does she want to eat or have a treat? Doe her eyes shine? If she is doing any of those things, just focus one one good thing.

One good thing a day. When my granddaughter spent time with me, my dogs were so alert and happy. I realized it was because we were happy. As hard as it was for me this morning, I told myself, smile and laugh for Zoe this morning so she smiles back. Our one good thing- no blood!!!!

Love you

[jmac]

Thanks for all the input, kind words, and suggestions, guys. I appreciate it very much.

Hannah got her laser treatment today. She also spent some time on a couple of hot spots she has from allergies. It went fine, but of course we don't know the cause for the occasional dragging. She does have good range of motion in both legs and also still has good muscle tone, according to the vet.

Because it is really bothering me, I decided to make an appointment at the vet that does the acupuncture. I requested the man we saw the first time, who was able to pinpoint the areas of soreness in her back. I am hoping he will be able to determine whether this is a disc issue or not. At this point I don't know whether I should be resting her due to injury or walking her to keep her muscle strength.

Before her laser treatment today I had her blood work done. Her ALKP is up a little bit since April. It was 250 today and was 186 in April, but that is still much better than the 1700 a year ago. He said it can rise a little bit with stress, pain, etc. so depending on what is going on with her it could be a factor. Neither of us are worried about that result. Her kidneys and electrolytes were fine, as was her ALT.

He said her Hematocrit is low though. It is at 37% and 37.3-55% is the normal range. He said we should not panic about this, but he does want to recheck again in 2-4 weeks because he is concerned about it continuing to drop, which would indicate she is anemic. He said I shouldn't need to worry about anything, but that I can periodically check her gum color in the meantime to be sure it is pink, although he expects it will be. He said if she becomes anemic they need to find the cause. Of course this is something new for me to worry about because I am a worrier.

I dug out the copies of her blood work over the past year and a half, and I found that her HCT level has bounced around. Back in Jan. it was only 35.3% but he said nothing about it! The month after it was 37.5%. Then in April it was 39%. Her MCV is also sometimes low, but bounces around. She has a consistently high platelet count as well, for the past two years, but he doesn't seem concerned about that.

I decided I am going to have it rechecked in two weeks and that I am also going to have a stool sample checked because it has been a long time since that has been done. I'm hoping and assuming there is no blood in her stool, but she is also biting and itching by her butt A LOT and I'm wondering if there could be a parasite or something. (She has had her anal glands expressed twice in the past 8 weeks-most recently two weeks ago, so I hope it isn't that again). I'm also going to call the vet to point out these fluctuations and see if we can make any sense of them. I tried to figure out if she was on certain meds at the times it was low, but I don't think that's the case.

There are just so many issues with my girl. The allergies may be the worst right now, followed by the toe dragging. She also feels really, really hot sometimes. Almost sweaty. Then it passes. The vet today said it may be allergy related when her skin is really irritated.

I thought again today about having to let her go when or if she is miserable and was wondering if she was close as I watched her scratch, bite, lick over and over for about 30 min. Then she seems to come out of it and acts happy and normal and wags her tail and barks at me for treats and gives me kisses. One positive is that her eyes look fabulous. They are SOOOOO much better since he has me putting the Tacrolimus in. And she still loves her mom.

I just have to come up with an action plan for what I'm going to do and then talk to myself about being calm and not being able to control the rest, but only to respond.

So, here's my plan:
1. Take her to the vet tomorrow for an evaluation of her back, legs, etc. to try to determine the issue with the dragging paw.
2. Have a stool sample checked to be sure things are okay.
3. Talk to my vet about the fluctuating HCT levels and the fact that it was even lower back in Jan.
4. Have blood work rechecked in two weeks.
5. Apply DermaPaw to sore spots from her itching each night before bed.
6. Love her and enjoy time with her each day.
7. Keep telling myself I can only respond to what happens and that it is not something I can control. (I'll need to practice this one a lot.)

If anyone has any input, I always love to hear it. Otherwise, just please keep us in your thoughts. I'm worried about my girl.

Julie & Hannah

[molly muffin]

Wow Julie, I think you have an excellent plan of action for Hannah. See what the vet says tomorrow. Either way you are going to be feel better for just having spoken to him and you can adapt for anything that you think or he thinks might be going on with her. I hope they can give you some good feedback on the leg issue as I know that is worrying you.
As long as she comes out of everything with the happy tail wiggle and kisses, then I think you're still doing okay. Hannah is probably trying to say "don't worry mom, it'll be okay"

Hugs,
Sharlene and the molly muffin

[molly muffin]

Hi Julie,

Did you and Hannah get to see the vet today to have her checked out for her back and leg?
Hoping all is well. Thinking of you.

Hugs,
Sharlene

[jmac]

Hi Guys,

Sharlene, thanks again for checking on us. It's so sweet of you!

We did go go the vet today. Hannah was pretty thoroughly evaluated by "Dr. Jim." He could tell that she has some back pain. I could see her close her eyes a little when he pressed her back. That was all she did to indicate pain. He didn't feel it was as bad as it has been in the past, but that it hurts her.

He seemed uncertain as to whether it is more intervertebral disc disease or spondylosis. He didn't think he could do any sort of adjustment and didn't think acupuncture was the best choice if she didn't do well last time. He recommended Gabapentin for pain once a day and suggested we do laser treatments in conjunction with it. It is a liquid version (60 mg/ml) and she will take .25 cc. I read about it and called back to make sure it doesn't contain xylitol. They said it is a special veterinary compounded version. She will also be trying Chu Shi Wei Ling Tang, a new herb, to see if it helps her allergies.

He wants me to continue to exercise her on very short walks a few times per day and to try walking her in high grass or sand to get her to lift her legs to maintain muscle.

I talked to the vet who does laser treatment and she wants to x-ray Hannah's back tomorrow to see if she sees any evidence of spondylosis or possibly any calcified discs. She's hopeful it might give us a bit more information about what's going on with her. Then she can laser her.

I did take a fecal sample in today as well. It hadn't been checked since 2007. Whoops! That's what happens when she doesn't go often and I don't have a sample when we go in for the yearly check up. We should have results tomorrow.

I'm super worried to start on more new drugs, but am going to take the plunge on the Gabapentin tonight and the herbs tomorrow. Any experience with either of these? Anything you think I should know?

Thanks guys!
Julie & Hannah

[molly muffin]

Hi Julie,

Well, I'm basically useless when it comes to knowledge of medicines and the herbs. But I am glad that there is a plan and if it helps Hannah, then it will be worth it. He thought this new herb should be in addition to the other herbs? I wonder if her back bothering her is causing the leg thing. Maybe a pinched nerve in a disc area. I'm not sure of the physiology, but my husband had a ruptured disc that can cause pain shooting down his leg, nerve, phantom pain even. He moves gingerly when it bothers him. His he controls through exercise. It just seems that a disc problem might have the same sort of effect on animals.

Gosh, that got long, I was just checking in to see how everyone one is doing tonight. I swear!

hugs,
Sharlene

[addy]

I'm up early and stopping by to give you a



BIG HUG


I think the two of us need to do Skype Doga

[jmac]

Sitting here at the vet while Hannah gets back xrays. I'm a nervous wreck because I'm worried she will be hurting more from struggling. Taking deep breaths, hoping we will at least have more information...
It's our 3rd day in a row at the vet. Ugh.
Julie & Hannah