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

Thanks, Ladies. I'll follow Hannah's lead and prevent her from jumping until she wants to do it on her own.

Addy, her back legs are not shaky, and she moves around at a normal pace with her tail up. She does seem a little awkward to me when she jumps off the one step on our deck (she chooses that path and jumps into the rocks by the fire pit before going to the grass to potty) that she looks a little awkward, but sometimes she is like that after having her toenails trimmed-slips around on the deck, tile floors, etc.

Do you agree that it is okay to just watch her at this point? She seems happy otherwise, still wagging her tail and moving around like normal. We were just at the vet on Wed. for the chin issue and we have an appt.8/1 for a blood check, so I'm hoping that if it doesn't get worse I can just watch her and keep track of her issues.

Also, I'm thinking ahead here, but assuming this problem persists or worsens, what do you guys think about changing treatment? I know my vet mentioned Trilostane as the other treatment he would try if things were worse. (And I also know I could go to a specialist for treatment or a second opinion). I don't want to not help her, but she also doesn't have really severe symptoms so I don't want to jump into anything too soon either.

Thanks again for your support! I really don't know what I would do without this forum!

Julie & Hannah

Hello Everyone-

I took both of my dogs to the vet today to get their anal glands expressed. I could smell Izzy's, and figured I would just get Hannah's done as well. We also made an appointment to see the vet since Hannah abruptly stopped being able to jump up onto the bed, furniture, etc. on Saturday. I talked to one vet Mon. and he told me to let her rest and prevent her from doing any jumping for 5-7 days and then to let him know. They decided to see her today.

First, both dogs had anal sacs that were completely full, but not infected or abnormal. I saw the vet I really like today and she manipulated Hannah's back, legs, etc. and said everything felt normal and she showed no pain or tension when the vet felt her back, and her legs had good movement, etc. She said they can usually tell when the dogs are in pain and Hannah didn't act like she was. She is otherwise normal at home too.

The only explanation the vet had was that it could simply be that her anal glands were so full that she was really uncomfortable. She told me to give it another 24 hours to see if anything changed. If not, they are going to have me go back Sat. and do an x-ray and some further checking. She said we could potentially try some NSAIDs, but she is always a bit hesitant with Cushing's dogs, and also mentioned something about a glucosamine supplement (I think???) but wanted to look over her blood work again.

I asked if she thought it could be anything that has to do with Cushing's, and she said that although the back end weakness is common, that Hannah doesn't have any signs of muscle wasting, (or have any other physical signs of Cushing's) and that usually it wouldn't be so sudden and abrupt. I just wanted to check in with all of you to see if you have any other thoughts.

She also took a look at the spot on Hannah's chin that we were in for last week and said it looks much better and thinks it is a combination of an irritation with the skin fold by her lip (so I should continue the medicated wipes once a day) with possibly a little lump or wart in it. She said it is mobile so she is not concerned and that I should just watch it to be sure it doesn't get irritated. I am relieved that is looking better, but I am always so unsettled when something else is wrong, that I can't quite shake my nerves/the bothersome feeling about this inability to jump. She seems fine on the stairs, and even going off and on the deck to go potty (which I had been limiting since Sun.). She is otherwise normal. I swear, it's always something. I always have this bad feeling that it is something terrible.

Anyway, thanks for listening, and let me know if you have any thoughts.

Julie & Hannah

Hannah still doesn't seem to be over the issue with jumping. Today she jumped up on the bed twice (using her stool) and then on the ottoman once, and then we were back to the point where she acts like she can't do it. She puts her front feet up and can't seem to jump. My vet and I discussed options of what to do. They think something is hurting and said we could try an NSAID-Metacam (he said it is more the kidneys than the liver that the drug impacts) or Tramadol. He feels that she might have some inflammation and recommended the Metacam-giving her a 12 lb. dosage (can't remember if that is ounces or what). He said they usually do the first dose at double, but thought for her we should not. He said the biggest issue would be GI upset with the natural steroids she produces mixing with the non-steroidal med. I just wanted to check in with all of you for any major issues/warning signs. I hate starting these things on weekends too!
Thanks!
Hannah & Julie

Hi Julie,

If Hannah were on Lysodren and Trilostane and you knew for a fact that her cortisol was within the recommended therapeutic range, I'd say try the Metacam. I used to give my Jojo Metacam once his cushing's was controlled but I doled it out sparingly. I put him on cosequin and he gets his fish oil and he has done well without an other meds.

Honestly, I don't trust Anipryl to effectively reduce cortisol so until you know for sure, I believe giving Hannah Metacam is too risky. If Hannah has arthritis, ask your vet about cosequin. Actually you can purchase it online without a prescription. If Hannah doesn't have arthritis and you think she may have strained a muscle, you need to keep her from jumping up on or down from everything and give her Tramadol if she appears to be in pain. That's my two cents.

Glynda

Thanks,Glynda.

She doesn't have arthritis, that we know of. Like I said, she was examined yesterday by the vet I really like. She said Hannah showed no signs of tensing or being in pain and that usually Shih Tzus will. I told her Hannah may be an exception because she is truly the sweetest, most kind dog ever. I said I could probably cut her foot off and she would give me kisses while I did it. This started last Sat. and I rested her the whole time.

The other option he gave me was Tramadol, but then said she may need to reduce inflammation.

I don't know what to do. Should I call tomorrow and say I don't want to risk this? What is the greatest risk? I know it can cause death and kidney failure, etc., and a million other bad things that are always on medication, and obviously they have to tell you every possibility. I am most worried about her liver. Is that your concern too? He said I could also try a lower dosage than she needs. (She is 12 lbs. and they have me giving the 12 lb. dose). It just says in all caps to STOP IF SHE IS NOT EATING OR DRINKING.

How soon would I see a problem? UGH. I hate this. I don't want them to think I am crazy, and I want them to know I value their professional opinion, and he did give me options, but how am I to know what is best?!?!?!

Any other input you have I greatly appreciate. I can't seem to enjoy myself when things are not right with my girls.

Julie & Hannah

Julie,

Jojo's internal medicine specialist, under no circumstances, would prescribe Metacam until an acth stimulation tests showed that his cortisol was where it needed to be. It is not only the adverse impact on the liver and kidneys that are concerning, the stomach ulcerations/perforations resulting in internal bleeding scares the stuffing out of me. Warnings on the label are very clear that NSAID should not be used in conjunction with corticosteroid hormones because the potential risk for side effects is increased. Cortisol is the same thing as corticosteroid hormones so the question is can your vet assure you that Anipryl has effectively reduced Hannah's cortisol levels?

Quote:

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Originally Posted by lulusmom

Julie,
Cortisol is the same thing as corticosteroid hormones so the question is can your vet assure you that Anipryl has effectively reduced Hannah's cortisol levels?

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I don't think he would say he is confident about that, no. He said Anipryl was a place to start, due to the fact that she did not have significant symptoms (as in I wouldn't have called the vet yet to say something was wrong) but that it was a place to start. She does seem slightly better--not begging for food. Water intake is the same, but it was only slightly higher, and she can hold her urine over night and during the day while gated in my kitchen, so we didn't want to move to anything stronger yet.

So, your suggestion would be to get the Tramadol? He did say that would eliminate my concerns about Cushing's.

Thank you so much again. I don't know where I would be without this forum. I call it my support group.

Julie & Hannah

Well, I'm on my way to pick up Tramadol for Hannah. The regular vets aren't there today, so there is a "sub." I told the person who answered my concerns, and she called back and said the Tramadol is ready. Anything I need to know about Tramadol or the dosage before we start? They said it is twice a day. Hannah weighs about 12 lbs.

Thanks!
Julie & Hannah

Hi Julie,

If it were me, I would start with 1/2 the recommended dose. It has been our experience that Tramadol can cause some pretty harsh side effects unless the dose is cut. For some reason, the recommended doses usually turn out to be too much and the pups are nauseous, dizzy, and lethargic. So folks who use it here, usually start with a much smaller dose.

Hugs,
Leslie and the gang

They gave me four 50 mg pills, quartered, and I am to give it to her two times per day. She is 12 lbs. so this would be 12.5 mg per dose. I'm not sure that I can cut the quartered pills, as they are already pretty small. My parents have two dogs that have been on it with no issue, but I don't know how their vet determined dosage. From your experiences, is this still potentially too high? Or is this about right? Again, not sure I can cut them anyway...

And maybe more concerning, what do you make of this?
[I]Contraindications include dogs who are being treated with L-Deprenyl for Cushings or cognitive disorders, or dogs taking serotonin reuptake inhibitors, monoamine oxidase inhibitors, or certain antidepressant medications.
I found it on this website when looking for dosage info. [I]http://vettechs.blogspot.com/2005/04/tramadol.html

And yet another one:

Interactions with Other Drugs:
The beauty of this pain reliever is that it is compatible with all the COX -inhibiting non-steroidal anti-inflammatory drugs, possibly even synergizing with them. It is also compatible with joint pain neutraceuticals such as glucosamine, MSM, chondroitin sulfate etc.

Tramadol is NOT compatible with L-Deprenyl. Animals taking L-Deprenyl either to control Cushing's syndrome or to control senility may not take any sort of narcotic medication including tramadol. Similarly, tramadol is not compatible with other psychoactive drugs such as serotonin reuptake inhibitors, tricyclic antidepressants, or monoamine oxidase inhibitors. If you are not sure if your pet is on one of these medications, check with your veterinarian.
This time from this website: http://www.veterinarypartner.com/Con...5&S=0&EVetID=0

What in the heck?!?! HANNAH TAKES ANIPRYL! I am starting to wonder about my vet (although the woman today was a sub since the regular ones were both out, but my regular vet suggested this too). Does anyone know about this? Is this information old or inaccurate? I called and left a message for the regular vet to call me on Monday and have decided not to do anything before then, except to continue to prevent Hannah from jumping on or off anything (she has no problem jumping down and does if I don't catch her).

Again, I have been very happy with my vet for the past 5 years (and they are definitely really current with their care, procedures, technology, etc.), but he did ask me on the phone yesterday, "Is Hannah the one with Cushing's?" Granted Hannah and Izzy look very much alike, and he has many clients, and we talk enough that he probably can call me without needing to review records, but I found that to be a bit concerning.

I am starting to feel like a crazy person. I don't want to second-guess everything that comes at me, but I feel like if I don't thoroughly check things out and be an advocate for her care, then something could go wrong. (I have picked that up from reading so many stories on this site). I don't feel like I should be the one who finds these things!!! (Unless somehow this is incorrect). I am so frustrated right now, I can't even stand it!


Thanks again for the advice (and for listening to me rant)!
Julie & Hannah

Hi Julie,

If memory serves me correctly, Dr. David Bryuette was involved in studies on Anipryl and I bet he can tell you if Hannah should have the Tramadol along with the Anipryl. If there are any serious contraindications, he should know. Here is an email addy I found for him but am not positive it is good. I would try anyway, tho.

David.Bruyette@vcahospitals.com

He is also a member here so you might contact him via a PM. He is listed as David Bruyette in the members list....you will find this under the "Community" button above.

I think you are very wise to research everything. You are a great advocate for Hannah!

Hugs,
Leslie and the gang

Quote:

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Originally Posted by squirt's mom

hi julie,

if memory serves me correctly, dr. David bryuette was involved in studies on anipryl and i bet he can tell you if hannah should have the tramadol along with the anipryl. If there are any serious contraindications, he should know. Here is an email addy i found for him but am not positive it is good. I would try anyway, tho.

david.bruyette@vcahospitals.com

he is also a member here so you might contact him via a pm. He is listed as david bruyette in the members list....you will find this under the "community" button above.

I think you are very wise to research everything. You are a great advocate for hannah!

Hugs,
leslie and the gang

---

thank you!

Hello-
I thought you might want to know that I did email David Bruyette, and I got a response from him. He said that it should be okay in dogs, and that there was an adverse response with humans. I wrote him back and included the information I found, as well as the link, to see if he believed it to be incorrect or outdated. There is nothing listed on the Anipryl drug sheet, but there is on the Tramadol info., at least from what I have seen. I also read a couple of questions written online with people reporting an issue with combining those two medications. I will see if he responds. As of now, I am waiting and doing nothing.

Tonight when I was putting a load of laundry in the washer, Hannah raced down the steps to see me, and then wanted to go back up too. I have still been limiting this (unless she does something like this without me being right there). She also jumped up onto our bed again out of the blue. I don't know if I should just let her do things as she wishes, or still try to limit and jumping and stairs. The vet couldn't seem to find anything wrong, so I don't know if I should mess with any meds period, or what. She is such a mystery to me!

-Hannah & Julie

Julie, I don't believe I have posted to you before, but I have certainly been following Hannah's story. I do want to caution you about letting Hannah do much racing around like a "wild woman". Our pups seem to be very prone to cruciate ligament injuries in their knees. Whether this is due to the muscle wasting from Cushing's, I don't know. To show you, my 1st Cushpup, Barkley, ruptured a cruciate ligament simply chasing a toy that I was throwing for him through the house. I threw the toy up to the kitchen, B goes tearing up there, & has a bit of a slip on the linoleum. Bamn!! He comes up lame. He had to go to surgery to repair this injury, & the abnormal pre-op labwork is what put us on the road to a Cushing's diagnosis.

My Lhasa was given tramadol when he ruptured his cruciate a year ago, simply by jumping off the bed. I gave him the dose suggested by the ER clinic that night. I swear, it was like Chewy was "stoned", on drugs, or something, he was so out of it. Chewy is not a Cushing's boy, so I can't blame the ACL rupture on Cushing's with Chew.

Debbie

Thanks, Debbie. I just don't know how long I should try to keep her from doing anything, since I have no idea what hurt and she otherwise walks and acts perfectly normal.

This started last Saturday. Then on Friday (after having her anal glands expressed, which is what they thought might have caused her to not want to jump) she did jump on the bed twice before again seeming to be unable. Do you think I should try another week? I just don't know how to know when she is feeling better...since she makes it very clear when she does not want to/can't jump.

The vet manipulated her back legs around and said she had really good range of motion. She also said that Hannah didn't appear to have any muscle wasting yet, and otherwise looked very healthy. I just don't know what it is.

I guess for now I will continue to limit her jumping/stairs, and I'll wait to see what I hear from my vet on Monday. Maybe I can try to break off some of the Tramadol if we even end up giving it to her, but I just don't think I'll be able to evenly break a quartered 50mg pill.

Thanks for the information and for the advice. I truly appreciate it!

Julie & Hannah

Hi Julie,
A belated welcome from me :)

Just wanted to re-enforce what Debbie said about ACL ruptures. My Roxee ruptured her's shortly before she was diagnosed with cushing's.

Hi,

Just wanted you to know that I have been following along and am sending hugs. I think it is really good news that your vet does not seen muscle wasting yet and that Hannah has a good range of motion.

Zoe has a weak front paw that they never did figure out what was wrong with. It would bother her off and on. When it obviously bothered her, I limited her for a while. She had such a bad experience with Rimydal that I did not want to try anything else.:eek:

Keep up the good work!!!!

Hugs,
Addy

Hi Everyone-

I'm thinking of possibly taking Hannah to an IM specialist. I'm wondering with the confusion about the medications, etc. if it is time to just have her seen by someone else. I don't know if an IM would have any better idea about what is going on with Hannah's sudden inability to jump, but maybe they could recommend a better plan that won't interfere with her Cushing's issues.

My main concern would be cost. I am willing to spend money on my dogs, and I probably spend a few thousand per year (without even major problems), but I don't want to go crazy spending loads of money and do every test out there.

Aside from the jumping issue, she is doing relatively well with her other Cushing's symptoms (although I have noticed that she does not seem as interested in walking--tends to trot for awhile at a pretty quick pace, then really slow down, sometimes even stops, and this tends to repeat throughout the walk). I took her just down a couple of houses and back today and saw the same thing; however, I assumed that now something might hurt, so maybe it is worse.

For those of you who do see a specialist, do you then go there for almost everything, or do you still see your regular vet for other issues? I am assuming they could talk to each other about medications, or that I could then be calling to check out what my regular vet was prescribing.

Hannah is due for her next blood test on Aug. 1st. I believe he just checks the main things--not a complete blood count. I'm thinking maybe this would be one pro about seeing someone now...I could have the test done there and they would then have some fresh information.

I haven't checked the cost, but I do know there are options in my area, and that my vet even said he recommended one that is within 15 min. of us. (This is when we talked about me possibly getting another opinion).

Just wondering what you guys think.

Thanks so much!

Julie & Hannah

Hi Julie,

Right now Zoe is seen only by her specialist. The main reason for that is I did not have a regular vet that I had a positive relationship with that I could trust to take care of her other needs and work with her specialist.

Her specialist does not have convenient hours, I have to take off of work and it is a further drive for us.

I have a regular vet in town I would like her to start seeing. He is willing to work with me and her specialist. If I like him, I would start taking her to him more often for routine things as it is more convenient and I would not have to take off of work. We have not yet gotten to that point. Call me paranoid:D:D:D:D:D:D

Not sure if that helped you.

Hugs to you and Hannah, she is sooooo cute.

Addy

Hello Everyone-

I finally talked to my vet today, and he did review some studies and looked for more info. with using Metacam and with using Tramadol with Anipryl.

He said he understood my hesitation not to use them. He said most of the studies are with long-term use, but admitted that since we don't know Hannah's cortisol levels, the Metacam could be more risky. (Glad I spent $31.50 on it; I should see if I can return it, as it has not been opened).

He said the contraindications with Tramadol and Anipryl are mostly human studies (which is what Dr. Bruyette told me), but said he understood my concern because it could translate into pets, but that since it was only going to be a few days, he thinks it would have been okay.

I have given her nothing and she still isn't "normal." I limit her activity, but I know she does not want to jump on the bed most of the time.

My vet and I decided it is probably a good time to see an IM specialist. He has other clients who go to this place and have been very happy, and referred me specifically to the doctor who has dealt the most with Cushing's, and was able to get me an appointment on Friday (thinking maybe they would have more of an idea about the jumping issues and what med to try, if needed).

I am starting to wonder if the disinterest in jumping (or inability to do so) is related to Cushing's. She also really drags some of the time during walks, and it seems to be worse lately.

I guess we'll see what the specialist has to say. I have such mixed feelings about the appointment. It will be good to get a second opinion and see someone who is more familiar with Cushing's, but I also dread getting bad news too. I'll keep you posted on what we find out.

Julie & Hannah

Hi Julie,

I am glad you made an appointment with a specialist. I hope you can get some answers as to what is going on with Hannah's leg weakness. Please keep us posted.


Love
Debbie & Logan

Julie -

How is Hannah doing? I was just reading your thread and was glad to read she had a normal ultrasound. Hopefully, she will not progress and you won't have to treat her with anything else. It's always so hard to know what tests to have, etc., etc. It is nice to be able to come here and compare notes and realize we all love our dogs and are doing our best.

Hello-

Thanks, Mary Beth, for checking in. I took Hannah to an IM specialist yesterday. I really liked her and she took her time answering my questions and telling me what she thought, while also listening to my concerns.

Basically, she believes that the dog should not be treated with Lysodren or Trilostane until symptoms are severe and the dog's daily life is being affected. She said they are very effective drugs that can really improve a dog's quality of life and can greatly reduce symptoms, but unless the symptoms are significant it is difficult for the owner to know if the drug is working. I am with her on this.

At this point she didn't really think it was time to start Hannah on either of those meds. Her symptoms are an increased thirst and appetite (more peeing, but not needing to go at night or having accidents in the kitchen, which is where my girls are barricaded when we are gone). She is not panting, has no potbelly, and does not have skin or coat issues. The ultrasound looked normal, which she agreed probably means it is still in early stages. Recently (the last few weeks) she has occasionally really dragged on short walks, although she has never been a huge fan of walks, which I figured could be slowing down due to Cushing's. The IM said it could also be if she is having any pain.

She examined Hannah and looked at her chin issue, since I noticed a little lump and some inflammation a few weeks ago and took her to the regular vet. She agreed with my vet that it is some sort of lip fold issue-I can't remember the correct medical term, but like an acne. I have some wipes to use as needed if it is looking irritated. They want to prevent a yeast infection. It does look much better.

She didn't have the answer about the sudden inability to jump. She said sometimes dogs don't show their pain at the vet, and that she has had people bring in dogs who are apparently not moving at home, and then at the office they are bouncing around like puppies. She suspects that Hannah does probably have some sort of back issue, and that potentially her Cushing's is playing a role because her muscles could be just a little bit weaker. Or it is possible that she just has a back issue. She said the smaller breeds of dogs are prone to disc issues.

She also told me the only way to really know would be to do a CT scan of her back, which she felt might be aggressive at this point. At this point, I really can't spend the money on that either. She watched how Hannah came over to me and put her feet up on my lap to be picked up, and agreed that she can't be in severe pain based upon how I describe her acting at home, and from what she saw in the office.

Basically, the recommendation she gave me was to go ahead and try the Metacam my regular vet gave me last week. I asked about the issue with the cortisol interacting with the drug. She said she has had several other Cush dogs on the drug, and that for some reason the natural steroid does not seem to react the same way as a synthetic steroid, and that the dogs do fine. She suggested I try it for a short time, like three days, to see if I notice any improvements in Hannah. She told me to make sure she is eating and drinking, and that if any of that changes, or if she is having GI issues to stop. She talked about the other side effects (internal bleeding, major stomach issues, etc. but said they do not see that with Cush dogs like they would if they were given prednisone).

I emailed Glynda several times to get info. from her. I know there are risks and I am still a bit worried about it, but after talking to the specialist who uses it in other Cushing's dogs I feel a little better than just hearing from my vet. Glynda said I should know what to watch for (I'm going to review the link she sent me) in case something goes wrong. If Hannah shows no improvement, the IM said I should stop.

At this point I am thinking I will wait to give it to her until Sun. night, just because of the fact that if something does go wrong I am more likely able to get into the regular vet office, rather than the ER vet (where we have made way too many trips with our pets!).

Here is the one other thing I thought of: Hannah has a blood test on Tues. (just a smaller profile CBC) to see how her liver levels, and other major things are doing with her being on the Anipryl. Do you think there is any way the Metacam could interfere with that? If so, I don't want to give it to her before the test.

I talked to the IM about if we should continue the Anipryl (the main difference we noticed is that Hannah is not begging for food as much) and she said it wouldn't be bad to go off it and see if I notice a difference, but she thought I should get this blood test to see if her ALKP level was still down. She said if it has gone back up I know the Anipryl is not helping that at all. (In her first test, after a month of Anipryl, her ALKP went from 1770 to 680 or something like that).

I'd love to hear if anyone knows the answer to Metacam affecting the blood test so I know if I should wait. At this point, it has been two weeks since she has stopped jumping up on furniture and she has had no medication for it. She seems fine otherwise.

Thanks for listening, and for any input you have!

Julie & Hannah

Hi Julie,

i have been researching Cushing's Neuropathy in dogs. I have found a few links regarding it but am unsure of really how reliable the information may be so I will keep looking. From what I found so far you need to catch it early. Zoe's onset of hind leg weakness was my most pressing concern for her over all her other symptoms.

I thought you might want to research that for Hannah.

Thinking of you and wishing you well. Thank you for all the well wishes.:):):)

Love,
Addy

Hannah had another blood test today to see how she's doing. Her ALKP level has dropped again, thankfully. Back in March it was 1770, in May it was 689, and today it was 327 (with normal being 23-212). The only thing she is taking is Anipryl, so either that is causing the ALKP level to drop, or it is somehow dropping on its own. At this point, we'll continue the Anipryl.

Her platelet count was slightly high again (505 and 148-484 is normal), as was her PCT (.47% and normal is .14-.46), and her MCV and MCH levels were just slightly low (MCV was 59.4, with 61.6-73.5 being normal & MCH was 21.1 and 21.2-25.9 is normal). These were normal in May. The vet said he is not concerned about any of these, so I guess I shouldn't be.

Everything else was normal. I'm glad her liver is doing better, and now I just wish we could get the hind end issues figured out. It's hard to know if I should be limiting her activity entirely, or doing something to help her maintain some muscle strength (if that is the issue). She still does not jump up on anything, and I don't let her do steps, but I did take her for a short walk to try to keep those legs moving.

She otherwise seems fine and happy, so I guess I'll try to focus on that instead of worrying about her. I'd love it if her back end recovers, but I'll take an otherwise happy girl for now.

Julie & Hannah

Hi, Julie!

Just here today trying to catch up on everyone. First of all, I am glad to hear you found an IM that you like and who seems to be so thorough! Hannah's recent blood test results sound WONDERFUL to me!!! Sounds like you should just continue to do exactly what you are doing. As far as her not wanting to jump, during all of Alivia's testing, they found she has some pretty severe arthritis in her lower spine (an x-ray showed it). After all, she is 13 years old. Anyway, they said it could be painful and that she should refrain from jumping a lot. I give her a glucosamine supplement (Cosequin DS - available online and at pet stores). I also have put doggie steps to my bed and a small stool by the couch so she doesn't have to jump as much. Overall, she seems to be doing very well.

I hope Hannah continues to do well!

Hi Julie,

I am pleased to hear that Hannah's liver enzymes are dropping...and based on what our vets in TN told me, the Anipryl is the reason. ;) They told me every pup they put on it, the liver values drop. Is it still helping with her signs? Squirt did very well on on it for quite some time so I am an Anipryl supporter for sure!

Hugs,
Leslie and the gang

Hi Mary Beth & Leslie,

Thanks for checking in. Hannah's other symptoms seem about the same on the Anipryl-her begging for food decreased slightly (although recently she has had a few episodes) and her drinking seems about the same, but it is definitely not buckets. I measured what I typically put in the bowl (about 3-3 1/2 cups) and between Hannah and my other Shih Tzu, Izzy (7.5 lbs.), they don't quite finish it in a day (although Hannah is drinking much more of it than Izzy). There is another dish Hannah sometimes uses (and Izzy never does) and that one doesn't go down too much. She definitely drinks more water, but not crazy amounts, and still does not need to go outside overnight. In fact, she sometimes makes it close to 10 hours overnight. Still no panting, no pot belly, no hair loss, no skin issues. Just the new mysterious lack of being able to jump.

We went to the vet yesterday because Hannah had an ulcer in her eye (something we have a lot of experience with). Izzy seemed to get mad at her in the middle of the night when Hannah was moving around on the bed, and I assume a tooth connected with an eye. It showed up as a small spot in the center of her eye (with the dye) and did not appear to be deep, thank God. We are on the usual routine of pain meds and antibiotic drops.

While we were there I asked the vet (another fill-in vet) to check her over, as we talked about the jumping issue again. She also checked her anal glands again to see how they were (they were really full a few weeks ago) and they were empty. So that is not the issue. I mentioned that she seems to strain when she poops and walks around and drops a few turds in a few different places. A couple of times I have even heard her make a grunting sound. She doesn't always go daily (which can sometimes make them hard) and I asked if they thought it was tough for her due to not going enough, or if they thought that was related to the inability to jump.

She felt her back again and said she felt absolutely no tension or resistance anywhere, but that she felt that Hannah did resist when she moved her legs a certain way, so she feels it may be some arthritis in her hips. She said that could contribute to her not wanting to poop (which is sometimes how it seems), but it could also be due to straining. I have only fed her dry kibble (she is on an Rx food, Royal Canin Urinary SO), so I bought a couple of cans and we are going to try that. I have read on here I can also try pumpkin. How much would I give a 12 lb. dog?

We talked about possibly using Cosequin, but I believe my regular vet said that many dogs don't respond well to it. I am sure he will be willing to try it and the other vet and I decided I would talk to him about it next week. This vet said that Metacam is good for arthritis, but I really do not want to do that long-term with Hannah because of Cushing's. My parents use Tramadol for their collie with arthritis and my mom says it works great. The vet just said it doesn't do anything for the inflammation. I have not tried Hannah on the Tramadol at all because I was worried about what I read about the contraindications with Tramadol and Anipryl, although I was told that was only in humans.

We went for our short walk tonight, which is now about two blocks for Hannah. She stops periodically, but I am never sure if she is tired, in pain, or if it is all about having to poop. She sometimes walks and drops a turd and then seems to realize she has to go. She has always been a bit odd with her pooping, but this seems to be more bizarre. I can't tell if she doesn't want to squat or what.

Sometimes I feel pretty encouraged about how she is doing-that her blood work has improved, she has no other major Cushing's symptoms, she seems to be fine walking and moving around the house (even doing stairs). Then I get worried and discouraged about not knowing what the issue is with jumping, pooping, now her sore eye...she sometimes looks and seems like she is about 20 instead of 12.

She is still very happy to chew on her bone and still follows me around like crazy, and I can still make her wag her tail by talking to her, so she must be happy. I just have this nagging feeling that her time is limited. But who knows....my vet and the IM specialist seem to think she is doing quite well. She does just seem like she aged a fair amount in the last 6 months or so...but again, she does not have symptoms that warrant more aggressive treatment.

For now, I try to walk her as much as she wants to go, in order to keep her mobile. I am going to talk to my vet about trying something for joints. I know it can't hurt to try. I have wondered if constipation is an issue for Cush dogs from reading about several dogs having issues on here. Maybe the poop issue is not connected to jumping. I don't know. I just want her to be able to walk around okay and do her business. I can handle no jumping.

Any thoughts or advice is appreciated!

Julie & Hannah

Hi Julie,

Pumpkin can be a bit tricky; too much can cause loose stools. Maybe ease in to it with 1 teaspoon and see how that goes. It depends on how much other fiber (soluble and insoluble) is in Hannah's diet.

Zoe averages about 19 pounds and does not have a lot of fiber in her diet but even then sometimes 1 tablespoon would be okay and sometimes 1 teaspoon was enough. But remember, she has colitis.
When I used to research it I found dose suggestions ranging all over the place.

I waited to treat Zoe until her symptoms became a bigger concern for me. If you are comfortable where Hannah is now with her symptoms, I understand why you would leave things the way they are.:):)

Hugs and love,
Addy

Dear Julie and Hannah
You have been so kind to check up on me and Apollo. I wish I could give you a magic wand about Hannah's leg weakness. Like Apollo it could be cushing myopathy. Apollo has had back issues for years, but he never had the hind leg weakness like now. I have him on joint supplements, L-glutamine( can get in any drug store-500mg- I open the capsule and give Apollo about a1/4 of the powder) also Glucosamine-Chondroitin for dogs. My gut feeling is it is the Cushing causes the legs to be stiff, and hardly mobile. Apollo used to climb on the stairs and ramps to the couch. He can no longer do so. I try to make him do little walks around the house and cox him with treats.
Have you had Hannah's intermediate hormones checked this can cause the weakness. This disease is so complex.
Sending prayers and good thoughts your way.
Hugs Sonja and Apollo

Hello-

We're thinking of starting Hannah on a joint supplement to see if it does anything to help her back end. My vet told me about a few options and gave me brochures to look at. I think sometimes he likes to give me the choice, but I would also like his professional opinion. The choices are: Phycox, Synovi, and Cosequin. He seemed to think Cosequin offered the less friendly dosing option for her if that makes sense. The only thing he said was that Phycox says it blocks the COX-2 enzyme to reduce inflammation, which he said is sort of like what Metacam does.

We are going back tomorrow to have her eye checked, and I also might have him check her ears, as she's been itching a lot. I might also start one of these. Does anyone have experience with any of these?

Thanks!
Julie & Hannah

Hi, Julie -

What did your vet mean by "less friendly dosing option"? Both mine have taken Cosequin for quite awhile and seem to do well on it. Alivia is 13 and Maxwell is 11. Initially they started on one tablet a day and then after a week or so you cut back to 1/2 tablet per day. The tablets are large and supposedly chewable, but neither of mine will take them like that. I crush it in a pill grinder and mix it with their food. I'm not personally familiar with either of the other two so I can't offer any comparison. It is definitely worth a shot for you to try one but it will take a few weeks to see if there is any improvement.

Good luck!!!

Hi Mary Beth,
I think he just meant that the other options would last her longer...or that because I said she probably wouldn't chew the chewable ones he thought these would be better because they are soft chews??? I'm not sure what Hannah would or would not actually chew (eat). I will ask again tomorrow. He really seemed fine with me choosing whatever I wanted, and that I could get it there, or buy it myself (he said they don't mark it up). I have no idea which one to use and have only heard of Cosequin. I guess I'll wait to hear from others, and then ask for more info. tomorrow.

Where do you buy yours?

Thanks for your help!

Julie & Hannah

Dear Julia and Hannah
You have always been kind to check on me. As far as the Cosequin goes, I have been using it for years on Apollo.
I have used Nutramax-Cosequin-Double-Strength-Chewable-Tablets.
I would put the name in google search and see what you come up with. Petmart, Petco, Dr Fosters might have. I bought the last one from Trader Joe's their brand.
You must be sure it is for the right size of dog you have.
Hope this helps.
Hugs Sonja and Apollo




http://www.amazon.com/Nutramax-Coseq...5117351&sr=8-1

Hi Sonja (& everyone else too!)-

I haven't posted in a while, but Hannah has not had any major changes. I did put her on Cosequin (the same one Sonja is using) about 2 1/2 weeks ago, and I do think it is helping her a little bit. She has jumped up onto the couch and the bed a couple of times, but it is still not a regular thing. I know it takes 4-6 weeks before I am supposed to see a big difference, so we'll see. She does seem a little better while walking and going poop, so I'm pleased with that.

Hannah has had some issues with straining to poop when she doesn't go every day (which I'm not surprised about), so I am trying to see if I can stimulate her with short walks, but otherwise the vet told me to try the pumpkin. She has been barking at us and scratching at our legs at night, usually a couple of hours after she eats supper, and I assume she is telling us she wants more food. This stopped for a while after going on Anipryl (back in April), but seems to be picking up again and has been going on for the last couple of weeks. The eating and drinking are still not over the top, and still no coat or skin issues, no pot belly, no panting, so regardless we'll stick with the Anipryl for now.

I've been trying to just enjoy the uneventful times with her and to not worry about every little thing, as long as she is happy. I teach 3rd grade, so I know I'll have plenty of stress with the beginning of the school year.

Thanks for checking in, Sonja! Although I have not been on here as often because of getting back to work, I'll still be checking in. And I'll definitely be back to posting when I have questions about Hannah.

-Julie & Hannah

Hi-
I have been so busy with the start of a new school year and last night I came home with a horrible migraine and was in bed all night. Ugh! Anyway, I have wanted to check in and get some input about Hannah.

It seemed that her hind legs were improving (she was jumping up occasionally and walking a little faster/further) after being on Cosequin. We started Aug. 19th, so it hasn't been a month yet. Lately though, she has been struggling again. The other night she was going soooo slowly up the steps and stopped halfway up. I ended up telling her to stop and carrying her. I also noticed she was definitely using her front end more than her back to get up the step onto the deck. She also has not jumped up for several days, and was REALLY dragging on the last couple of walks. I'm not sure if this is a sign of Cushing's getting worse, or if it could just still be something she has done. I have not had a chance to talk to my vet yet, but the original suspicion was that she strained or injured something in her legs (back checked out okay from them feeling) and that is why she was hesitant to jump unless the reward was worth it. I'm wondering if maybe she injured herself again from overdoing it a bit...

She has also been vocalizing more in the evenings (not overnight), about an hour after dinner, usually from about 6:30 to 8:30. She barks at us, and sometimes will then scratch our legs if we ignore her. I assume she wants food and sometimes I give her a little more, as she is not at all overweight. Sometimes I give her a rawhide and that does the trick, but not always. She also has terrible allergies right now and is so itchy. It's terrible. I have a call into the vet about what I can do besides Benadryl. She used to take a steriod at this time, which is obviously not an option anymore. I also have that pheromone spray you can put on a bandanna and put around their neck to keep them calm. That seems to work well to get her to sleep. She just seems so miserable. I am sometimes wondering if the barking is due to being so frustrated with how itchy she is.

The issue is I am struggling with the thought of is this all Cushing's related, or not?? She still is not a voracious eater. She eats quickly, but doesn't totally inhale her food, and she will wait until Izzy walks away from her dish before digging in; she doesn't push her out. She does drink a lot, but not "buckets." She doesn't empty a water bowl (medium sized) in a day, and this is with Izzy drinking too. Still no other signs....

I got a message from the other vet that said I could try increasing her Anipryl to the full 10mg pill each day since I did notice a decrease in that barking behavior when she started back in April. I'm open to that, but the pills cost me $87 for 30, so that is significant. We talked about the other option being different treatment. I am open to that at some point, if necessary, but I don't feel confident that her symptoms are strong enough for me to be able to see a major difference. I don't know how I would measure the food thing because I don't think she eats THAT differently from how she ever did. She likes her food. I could TRY to watch how often she gets drinks, but after she licks and chews herself for awhile she always gets a drink, so that could be somewhat related to allergies. I am just worried about her back legs getting really weak. I guess my gut tells me it isn't time to move to something stronger because I don't want her to end up really sick or dead because of getting too much, but I'm not sure what to do.

Any input? When it comes to Trilostane or Lysodren do you usually just go with what your vet is familiar with? Is there any way to decide if one is better than the other for your dog? Is one any safer? How do you decide when it is time? I am such a worrier anyway, and so, so busy now that my husband and I are back to teaching. If I have to put her on something else I really think I would drive her to my parents' house (they are retired) so someone could watch her all day. I feel like maybe it is complicated by all of the allergy issues. And maybe the up and down is normal. How long do they usually need to be on Cosequin to see an improvement?

Sorry for the long, rambling email. It has been swimming around in my head for a few days now. I have been trying to read to catch up on all of you, and I'm always thinking and talking about my "Cushing's group." I really don't know what I'd do without you guys.

Any thoughts are appreciated.

Julie & Hannah

I re read your entire thread to refresh my memory... couple things.. did you ever give the milk thistle? I ask because when I used it my dog's alkphos levels went down. I know it was recommended but not sure if you tried it. I throw it out there as if you are using it, maybe that is why the numbers are down and not the anipryl. I tend to agree with the others and your vet that maybe you should try not giving it to see what happens.

I see where you did the ldds test but never saw an acth test. I would be curious how high her cortisol levels are. That would tell you how 'advanced' the cushing's is. That would assist in deciding whether to treat or not.

I can see why you'd be asking questions about lysodren/trilostane but I still don't see enough symptoms that I'd go there yet. Of course this is the internet and I might be missing a whole lot of the picture so... you make the call there.

Regarding which is best - theyare equally effective but work differently. I think most go with what their vets are most comfortable with. I used lysodren and my gal did just fine.

Since you mentioned the itching - have you tried melatonin? It could be that the hormones are elevated (common in cush dogs) and as a result some dogs get skin issues which can include itching and licking. Melatonin is available at health food stores and I used it with my dog. She was a licker.

It seems like your biggest concern is the issue with jumping and stairs. Have you done xrays etc to eliminate those issues? If so it probably is cushings related.

I'm not sure I helped you a whole lot but those are my thoughts for now... Kim

Hi Kim,
Thanks for sharing your thoughts. I did not ever try the milk thistle, so it has to be the Anipryl. We decided not to try anything else just for that reason-so we would know what was causing what to happen. My vet has never done, nor suggested the ACTH test. I remember asking about it once, but I can't remember what he said. Do you think it would be worth checking, even if her symptoms are not that strong yet? I really still feel like we are not there yet. The main things I feel that I would be able to watch for are eating and drinking, and I'm not sure they are excessive enough. Should I test the hormone levels you talked about? I have heard of people using melatonin, but thought it was more to calm them. I will ask my vet about it when I talk to him. They have not done x-rays on her. Neither the regular vet nor the IM thought there was a point at the time it initially happened. They said they may not see anything and that a CAT scan might be better. I'm not spending money on a CAT scan at this point. I know my regular vet would do an x-ray in a heartbeat; he just didn't want me to pay for it if it was inconclusive. We had spent a lot at the time with her meds, visits, tests, and a $700 dental on my other dog. I am curious what her cortisol levels are. She doesn't have any skin issues yet, but I wonder if the Cushing's is making the itching worse.

You gave me lots of good things to think/ask about! Thanks!

Julie & Hannah

I wouldn't waste money on testing the sex hormones. I throw it out because based on what you have shared I agree that your dog has early signs of cushings and you shouldn't have to treat yet. That said, some dogs are classified as 'atypical' cushings early on and they have skin issues, itching, etc. Melatonin is a cheap and easy and safe treatment. I was wondering if it might not help with the licking and itching but if you think its allergies then go down the benedryl path.

What the acth test should tell you is how high the cortisol is.... that is an indication of how far along into cushings she is. The more uncontrolled the cushings the longer she's probably had it and the more likely you need to treat. That is why I throw that out... but really you are the one watching her and you'll know when its time to throw out some more money towards tests. ;):) Kim

I know the struggle you are having, I went through it myself with Zoe, when to treat, how to treat, her symptoms, etc. I think agree with Kim that knowing the results of an ACTH test might shed some more light on it for you. If you feel you are not there yet to move to stronger treatment, then you go with your gut. You see Hannah every day and know her inside and out.

Zoe's hind leg is still a problem for her, I see it now, what she does with it, how she walks and will have new IMS check it out and since we lowered her cortisol somewhat, the arthritis in her front paw is flaring up again. Other than that, she is doing well.

You will know when to treat.

Love,
Addy