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

Hi Julie: Over on the diabetes forum on Patty's thread about her dog Ali, Benadryl was not cutting it for her allergies and she started bathing her in Zymox.

Someone said the Zymox creme rinse is the key. Not to rinse it all out and it gives some relief.

I hope you find some answers!

Judi

Hi Julie - I ditto what Addy said - I have been there to - its hard to make these decisions - but I agree an ACTH test is probably a good place to start then you will know where you are at - thinking of you and Hannah:)

Hi Julie,

I've been trying to catch up when I can and have finally found a chance to post. Between you and I, this post is a very dry and not so suspenseful novel. :D Check out my contribution in blue below.

Quote:

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Originally Posted by jmac

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...

I have a couple of thoughts on this. Hannah is 12 years old so she is a senior and older dogs, like most older people, can't do a lot of the things they used to do. I say most people because not all of us stay in tip top shape by working out regularly. A senior with cushing's, even controlled cushing's, shouldn't be expected to jump up and down. I can't remember the last time either of my cushdogs took a leap or jumped up on anything and if they did, I'd have a stroke....well maybe not a stroke. :p

If Hannah's problem is being caused by continued muscle wasting due to the catabolic effect of cortisol, you should be able to tell by looking at and feeling Hannah's hindquarters. The head, spine and hips usually feel and look bony. It's easier to visualize this on shorthaired breeds so with Hannah's longer coat, unless you've given her a summer cut, you'll need to feel. Has your vet mentioned loss of muscle mass?


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.

I almost lost my Buster to a rawhide. He swallowed a piece of it and it lodged in his esophagus. These do not dissolve and unfortunately, none of the local vets had a scope long enough to remove any foreign object below the trachea. I had to rush him to a specialty hospital 50 miles away. The surgeon told me they see this way too often and didn't know why rawhide chews haven't been banned. I was scared to death because the esophagus is directly in front of the heart wall which is a thin membrane. The rawhide can easily erode the wall and once it breaks through the heart wall, the prognosis is not good. I was in tears for three hours in the waiting room. They had to hydrate him with fluids before scoping him. Buster was fortunate that there was no damage nor was there any scar tissue on his check up a year later. That was the last time any of my dogs or my family's dogs saw a rawhide.

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.

Hannah could be like Marianne's Barkis and experience itching with high cortisol but that is not the norm. For that reason, I'm not sure Hannah's cortisol is high. As others have said, the only way to know is to do an acth stimulation test. I have to admit that I have always been concerned about Hannah's diagnosis. As I recall, her original diagnosis was based solely on the LDDS and high ALKP. The abdominal ultrasound which was done a few months later showed normal adrenals and liver. With ALKP that high, I would have expected both to have shown some degree of abnormality.

Physical symptoms are a large component of a diagnosis and as I recall, your vet had to ask you if Hannah had any symptoms associated with cushing's. You didn't seem quite convinced in your first post that Hannah had any of the usual symptoms. I believe you said you thought that she may have been drinking a bit more and maybe had an increased appetite. If you had to analyze Hannah's behavior in retrospect because you hadn't noticed anything until your vet brought it up, I'm not sure that's enough evidence to confirm a diagnosis.

Given the lack of overt symptoms, I'm glad that your vet prescribed a benign treatment like Anipryl. ACTH stim tests are not necessary when treating with Anipryl because it's pretty well known that it rarely has any effect on cortisol. I've read studies that have shown efficacy rates as low as 20% but according to Dr. Mark Peterson, it is closer to 10%. I apologize for not asking before now but did your vet tell you that he was prescribing Anipryl to remedy symptoms, reduce ALKP or both?

As I recall, when the initial urinalysis was done, Hannah's urine was not dilute and USG was 1.023. Despite the various reference ranges used by labs, I believe it has been established that a USG of 1.023 falls within the normal range for a healthy dog that is adequately hydrated so I have to wonder if there was any urine abnormalities when Hannah was diagnosed.

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.

Can I assume that the other vet thinks that perhaps the barking is due to cognitive problems as opposed to cushing’s so an increase in dose may help?

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.

Sorry for being lazy and not going back through your thread but has Hannah seen an ortho or neuro vet for her hind leg weakness?

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?

According to Nutrimax Labs, Cosequin is a supplement that provides nutrients to maintain joint health, it works more gradually than drugs. Improvement can range from gradual to dramatic. Following the administration schedule on the label, for your dog’s weight, they recommend an initial administration period of four to six weeks. Some dog may show a response in a shorter period of time.

It is good to choose the drug that your vet is most familiar with but that’s only if the dog has symptoms. If I was quite sure my dog had cushing’s but was not yet overtly symptomatic, I wouldn’t treat unless I knew for sure that an accompanying condition was being exacerbated by high cortisol. Right now Hannah doesn’t really have the usual symptoms associated with cushing’s; you don’t know if her cortisol levels are abnormal and you don’t know if her intermittent weakness is being caused by high cortisol. If an acth stimulation test shows that Hannah has high cortisol and you choose to start treatment, I personally would not choose Lysodren as the absence of symptoms will make it difficult for you to tell when she is loaded.


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.

You’re reading somebody's post who has mastered the art of rambling so you have a ways to go catch up with me. Besides, rambling is part of dealing with cushing's.

Any thoughts are appreciated.

Julie & Hannah

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Hi Glynda,

Thanks so much for your response. I didn't find it dry at all! :D
I really appreciate your input.

I also realize that Hannah's age could be contributing to her hind leg issue, but the thing that alarmed/confused me about it was that it seemed like one day she just couldn't jump anymore. She couldn't use her little stool to get on the bed. That is why they assumed it was more of an injury than Cushing's or age. It sort of improved after about 10 days on Cosequin. She jumped up a couple of times, but now we are back where we started, or worse. Now she struggles with steps, which were no problem before. I have not seen any specialist other than an IM. I don't have tons of money (my husband and I are both teachers) to spend unless I feel like things are necessary. My husband already teases me about all the things we could do with the money we spend at the vet. I guess I am okay with her not being able to jump/use steps anymore, as long as I know she doesn't have some injury; however, I'm not going to pay for a CAT scan or MRI. I would be willing to pay for an x-ray, but my vet didn't know that it was worth it because he said sometimes they don't show what the issue is.

My regular vet and the IMS don't seem to think she has muscle wasting. I feel like her spine is a little more pronounced, but her head and hips feel the same.

I am VERY careful about rawhides. Hannah also had one stuck in her throat several years ago and it was the most horrible experience I've had with her. She got it out on the way to the emergency vet. I thought she was going to die in front of me. I watch her like a hawk with them and cut off the chunks that get soft. They should write on the packages about that so people are careful. The vet there said the same thing about seeing it all the time.

My other vet did not seem to think the barking was due to cognitive issues, and this is something she also did a couple of years ago, but I really never knew what she wanted. I now assume it is food because she is happy if she gets more. I think she just said if I increase the Anipryl dose that it might help her since the barking was the only real change I saw after the first month on Anipryl (and the drop in ALKP). I did not increase the dose bc of cost. I also want to see if she calms down after allergy season.

According to my vet's urine numbers, she had just slightly dilute urine. Normal was 1.025 or more. He was not too concerned about it.

Both vets tell me it is not worthwhile to do an ACTH because they say they can't really put a number on what "high" is or how "high" the level should be. They said it is just to monitor treatment. This is sort of confusing to me. He said we don't really have a reference because we don't know what her "normal" cortisol level is.

I do think she has some slight symptoms, and even had the vet not asked me, I was going to have him check her for a UTI because she was urinating more often. She will go about every 2 hours if I let her out, but she can still hold it for 8 hours while we are at work if she has to. I gate them in my kitchen with their water, beds, and food, as well as a potty pad. She hasn't used it. But, if I leave her loose, she will occasionally pee on the rug. (I have found stains). I would just say she has minor symptoms. Again, she doesn't empty a water dish in a day, even with Izzy using it too. She just drinks more often (and the drinks are longer). She wants to eat more often too.

The vet put her on the Anipryl specifically for Cushing's but it happened to significantly lower her ALKP as well. I can't figure out the normal ultrasound either. Their explanation, as well as guesses from others on here, is that she is in the early stages.

Where would you recommend I go from here? Would you push for an ACTH test? Will it tell me something? Would you do an x-ray to see how her back end is? Do you suspect it is just joints? I really don't think it is her back at this point because it has now been a couple of months and nothing is worse and she does not tense or show any pain when they examine it. The one vet said she felt some slight resistance with her hips, which makes sense.

Again, I really appreciate your help! I sure worry about my girl. Some days I really worry that she is close to the end, and feel so down. Then others I feel like she is pretty good, and I think she'll be with me for a while.

I'd love to hear your advice!

Julie & Hannah

At ER vet with Hannah. Can tell she is in pain. walking really slowly. Not sure if it is her hips or back. Cried the whole way here. Please keep us in your thoughts.

Sending love, strength and prayers your way. Kim

We are back from the vet. She was very nice (I was pretty upset because we had to put our dog Bailey to sleep after being paralyzed from a back issue) and did feel that Hannah has a disc issue in her mid-back. She said an x-ray might show that, but might not, and the only real way to see was a CT scan, which she also felt did not make sense at this point since we would not plan to attempt surgery even if she becomes paralyzed. We went home with Metacam. I know many of you have concerns about using that on a Cush dog and I have now consulted with 4 different vets who say they have used it safely with Cushing's dogs because it doesn't seem to react the same with a natural steroid as it does with a manufactured one. I hope that is the case. If this doesn't work, our other option is Tramadol, which I've also heard can make the dog act weird.

The vet told me her reflexes are still okay, but she is definitely in pain (which I knew so that's why we went to the emergency vet instead of waiting) and that she may get better, may stay the same, or may get worse. She said it doesn't guarantee she will become paralyzed like Bailey, but she could. My biggest issue at this point is what to do with her tonight. She usually sleeps on our bed but I can't risk her jumping off (she gets down sometimes to get a drink). I don't know if we will sleep on the floor with her or try to get her comfy on some blankets and her dog bed.

I am so, so sad. It's my 3rd anniversary on top of everything, but I am so worried this could be the end for my Hannah. I dread the thought of not having her with me. I've had her for 8 years (my first dog on my own after leaving mom and dad's after college) and she is the sweetest dog I have ever known (and I love them all).

Please say a prayer for my little sweetie. I love her so much and I'm so worried about her.

Julie & Hannah

Hugs and prayers being sent for you and dear Hannah. I have a little sweetheart of a Havanese and now a Shih Tzu - I swear the little ones are so sad to see when sick or in pain.

I think if it were me I would try her in a dog bed and blankets right beside your bed with your hand near for her to see and sniff or a pillow from your bed so it smells like she is with you.

Love and many hugs, happy anniversary too!

Keeping you both in my thoughts and prayers.

Happy Anniversary from me as well!

Sending huge and loving hugs, Lori

Hi Julie,

I am so sorry to hear about Hannah and her possible disc problem. I'm pretty sure Sonja's Apollo has a disc problem. You could ask her about it. I think she has been doing physical therapy and acupuncture. I just wondered if your vet had any thought on either of those options helping Hannah.

Kim is using a product called Duralactin (not sure of spelling) for Annie which was recommended by University of Kansas vet school, I think and also acupuncture and has found some relief for Annie's pain. You could ask Kim about it.

I am throwing this out there for you in hopes of finding some additional or alternatives for little, sweet Hannah.

Sending love and hugs and hopes to dry your tears that maybe we can find some additional help for Hannah.

Try to get some rest and yes, don't let Hannah jump so maybe a nice cushy big pillow on the floor right next to you may help. Zoe does not like her regular dog bed all that much but I found some big soft pillow beds and she will sleep in the middle of them.


Love you dearly,
Addy

Thanks so much for your messages. I really appreciate knowing I have a support group.

Hannah is the same. I am relieved she is not worse. I keep waiting for the dragging back leg, and praying that it will not happen. I barely slept last night and because Hannah has always been on our bed, she was not content even on a fluffed up comforter with my robe. She kept whining and looking at the bed. Finally, my husband and I decided to take the mattress from our spare bed and put it on the living room floor. That way she could either sleep on it or right next to me. She slept on the floor the whole night and I woke up every time she moved to itch or get a drink.

One thing the ER vet said I could try is acupuncture. I have never had that done on myself, but I am willing to try it to see if it will help. My vet also thought that was an excellent option, especially with her Cushing's. They can get us in tomorrow. It is $170 for the the consultation (and hopefully treatment as well) and then $80 for each treatment after that (they told me to plan on once per week for a month, but that all cases are different). I realize it might not end there, and there is no way I could keep up with that expense on a regular basis, but for now I will try it to see if we can get her feeling better.

They said this vet has a background in Chinese medicine and chiropractic. I am really worried about him wanting to do some sort of adjustment on her back. I have never seen a chiropractor and have a friend who is a physical therapist who is very against it. But I know many people think they are wonderful. It makes me really nervous.

Does anyone have any experience with acupuncture? Or a chiropractor vet?

I am holding it together, but barely. I'm SO terrified she will be paralyzed. I hold my breath every time she gets up to see if she will be able to stand. I hate it. I'm praying for the best.

Julie & Hannah

Julie I am so sorry to see this. I think acupuncture is an excellent idea. I know some humans who have had marvelous luck with it and my secretary had a dog who couldn't use his back legs.

The vet gave him some kind of shot in his back and in 2 days they worked again. She didn't ask for details so I have no clue what it was.

big hugs to you and Hannah. It is so hard to concentrate when we know our babies are hurting.

Judi

One of Administrator's, Kim (frijole), is having acupuncture treatments done on her sweet girl, Annie, and I do believe it has helped Annie a lot. Hopefully Kim will stop by and tell you all about this.

Love and hugs,
Lori

:D Ask and ye shall receive.

My Annie has an adrenal tumor and spondolosis and one of her back legs is almost lame. She has lost a ton of muscle mass.. if you really want to see how much check out my photo albums.. you will be shocked..

She is skeletal, very delicate to look at but I attribute the fact that she is even still alive to her weekly acupuncture visits. They give her B12 shots each week too. My vet went to the Chi Institute for certification (Florida) and she varies the treatment but Annie comes out energized and with a huge smile on her face every time. She loves going to the vet.

I am heading out of town for 4 days leaving tomorrow morning and I know I leave her in fantastic hands and that she won't be afraid because she loves them so much. So definitely give it a try.. I was desperate because the IMS did not want her on any pain meds... and frankly she isn't in constant pain... she suffers episodes when the tumor is active that drain her (HBP). Anyway... do give it a try! Hugs, Kim

Hi-
I just thought I would post a quick update on Hannah. I am relieved she has not gotten worse. We went to the vet who is licensed as a regular vet, but also practices Chinese medicine. Hannah got acupuncture. It was a little nerve-wracking and she did make a couple of little cries when he put in a couple of the needles. He said she is really tense in her back and the muscles were really hard so she is in a lot of pain. He did say that her reflexes are all good. I try to keep telling myself to focus on that-the positive-but I am still soooo worried it will get worse. I have not had a decent night of sleep since Monday because I wake up every time she moves, worried that she will hurt her back by itching/biting because of her allergies. We are supposed to go back next Thurs. for another session. Tonight she was a little more perky and was barking at me for more food, chewed on a bone, and wanted to move around a little more. I guess that is encouraging too, but she is still so stiff and has a strange gait. I know it could take a long time for her to get better, if she does...it is just so hard. I can't sleep on the living room floor forever, but I can't have her putting her front feet up on the bed, begging to get up. I don't feel like I can keep this close of a watch on her forever, so I sure hope she will get better. I know she shouldn't jump up or down or do steps ever again, even if she fully recovers, and that in itself will be a bit of a challenge, but certainly easier than me being worried every time she MOVES now.

The vet also gave me something to put on her food to make her stools a little softer since we determined the sore back is probably why she had such difficulty going poop. She was able to go much more easily tonight, so that was good.

Does anyone know of any good and safe calming agents? I am currently using a DAP spray on a bandanna, but wonder if there is something that will last longer. The diffuser didn't seem to do much. The spray works, but it is short lived.

I brought home my first cold of the year, a gift from my third graders, so I hope I can get some sleep tonight.

Take care,

Julie & Hannah

Melatonin seems to calm some dogs, I used melatonin for my boy, Harley. Harley was terrified of thunderstorms but while on the melatonin he no long had a fear from thunderstorms, it made him very calm.

Hi Julie,

Stopping by to give hugs and see how you and Hannah are doing.

Love,
Addy

Hi Addy,
Thanks for checking on us!

Hannah seems to be about the same. She had acupuncture last Thurs. and we have another appointment this Thurs. Last night was her last day of pain meds.

My problem is that I truly CANNOT relax. Each day when I get home from work I am so worried that something is wrong. Something seems wrong. Like tonight I am wondering why she is not chewing on her bone. She seems a little out of it too. She did poop tonight (the acupuncture vet gave me something to temporarily soften the stool to help so she doesn't strain her back as much) and she is still moving around (sometimes with a little more speed in the house--although then I want her to slow down), but I am always worried.

I wish I knew if I was "over the hump." We were at the vet last Monday, so it has been just over a week. She seemed to be in a little less pain, but now we'll see without pain meds. I still have not slept in bed. I've spent the last two nights on the floor by my bed, to try to get her to sleep in the dog bed. I intend to move to the bed each night, but it hasn't happened yet. I can't do that forever either, but last night she still wanted to be in bed because Izzy (my other dog) and my husband were there.

I just need something to get a little easier. I feel like I am a stressed out wreck at work too. I'm starting to think I might go crazy. I look forward to the appointment Thurs., but it makes me nervous at the same time. Ugh. I just want it to get easier...

My aunt rubs her dog down with a dryer sheet - vet told her it gives them a calming effect:rolleyes::):cool::confused::D Dont really know - aunt said it worked on her pug - i hope things get better for you and Hannah - I know the feeling sleeping on the floor - the couch - when Penny could walk I didnt know where to put myself - and shes 82 lbs alittle much to lift - we are sending love and prayers to you and Hannah!!! The only thing that has helped Penny is going off Vetoryl and going on Rimadyl :eek::eek:I know!!!!

Oh Sweetie,

I am so sorry you ae so stressed. You are not going crazy, you just are filled with anxiety and not sleeping properly makes it worse.

There is nothing wrong with asking doctor for temporary help.

Love,
Addy

Hi Everyone-

I need a little help. I have questions about two things: 1)acupuncture and 2)Tramadol dosing.

1) Hannah had acupuncture treatment number 2 yesterday for her back problem. She has improved over the past week but still had pain on one needle insertion right in the sore area. This morning she seemed lethargic to me and when I took her out to poop this afternoon she seems to be moving more slowly. She is moving a little more slowly in general. I called the vet this morning and mentioned it and they said some pets will be tired after and I read online that they can initially seem worse. For any of you who have experience with acupuncture, have you seen the same thing? I mean she still walks, eats, wags her tail, chews a bone, etc., but she is moving more slowly. She was almost trotting around behind me in the house the past couple of days.

2) My regular vet and the acupuncture vet recommend Tramadol for pain if she needs it from this point on. My regular vet told me tonight (because I called and asked about why she seems slower) that I should give it tomorrow if I think she is in pain. They gave me 50mg tablets quartered, and it says to give the 1/4 tablet twice a day. Hannah is about 12 lbs.-she varies from 12 to 12.5 lbs. Does that sound okay to you? I know many of you have mentioned concerns about Tramadol and strange reactions.

Also, I am unsure if she is truly in more pain, or if this is a typical reaction after acupuncture. I suppose I can call them again tomorrow morning and ask them. I don't want to give meds if I don't need to, but I don't want her to be in a lot of pain either.

Thanks for your help!

Julie & Hannah

Julie, I would give 1/2 the dose the vet suggested. Several of us have initially used tramadol at the dosage that was suggested, & proceeded to watch our pups become so totally "stoned", they had absolutely no idea what was going on. This has happened to me twice, once with Harley, once with Chewbacca. Harley was my 12 lb. Tzu that the ER clinic suggested 1/2 of a 50 mg tablet after he ulcerated his cornea quite badly. I proceeded to watch a little dog who had no utter clue as to what was going on, wouldn't respond to my voice, get lost in the house, wouldn't eat or drink. It scared the crap out of me! After I cut the dose back, he did fine. I would not dose twice a day unless you were absolutely sure Hannah needed it.

Debbie

Thanks! So, do you think I should just give the 1/4 tablet once? I also read some stuff about not giving Anipryl with Tramadol, but Dr. Bruyette responded to my email and said it is okay in pets. I found a few places online though where people have reported negative reactions and it says not to. UGH.

Julie & Hannah

I used Tramadol with my boy, Harley, many times. He never had an adverse response to it but like Debbie has mentioned some member's pups have. Harley weighed about 25lbs and when he was acting uncomfortable he received 25mg of tramadol 2x a day with no adverse effects...like we say...all pups are different!

Julie Penny has been using Tramadol for a long time - between all her knee surgries - teeth being pulled and her lumbar pain -- she is 82 lbs - she can take 1 1/2 tablets 2 - 3xs a day 50mg tablets!! OMG if I did that she would be in a coma!!:eek::) I give her 25 to 50 mg just at bedtime - she relaxes - sleeps well and the next day she is good to go - so start off low - the vet said Penny is just very very sensitive to the med but as other members are saying it does make some of them stoned!! So low does to start but it really really helps Penny - she relaxes and gets a good nites sleep and I can see the difference by morning - she moves alot better - but again every dog is different - low dose - and go from there - hope it helps - xoxo

Have any of you used Tramadol with Anipryl? So many things to think about...

Thanks!!!

Julie & Hannah

Julie

Penny took tramadoly while she was on Vetoryl I dont like all these drugs but at this point in her life if the tramadol gives her a rested good nites sleep then I have to use it ---- Penny is on the dreaded Rimadyl too:eek::eek:I know but we took her off it and she ended up in the hospital in the worse pain last week when we thought we were going to lose her and shes back on it and she is doing good - so Addy put it well I am between a rock and a hard spot so right now I have to have her comfy - she is going on the Adequan Shots next week also so then I will start to cut back on Rimadyl - hope Hannah feels better xo

http://www.marvistavet.com/html/body_tramadol.html

Julie I dont know how reliable this article is but it says not to use with Anipryl



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 nutriceuticals such as glucosamine, MSM, chondroitin sulfate etc.

Tramadol is NOT compatible with Deprenyl. Animals taking 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.

Tramadol may not be compatible with SAMe, a liver and joint support nutriceutical. Until further studies are performed, these two treatments should not be used together.

Tramadol can induce sedation when combined with amitraz, the active ingredient in the Preventic® tick control collar and also in Promeris Canine®, a flea and tick control product recently removed from the market. Amitraz is also sometimes used in the treatment of demodectic mange.

Hi Julie,

After doing some researching on the treatment of using Tramadol and Anipryl together, if it were my dog, I wouldn't do it. Anipryl (selegiline), also known as L-Deprenyl, is a monoamine oxidase inhibitor (MAOI.) When Anipryl and Tramadol are used together a condition known as serotonin toxicity may develop.

I found this excerpt from the British Journal of Anaestheasia:

Quote:

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Pethidine, tramadol, dextromethorphan and methadone definitely are weak SRIs (see Table 2), and may infrequently precipitate dose-dependant serotonin toxicity (when administered in conjunction with any type of MAOI), but perhaps only in large doses or susceptible individuals.

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Here is the link: Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity

I am truly a big worry-wart when it comes to interactions like this so hopefully others will comment as well.

Love and hugs,
Lori

Hi Julie,

My dogs have taken Tramadol as directed with none of the problems described by others. Apparently, dogs are like people....some are very sensitive to certain drugs and others aren't.

I think it is very interesting that more than a few websites state that Tramadol should not be given with Anipryl, yet Dr. David Bruyette, advised you that you can give both. I personally believe Dr. Bruyette would never tell you that it was okay to give both unless he knew for sure that it was safe, and who better to know than the developer of Anipryl himself. Having said that, I will say that I am with Lori on this one. I'm a worry wart too and to be perfectly honest, if my dog was experiencing chronic, severe pain, choose Tramadol over the Anipryl.

I sure am curious about where Hannah's cortisol levels are. If cortisol is elevated, Hannah would be getting a double dose of anti-inflammatories, one steroidal (cortisol) and one non-steroidal (Rimadyl). That's a major arthritic pain killing combination. Aside from being lethargic, what are you seeing in Hannah that makes you think that Rimadyl is not controlling her pain? Does she have trouble getting to her feet? Does she yelp in pain? Does she limp intermittently?

Thanks everyone! I found some of the same information and then Dr. Bruyette says it is fine. Here is the sentence he used:
Tramadol does not work in a similar manner to other narcotic pain relievers so I would not be concerned.

I am also a worrier, so that is why I am not thrilled about experimenting to see what might happen to Hannah.

Glynda-she is not on Rimadyl and never has been. She was on Metacam for a week (which I know would be the same concern) but I talked with 4 different vets: my regular vet, and IM specialist, the ER vet when Hannah went in, and now the acupuncture vet. They all say that for some reason the NATURAL steroid in combination with an NSAID does not produce the same things as for example, prednisone would with an NSAID.

After hearing it from four of them and knowing Hannah was in a really bad place at that time, we gave the Metacam with no issues. I asked what to look for, read about it online and in the insert, and remembered what Glynda had told me could happen. The Metacam did seem to help her.

Hannah is a pretty stoic dog. I only knew something was really wrong last week because she was moving SO slowly and her back end seemed to sway a little.

Now I don't really know how bad the pain is. She just seemed better before the acupuncture treatment on Thurs. and was a lot slower and sort of out of it yesterday. I read that dogs can seem a little worse initially after acupuncture and the vet told me she could be sleepy afterward, but I assumed it would be that night--not the next day. Yesterday she was walking really slowly when I took her for her super-short walk (like three houses down) to get her to poop and just moved more slowly in the house. She was almost back to a little "trot" when following me in the house on Wed. So, my only guess, was that maybe she is in pain.

At the acupuncture appointment on Thurs. she did not show tensing when he palpitated her abdomen and she DID the previous week at the first appointment, so we took that as a good sign that something was a little better. She still did a little yelp when he put in a needle in the main area that is sore. She did the same thing the first time. These are the ONLY times I have ever heard Hannah indicate she was in pain. Even at the ER vet she just breathed a little louder when they felt the sore area. She's sort of tough to figure out. I wish she could TALK to me!

At this point, I'm scared of Anipryl and Tramadol. I gave her Anipryl already this morning. Anyone know how long she should be off of it to take Tramadol? I think I'll call the vet (or both) and ask. I guess I should hold off today. I hope she'll just improve a little on her own.

Again, thank you SO MUCH for all of your help! I sincerely appreciate it and get so much information from here. I am the one bringing things to my vet much of the time, and it is usually from stuff I found out from all of you.

Keep your suggestions coming, PLEASE!

-Julie & Hannah

Hi Julie - yup worry is my middle name to - thats why I gave you that link last nigth and said I dont know how reliable it is - every vet has his opinion - so if you trust in your vet then I would listen to him -it is really hard to know what to do and what not to do -- How is Hannah today?? Thinking of both of you always:)

Thanks for the link, Cindy. Like I said, I found similar info. online. I talked to the acupuncture vet office this morning and they said the same thing-in their books it says it can be in an issue in humans. She told me that if Hannah seems to be in pain I should give HALF of the amount they recommend to give her a little boost and they felt that would be safe. It is just so hard to know if she is in pain or how much pain she is in. She is walking around the house and is wagging her tail a normal amount of the time. She is eating, waiting patiently for some bacon to fall on the floor as my husband eats breakfast....some of the normal things she does. She is just slower. Maybe that is a sign for me to hold off until she seems really slow or worse. The vet said they don't want her to be in pain so if I think she is to give the Tramadol. I don't like going off of what I "think" when she is sometimes hard to read. And being an anxious person, I may think it is worse than it is. That's why I'm going to kind of watch for today and then see where we're at. I guess 1/8 of a 50 mg Tramadol probably won't put her at major risk of some complication with Anipryl. With so many issues it's just tough to know what to do sometimes! I know you all can relate to that!

-Julie & Hannah

OMG Julie you are so right!!! Yup I can relate especially after her episode last week - it was easier for me cause she was in severe pain - loud groans - pushing her body into wall - doing the weird mouth things (they think that was she was in so much pain she felt sick to her stomach) but like I said I got my answers when we put her back on the Rimadyl and tramadol - she was 90 percent better! So I know what she needs - last night she took a tramadol and sleep but stll go up during the night to go to the bathroom - so it doesnt put her out cold - that was 50 mg (82lbs) so starting at 1/8 should be fine - let me know how it goes -- Penny is sending HUGS and KISSES to Hannah! That little face is just so cute!!!!!!!!!!!!:):)

Hi Julie,

Please see my comments in blue below:

Quote:

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Originally Posted by jmac

Thanks everyone! I found some of the same information and then Dr. Bruyette says it is fine. Here is the sentence he used:
Tramadol does not work in a similar manner to other narcotic pain relievers so I would not be concerned.

I am also a worrier, so that is why I am not thrilled about experimenting to see what might happen to Hannah.

I don't blame you at all, especially if you aren't for sure that Hannah really needs it.

Glynda-she is not on Rimadyl and never has been. She was on Metacam for a week (which I know would be the same concern) but I talked with 4 different vets: my regular vet, and IM specialist, the ER vet when Hannah went in, and now the acupuncture vet. They all say that for some reason the NATURAL steroid in combination with an NSAID does not produce the same things as for example, prednisone would with an NSAID.
Hi Julie,

After hearing it from four of them and knowing Hannah was in a really bad place at that time, we gave the Metacam with no issues. I asked what to look for, read about it online and in the insert, and remembered what Glynda had told me could happen. The Metacam did seem to help her.

Sorry I get my NSAID's mixed up. :D Of the four vets you talked to about Metacam, did any of them mention that dogs with high cortisol don't usually need an NSAID? It is when cortisol has been brought down to a normal level (normal for a cushdog) that the aches and pains of arthritis are usually unmasked. Were any of them curious about Hannah's cortisol levels or are they all assuming that since Hannah is in pain Anipryl must be effectively controlling Hannah's cortisol? I'm very confused about this but then, I am easily confused. :confused:

Hannah is a pretty stoic dog. I only knew something was really wrong last week because she was moving SO slowly and her back end seemed to sway a little.

Now I don't really know how bad the pain is. She just seemed better before the acupuncture treatment on Thurs. and was a lot slower and sort of out of it yesterday. I read that dogs can seem a little worse initially after acupuncture and the vet told me she could be sleepy afterward, but I assumed it would be that night--not the next day. Yesterday she was walking really slowly when I took her for her super-short walk (like three houses down) to get her to poop and just moved more slowly in the house. She was almost back to a little "trot" when following me in the house on Wed. So, my only guess, was that maybe she is in pain.

Are your vet(s) suggesting pain meds because you are guessing Hannah is in pain or has she been formally diagnosed with arthritis, dysplasia or spinal problems? Can you remind me if Hannah had Xrays that showed any abnormalities? I do remember that one of the vets manipulated her and she did not appear to be in any discomfort and the IMS said Hannah may possibly be in pain but didn't appear to be based on her behavior during the appointment and your description of her at home. Do your vet(s) know for sure that Hannah's issues are not due to muscle wasting caused by excess cortisol? Muscle wasting makes a dog weak but it doesn't cause pain per se. If it did, my wimpy Jojo would have been yelping in pain constantly.

At the acupuncture appointment on Thurs. she did not show tensing when he palpitated her abdomen and she DID the previous week at the first appointment, so we took that as a good sign that something was a little better. She still did a little yelp when he put in a needle in the main area that is sore. She did the same thing the first time. These are the ONLY times I have ever heard Hannah indicate she was in pain. Even at the ER vet she just breathed a little louder when they felt the sore area. She's sort of tough to figure out. I wish she could TALK to me!

This takes me back to the xrays. What is the main area of soreness and was this area xrayed to try to figure out what is going on? I wish I had nickel for everytime one of us said "if only they could talk". I honestly believe if they could talk, a lot of them would tell us to take a chill pill and go to bed because we are depressing them. :p I also believe that if our cushdogs felt every ache or pain we think they feel and if they suffered from the angst that gives us knots in our stomachs, they'd be big old hypochondriacs. :D

At this point, I'm scared of Anipryl and Tramadol. I gave her Anipryl already this morning. Anyone know how long she should be off of it to take Tramadol? I think I'll call the vet (or both) and ask. I guess I should hold off today. I hope she'll just improve a little on her own.

I don't have an answer to that question but if Hannah truly does have joint or spinal problems and Anipryl has actually decreased her cortisol, then you should see some improvement as cortisol goes up after discontinuing the dosing. If that is the case, you wouldn't have to worry about Tramadol.

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Glynda,
Thanks again for your quick response. Hannah has not had an x-ray, but there has been a new development since my initial posting about her having either rear-end or back pain. A couple of weeks ago on Tues., the 27th, Hannah was walking VERY slowly, so slowly that I knew something was wrong. She was also wobbly with her back end and it was swaying a little as she would stand. I was instantly worried about a back problem and even did the test where you turn the toes under to see if they put them back. She did, but she definitely was not right to me. We went to the ER vet right away. They were able to determine easily that she has pain in her middle back just by feeling. She was tense in her back and abdomen when the vet manipulated and also breathed harder/made a little groan when she felt that area. She said we could do x-rays, but didn't really need to, since she was absolutely sure there was pain in that area and there was some sort of disc problem. She said the only thing she would do was a CAT scan if I would at some point be interested in surgery. Since I would not do surgery, even if Hannah became paralyzed (because of her age, issues, and our financial status) we didn't do them. She was definitely showing the pain this time, but still in her own little stoic way. That's when we went on Metacam for 7 days and she had acupuncture the following day, as they recommended it as a good way to help her heal.

She also indicated she was in pain in the same area for him when he manipulated the area. It is in her middle back. She also tensed when he manipulated her abdominal area that day. She even yelped a little when he put in one of the needles in that area (as she did again this week in the same spot). Therefore, we know it is a spinal problem.

She may not have any hip or arthritis issues at all. This whole thing could have been a sore back that just got significantly worse last week. That is my guess. I also think that is why she was having difficulty defecating. Her back hurt.

So......that is why we are talking pain meds. They are relying on me to know if she is in pain, which I appreciate, but then it is hard for me to now sometimes. Of course I don't want to leave her in pain, but I don't want to jump the gun either. That's what makes it hard. She did seem better, but maybe this is another little rough spot.

Do you know if I do stop Anipryl how long it would be to get out of her system? She takes a half of a 10 mg pill once a day and has been since April.

No one seems to want to check her cortisol. They say that it is hard to know what "normal" was for her and how high is "high." I don't think they believe cortisol is being controlled by Anipryl, just the symptoms. The one thing Anipryl HAS done is bring her ALKP down from 1770 to 317 since April. That is why we decided to continue. Her symptoms don't seem to be that bad and I do think we could try going off of it to see. The IM even said I could try that to see if symptoms got worse (so I know if I want to spend $80 every 2 months). I could also see if her ALKP rises from being off, I suppose. At this point, I am more concerned about her back. She may not be here for me to worry about Cushing's if we don't get this figured out.

Does this help you out any more with where we are?

Thanks!
Julie & Hannah

Hi Julie.

I have to transport my little blind chi to his forever home and pick up a little Bichon with a broken leg at the shelter so I only have a minute. Lucky for you this is going to be one of my shorter posts so no eye strain. :D I did quick check online and see that Anipryl has about a nine hour half life. I have the FDA NADA number for Anipryl somewhere and will go back and check the clinical trials that were done to see if I can come up with anything else. Anipryl is not without side effects. Muscle pain and constipation is listed as a human side effects and I'm hoping to find something more about that for dogs when I have time to read. Did you happen to notice if any of Hannah's issues appeared after you started Anipryl?

Will be back later.

Glynda-
The straining while pooping was after Anipryl...but not immediately, and also coincided with when she stopped jumping, etc. (the back problem). I'll wait to hear more. And, for the record, I love your long notes. You are thorough, and I am too. I like that! :D So, thank you. I'll wait to hear more.
Julie & Hannah

Hi Julie,

I haven't written to you before but someone asked me to take a look at your thread because we have a larger dog who has back problems and have been down a pretty thorough diagnostic road with him over the past year and a half with the last step being that we did the MRI.

Took me a while to read it all that! :)

My immediate thought looking at your last couple of posts was the same as my overall thought after reading the whole thing:

I would have x-rays done - a good comprehensive set by someone who really knows what they're doing.

And then I would have the vet send those x-rays to a radiologist for a review.

I'll put my reasoning in a second post cuz I want to explain our dog's history and why I think x-rays would be a worthwhile investment.

Natalie

The main reason I would do a good set of x-rays is that it's noninvasive and relatively inexpensive and you might get good information out of them.

You might not too. But that's the risk you take with any diagnostic test.

What really concerns me is that there is a lot of medication that has a certain amount of risk being suggested for Hannah without anything like a diagnosis to go with it. How can proper medication be suggested when no one really knows what is being treated?

Cosequin, for example, would be good for arthritis in the legs and hips but isn't generally considered all that helpful for degenerative discs. And an NSAID like Metacam, which I've used in two dogs and our dog with the bad discs is taking daily, is a good medication but if inflammation isn't the problem, then you're stressing the liver and perhaps the GI tract for no good reason.

The x-rays have a chance of giving you a diagnosis.

Among the things the x-rays might show are signs of joint degeneration in her spine and/or hips, knee, ankle, inflammation from arthritis in any of those joints, bone spurs, or even that there's some entirely different issue completely unrelated to her hips or back and it only seems like it's her back that hurts.

My experience with x-rays comes from two cats, both of whom have hip dysplasia, and a dog with two degenerated disks at the thoracic/lumbar junction in the mid-back so sounds like about the same place that pain has been localized in Hannah.

In all three cases, there are signs of the problem apparent in their x-rays.

Our kitty Gus (he passed away this spring from cancer), for example, had obviously badly degenerated hip joints in his x-rays. As the last vet who saw his x-rays said, it hurt her just to look at how bad his hips were.

His sister Katie is not as badly afflicted but she was diagnosed with hip dysplasia when she was young and I can definitely see that her hips bother her more now that she's 15.

Our dog, Jack, is only four years old but started having apparent back pain in spring of 2010. The first time it happened, he seemed to recover with rest. But a few months later he was having problems again and he has had mild to moderate chronic pain since around September of 2010 and has been on daily Metacam since November of 2010.

His two bad discs - T13-L1 and L1-L2 - are clearly visible on x-ray because he has narrow irregular disc spaces there and bone spurs extending across them.

So I think there's a chance x-rays will tell you more about what - or isn't - going on with Hannah. If nothing else, they should be able to help rule out some things.

The main thing with the x-rays is to have someone really good do them.

To make sure they get all the needed views and take good pictures first. And then to provide an accurate and skilled interpretation of those pictures.

We are fortunate that our general practice vet has a particular interest in radiology and has taught radiology at the vet school. So he's particulary good at taking them and at reading them.

If he hadn't had that skill, then I might have asked to have a veterinary surgeon or radiologist do them. And even with our vet's extra experience, he sends many of the x-rays he takes out to a radiologist for review. We had x-rays done on Katie recently because she was feeling poorly and he asked a radiologist to review them to be sure that his interpretation was confirmed.

So I would also request that the x-rays be reviewed by a radiologist.

And depending what the vet does or doesn't see in them, there might be others who should review them, like a surgeon in the case of signs of soft tissue injuries, dysplasia, etc. or a neurologist if there are issues in the spinal area.

I recognize that lots of consults / reviews might not be possible. And it might not be necessary at all if the standard review shows nothing or screams something obvious.

If you can manage the comprehensive set of x-rays of the spine, hips, and full length of the legs - which in your small dog should cost less than in my 55 pound border collie! ;) - and a radiologist review, that would, to me, be the best investment of your money at this point. And hold off buying any more medicine until they find out what they are treating!

I would honestly forget about any relationship to Cushing's and leg problem.

First because from all you've said it sounds more like a bone or connective tissue problem - or something entirely different.

And because you can spend a lot of time trying to fit symptoms into the one thing you know she has and that may actually be blinding you or the vets to the actual source of the problem.

So I would let go of all of the assumptions all of the doctors have made and do what you can to do solid diagnostic detective work to find out what the problem actually is.

I know your experience with Bailey has made this terrifying for you but it's at least as likely and probably a lot more likely that she "just" has some chronic pain that will never get any worse. Borrowing pain from the future about an outcome that probably will never happen won't help you or her.

If you can find out more about what's happening with her body, you have a chance to stop worrying about nightmare outcomes from the past. And if there is a nightmare outcome, you won't be any worse off than you are now and you will know what you are dealing with.

Sending you a big hug - I know how frustrating this can be.

Natalie