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

Starting to FINALLY get a tiny bit of a chill in the air here in Texas.
After this food talk now I am hungry. I think I need to make s'mores here in Texas. yum!

and now smores! You guys are really killing me. I can't have anything until after some medical tests in the morning. :( Well, except for like 6 glasses of water an hour before the test. It just doesn't compare!

Sharlene

Hi Julie
Hope Hannah is having some relief from her skin problems, hope all good with you
Trish xx

Hi Guys-

We had the derm appointment today. The vet was definitely impressed by the amount of paper work that was faxed over for Hannah (and I think it was only the past two years!), and told me that she could tell "this dog gets some excellent care" right when we met. She looked her over (although not quite as carefully as I anticipated, although I held her for most of the visit) but seemed to suspect Sarcoptic Mange from the get-go. She did something where she scratched her ear to see if she moved her back leg. She didn't do much there, but I told her that last night when I was wiping the inside of her ear she was moving her back leg like crazy. I'm not sure if that is a definitive sign or what. She said she has seen like 8 cases in the past week and that it is endemic here. She said a couple of the dogs didn't have classic signs at all. So, they applied Revolution before we left and we came home with two more doses for Hannah and three doses for Izzy.

She also tested her skin for yeast. She used tape (no slide scraping) and did one area of her neck and two of her feet. She also swabbed her ears, which were clean, but VERY itchy. It came back that there was not yeast on her neck, which if it's true, I am thrilled about because it means the ketoconazole wipes worked. Her ears were also clean. However, her feet were "loaded" with yeast.

This is where things got a little concerning for me because her recommendation was to treat orally with ketoconazole so we can take care of any yeast on her body. I told her I was very concerned about that since my two other vets (at two different clinics) have concerns about giving her that with elevated ALKP, ALT, and GGT. She didn't seem to have those concerns at all. She said she thought it would be safe and mentioned that it is actually a treatment for Cushing's. Of course I have seen this, and told her that I really didn't think it was used much, and that no vet that I talked to mentioned it as an option if they were ever to treat her. (My dad was with me on this visit-to drive so I could hold Hannah on the trip-and seemed to think it was funny that I was challenging her. I told him I have read a TON and talked to my vets extensively so I had no problem questioning this).

She again told me that she thought it would be totally fine, but that she didn't want to force me to do something I was uncomfortable with. She said that I could continue using the wipes all over her feet and legs and wherever she is itchy. She then recommended floconazole as an alternative and said it is safer. She said it isn't supposed to be metabolized by the liver, but that she felt it still probably was somewhat. She also said it would be really cheap.

She summed it up by saying the Revolution was worth trying because of her intense itching, but that we have to take care of the yeast too, in order to stop the itching. I get that, and realize that we many not know if she does have mange because of the yeast causing itching as well. I mentioned that Izzy really is not itching and she said Hannah could just be more sensitive to it because of possible Cushing's or a diminished immune system. She wants to see her again in four weeks to see how she is doing. I can pick up fluconazole whenever I want if I choose to try it.

I remember when Glynda suggested Sarcoptic Mange months ago, and I looked back and saw that it was 12/23/11. I don't think it's possible she had it then because it would've been a year and I didn't do any treatment for it. My regular vet questioned demodectic mange last spring, but didn't think she showed typical signs.

The derm vet asked about wildlife in our area and how much Hannah is outside. I said we have seen foxes, raccoons, and coyotes in the past, but not lately, and that Hannah is outside for about 2 min. only to go to the bathroom, but she seemed to think it was still possible.

I'm sort of confused about the whole thing. I guess we'll see what happens. I read I should wash their beds/blankets etc. for mange, but she didn't tell me that. Does anyone know if that is true? And Izzy is getting groomed tomorrow so I am going to "Revolutionize" her tomorrow night.
I'd also appreciate any thoughts on the ketoconazole or fluconazole. My regular vet did think I could try the keto if we checked her liver values after a week. The more holistic vet, however, seemed pretty against it. I hate that it's such a difficult decision to make her feel better. Ugh. I'd love some advice!

Julie & Hannah

Hi Julie,

It sounds like the vet is guessing at sarcoptic mange and that's what they do most of the time as it is very difficult to get a mite on a skin scraping. The female mite burrows deep under the skin and lays eggs as she goes. This causes an inflammatory response and makes the dog itch like crazy. It is very contagious and you can get it too but it's much milder for us and usually goes away without intervention. I've had it on my stomach and it does itch.

If Hannah had scabies for a year she would probably have no hair left and would have had serious fungal infections long before now. I can tell you, however, that the ear crusties don't show up until later in the infestation. Revolution works well and I've used a ton of it. Whenever there is an infected dog who has exposed other dogs, everybody gets Revolution. The last rescue we had exposed two households, including mine. We had to treat 15 dogs and none of those we treated ever developed a problem. Early prevention is a good thing. Our vet contacted a derm vet who said to apply Revolution every two weeks for severe infestations so check with your vet about this.

Once you treat, you should launder the dogs' bedding in hot water and dry them in the dryer on hottest heat. Use a disinfecting spray in areas frequented by the dogs. I found that it's impossible to disinfect everything but I focused on certain areas where the dogs live like their sleeping area, the sofa and surrounding areas. A good commercial disinfectant spray is best.

It's completely possible that Hannah doesn't have sarcoptic mange but if she does, Revolution will will the mites and the fluconazole should clear up any fungal infection. I would prefer fluconazole over ketoconazole so I'm not sure why your vet didn't prescribe that to begin with. :confused:

Glynda

Hi Glynda,

Thanks for your thoughts! Can you give me an idea of a disinfectant you might use? Like Lysol? I am starting on the beds/blankets tonight and will finish tomorrow after Izzy is groomed and I get the Revolution on her. I talked to a vet tech tonight who also told me to vacuum everything really well.

Hannah was at my parents' house today before the visit, and spent the night there a couple of weeks ago. They have four dogs. Do you think they need to be treated (if Izzy really isn't itching)? Can they watch and wait? Hannah and Izzy have to stay there next weekend when we go see my in-laws too.

So you think the floconazole would be safe with her unknown liver issues? The ALT did drop but is still 186 so they are still concerned. I wonder why the other vets never thought of it???

Julie & Hannah

Hi Julie,

I can't remember the name of the disinfectant I used. I got it at a janitorial supply. Lysol is certainly better than nothing but I wanted to make sure I had hospital quality disinfectant. I did forget to mention to vacuum everything as any crusty flakes that fall off the dog can be full of mites waiting for the perfect host.

It's always better to treat any dog that has been exposed as soon as you have a diagnosis. If you treat right away, you can avoid a full blown infestation and making the dog suffer. Scabies is so incredibly itchy and my heart broke for the last little guy we had that was infested. That poor guy got no sleep and neither did his foster mom.

Both Ketoconazole and Fluconazole effect the liver but Ketoconazole is more likely to cause liver toxicity. I think you will be okay giving the Fluconazole to Hannah. I had a darling little foster Shih Tzu, Mabel, who had demodex with resultant yeast infection. She also had uncontrolled cushing's and was given Fluconazole. It cleared up the yeast infection with no problems.

Thanks, Glynda. Did Mabel have multiple elevated liver enzymes? Did you adopt her out within the last year? I feel like I remember you telling about her.

I'll vacuum tomorrow (I always do on Sun. anyway) and again on Mon. or Tues. The vet tech said to do it again a couple of days after treating. We'll wash the beds again too. That's a big job since there are 5 beds and three blankets! I will have to wash Hannah's t-shirt and sweater too. She needs them to keep her protected from her own scratching, but I'm guessing we want to get the mites off of those too (assuming there are any).

Thanks!

Julie & Hannah

Yes, Mabel had elevated liver enzymes as she was not yet diagnosed so her cortisol was out of control. Mabel was adopted in early 2008 by a wonderful couple who adored her. She was tragically killed December 21, 2008. She had gone out the back door with her dad and neither mom or dad knew it. When dad backed out of the garage, he ran over her. It was awful. We were all devastated but her dad was beyond devastated and ended up in counseling to help deal with his guilt and grief. Mabel had been through so much pain and suffering and I am so grateful that she spent the last year of her life being loved and adored by me, Gil, her new mom, dad and brother, also with cushing's. The anniversary of her passing is fast approaching and I can't believe it's been four years. She is forever in my heart.

http://www.k9cushings.com/forum/albu...&pictureid=234

Hi Julie, hope this helps to get things cleared up on little Hannah's skin. Poor thing. It sure would be awesome for her to have some relief.

Oh gosh, that is so sad about Mabel's tragic outcome. I'm sure her new family was just devastated. :(

Good luck with Hannah,
Hugs,
Sharlene and Molly muffin