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

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