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:

---

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

---

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