Diesel

[labblab]

Welcome back to you and Diesel! I’m sorry, though, that he doesn’t seem to be feeling his best. One quick question for you — in looking back through your original posting, I’m not seeing how old he is. Just out of curiosity, can you tell us his age? That may have some bearing on the treatment decisions going forward.

In terms of these recent monitoring ACTH results, the interpretation notes are pretty consistent with what we’ve seen to be generally recommended. For Cushpups who are still experiencing unwanted symptoms of the disease, you’d probably want to see the cortisol dropped somewhat lower. However, for dogs who are doing well, Diesel’s level of cortisol is probably just fine. One thing we can be reassured about is that it’s not too low.

So the question here is, Diesel seems to be having some problems but are they due to a higher level of cortisol or are they due to something else, even perhaps aging? The fur loss and pus sound like a skin infection to me. I’ve had similar problems with my nonCushpup that we ended up treating successfully with medicated shampoo. But Cushing’s itself can leave dogs more vulnerable to skin infections.

What’s the status of Diesel’s thirst and urination? Are they normal at this point? How about other common Cushing’s symptoms such as panting, seeking out cool places, muscle loss in his hind end?

Diesel’s pickiness about eating is a big question mark. Excessive hunger is more commonly associated with Cushing’s, and when we hear about lack of appetite, our first worry is that cortisol may have been driven too low by the medication. However, that isn’t the case here. Combined with his shivering, grogginess, and his new reflex to be startled, I’m afraid I do have one worrisome thought. As a Boston terrier, he’s a breed that can be more vulnerable to brain inflammation caused by enlargement of the pituitary tumor that causes Cushing’s. Because of the flat face and skull, there’s greater risk that a pituitary tumor may end up placing pressure on the areas of the brain that control hunger, vision, etc.

I don’t wish to worry you unduly by telling you this, but I think it’s important for you to know that it’s a possibility. The only way to know for certain is to pursue imaging of the head — either CT or MRI — and this can be quite expensive. If this is indeed the problem, then surgery or radiation may be an option. But again, the treatment is quite expensive and may or may not be a good option depending upon the dog’s age and overall health. If this is the problem, you can likely expect to see a worsening of neurological problems such as increasing loss of coordination and aimless circling around, even pressing the head against hard objects like a wall.

But this may not be the problem at all. Hopefully, it’s not. However, given Diesel’s poor appetite, regardless of cause, I’d probably be hesitant to lower his cortisol any further. Anyway, these are my initial thoughts. Thanks in advance for any additional info. And again, welcome back!

Marianne

[DieselsMom]

Thanks for the reply Marianne.

Diesel is 9, will be 10 in August. He still drinks and pees a lot; has hind end weakness.

He's always had trouble sleeping. He has difficulty breathing when he's laying down because of his brachycephalic problems. He's had two palate resections with little success. The surgeon says Diesel has too much excess tissue and during his second surgery the surgeon found a lot of scar tissue that was making things worse.

His vet and I have discussed a CT but because Diesel hasn't done well with anesthesia in the past, the vet is hesitant to do it.

Do you know of dogs that have had trouble with the compounded Trilostane? I'm not sure if it was the increased dose or the ingredients that caused Diesel to stop eating when we tried the compounded meds before.

I ordered a thermometer from Amazon, but it's not accurate, so I need to get something different.

I weighed Diesel yesterday and he's lost another pound.

Cindi