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

[jmac]

Thanks, Ladies. I'll follow Hannah's lead and prevent her from jumping until she wants to do it on her own.

Addy, her back legs are not shaky, and she moves around at a normal pace with her tail up. She does seem a little awkward to me when she jumps off the one step on our deck (she chooses that path and jumps into the rocks by the fire pit before going to the grass to potty) that she looks a little awkward, but sometimes she is like that after having her toenails trimmed-slips around on the deck, tile floors, etc.

Do you agree that it is okay to just watch her at this point? She seems happy otherwise, still wagging her tail and moving around like normal. We were just at the vet on Wed. for the chin issue and we have an appt.8/1 for a blood check, so I'm hoping that if it doesn't get worse I can just watch her and keep track of her issues.

Also, I'm thinking ahead here, but assuming this problem persists or worsens, what do you guys think about changing treatment? I know my vet mentioned Trilostane as the other treatment he would try if things were worse. (And I also know I could go to a specialist for treatment or a second opinion). I don't want to not help her, but she also doesn't have really severe symptoms so I don't want to jump into anything too soon either.

Thanks again for your support! I really don't know what I would do without this forum!

Julie & Hannah

[jmac]

Hello Everyone-

I took both of my dogs to the vet today to get their anal glands expressed. I could smell Izzy's, and figured I would just get Hannah's done as well. We also made an appointment to see the vet since Hannah abruptly stopped being able to jump up onto the bed, furniture, etc. on Saturday. I talked to one vet Mon. and he told me to let her rest and prevent her from doing any jumping for 5-7 days and then to let him know. They decided to see her today.

First, both dogs had anal sacs that were completely full, but not infected or abnormal. I saw the vet I really like today and she manipulated Hannah's back, legs, etc. and said everything felt normal and she showed no pain or tension when the vet felt her back, and her legs had good movement, etc. She said they can usually tell when the dogs are in pain and Hannah didn't act like she was. She is otherwise normal at home too.

The only explanation the vet had was that it could simply be that her anal glands were so full that she was really uncomfortable. She told me to give it another 24 hours to see if anything changed. If not, they are going to have me go back Sat. and do an x-ray and some further checking. She said we could potentially try some NSAIDs, but she is always a bit hesitant with Cushing's dogs, and also mentioned something about a glucosamine supplement (I think???) but wanted to look over her blood work again.

I asked if she thought it could be anything that has to do with Cushing's, and she said that although the back end weakness is common, that Hannah doesn't have any signs of muscle wasting, (or have any other physical signs of Cushing's) and that usually it wouldn't be so sudden and abrupt. I just wanted to check in with all of you to see if you have any other thoughts.

She also took a look at the spot on Hannah's chin that we were in for last week and said it looks much better and thinks it is a combination of an irritation with the skin fold by her lip (so I should continue the medicated wipes once a day) with possibly a little lump or wart in it. She said it is mobile so she is not concerned and that I should just watch it to be sure it doesn't get irritated. I am relieved that is looking better, but I am always so unsettled when something else is wrong, that I can't quite shake my nerves/the bothersome feeling about this inability to jump. She seems fine on the stairs, and even going off and on the deck to go potty (which I had been limiting since Sun.). She is otherwise normal. I swear, it's always something. I always have this bad feeling that it is something terrible.

Anyway, thanks for listening, and let me know if you have any thoughts.

Julie & Hannah

[jmac]

Hannah still doesn't seem to be over the issue with jumping. Today she jumped up on the bed twice (using her stool) and then on the ottoman once, and then we were back to the point where she acts like she can't do it. She puts her front feet up and can't seem to jump. My vet and I discussed options of what to do. They think something is hurting and said we could try an NSAID-Metacam (he said it is more the kidneys than the liver that the drug impacts) or Tramadol. He feels that she might have some inflammation and recommended the Metacam-giving her a 12 lb. dosage (can't remember if that is ounces or what). He said they usually do the first dose at double, but thought for her we should not. He said the biggest issue would be GI upset with the natural steroids she produces mixing with the non-steroidal med. I just wanted to check in with all of you for any major issues/warning signs. I hate starting these things on weekends too!
Thanks!
Hannah & Julie

[lulusmom]

Hi Julie,

If Hannah were on Lysodren and Trilostane and you knew for a fact that her cortisol was within the recommended therapeutic range, I'd say try the Metacam. I used to give my Jojo Metacam once his cushing's was controlled but I doled it out sparingly. I put him on cosequin and he gets his fish oil and he has done well without an other meds.

Honestly, I don't trust Anipryl to effectively reduce cortisol so until you know for sure, I believe giving Hannah Metacam is too risky. If Hannah has arthritis, ask your vet about cosequin. Actually you can purchase it online without a prescription. If Hannah doesn't have arthritis and you think she may have strained a muscle, you need to keep her from jumping up on or down from everything and give her Tramadol if she appears to be in pain. That's my two cents.

Glynda

[jmac]

Thanks,Glynda.

She doesn't have arthritis, that we know of. Like I said, she was examined yesterday by the vet I really like. She said Hannah showed no signs of tensing or being in pain and that usually Shih Tzus will. I told her Hannah may be an exception because she is truly the sweetest, most kind dog ever. I said I could probably cut her foot off and she would give me kisses while I did it. This started last Sat. and I rested her the whole time.

The other option he gave me was Tramadol, but then said she may need to reduce inflammation.

I don't know what to do. Should I call tomorrow and say I don't want to risk this? What is the greatest risk? I know it can cause death and kidney failure, etc., and a million other bad things that are always on medication, and obviously they have to tell you every possibility. I am most worried about her liver. Is that your concern too? He said I could also try a lower dosage than she needs. (She is 12 lbs. and they have me giving the 12 lb. dose). It just says in all caps to STOP IF SHE IS NOT EATING OR DRINKING.

How soon would I see a problem? UGH. I hate this. I don't want them to think I am crazy, and I want them to know I value their professional opinion, and he did give me options, but how am I to know what is best?!?!?!

Any other input you have I greatly appreciate. I can't seem to enjoy myself when things are not right with my girls.

Julie & Hannah

[lulusmom]

Julie,

Jojo's internal medicine specialist, under no circumstances, would prescribe Metacam until an acth stimulation tests showed that his cortisol was where it needed to be. It is not only the adverse impact on the liver and kidneys that are concerning, the stomach ulcerations/perforations resulting in internal bleeding scares the stuffing out of me. Warnings on the label are very clear that NSAID should not be used in conjunction with corticosteroid hormones because the potential risk for side effects is increased. Cortisol is the same thing as corticosteroid hormones so the question is can your vet assure you that Anipryl has effectively reduced Hannah's cortisol levels?

[jmac]

Julie,
Cortisol is the same thing as corticosteroid hormones so the question is can your vet assure you that Anipryl has effectively reduced Hannah's cortisol levels?

I don't think he would say he is confident about that, no. He said Anipryl was a place to start, due to the fact that she did not have significant symptoms (as in I wouldn't have called the vet yet to say something was wrong) but that it was a place to start. She does seem slightly better--not begging for food. Water intake is the same, but it was only slightly higher, and she can hold her urine over night and during the day while gated in my kitchen, so we didn't want to move to anything stronger yet.

So, your suggestion would be to get the Tramadol? He did say that would eliminate my concerns about Cushing's.

Thank you so much again. I don't know where I would be without this forum. I call it my support group.

Julie & Hannah

[jmac]

Well, I'm on my way to pick up Tramadol for Hannah. The regular vets aren't there today, so there is a "sub." I told the person who answered my concerns, and she called back and said the Tramadol is ready. Anything I need to know about Tramadol or the dosage before we start? They said it is twice a day. Hannah weighs about 12 lbs.

Thanks!
Julie & Hannah

[Squirt's Mom]

Hi Julie,

If it were me, I would start with 1/2 the recommended dose. It has been our experience that Tramadol can cause some pretty harsh side effects unless the dose is cut. For some reason, the recommended doses usually turn out to be too much and the pups are nauseous, dizzy, and lethargic. So folks who use it here, usually start with a much smaller dose.

Hugs,
Leslie and the gang

[jmac]

They gave me four 50 mg pills, quartered, and I am to give it to her two times per day. She is 12 lbs. so this would be 12.5 mg per dose. I'm not sure that I can cut the quartered pills, as they are already pretty small. My parents have two dogs that have been on it with no issue, but I don't know how their vet determined dosage. From your experiences, is this still potentially too high? Or is this about right? Again, not sure I can cut them anyway...

And maybe more concerning, what do you make of this?
[I]Contraindications include dogs who are being treated with L-Deprenyl for Cushings or cognitive disorders, or dogs taking serotonin reuptake inhibitors, monoamine oxidase inhibitors, or certain antidepressant medications.
I found it on this website when looking for dosage info. [I]http://vettechs.blogspot.com/2005/04/tramadol.html

And yet another one:

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 neutraceuticals such as glucosamine, MSM, chondroitin sulfate etc.

Tramadol is NOT compatible with L-Deprenyl. Animals taking L-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.
This time from this website: http://www.veterinarypartner.com/Con...5&S=0&EVetID=0

What in the heck?!?! HANNAH TAKES ANIPRYL! I am starting to wonder about my vet (although the woman today was a sub since the regular ones were both out, but my regular vet suggested this too). Does anyone know about this? Is this information old or inaccurate? I called and left a message for the regular vet to call me on Monday and have decided not to do anything before then, except to continue to prevent Hannah from jumping on or off anything (she has no problem jumping down and does if I don't catch her).

Again, I have been very happy with my vet for the past 5 years (and they are definitely really current with their care, procedures, technology, etc.), but he did ask me on the phone yesterday, "Is Hannah the one with Cushing's?" Granted Hannah and Izzy look very much alike, and he has many clients, and we talk enough that he probably can call me without needing to review records, but I found that to be a bit concerning.

I am starting to feel like a crazy person. I don't want to second-guess everything that comes at me, but I feel like if I don't thoroughly check things out and be an advocate for her care, then something could go wrong. (I have picked that up from reading so many stories on this site). I don't feel like I should be the one who finds these things!!! (Unless somehow this is incorrect). I am so frustrated right now, I can't even stand it!


Thanks again for the advice (and for listening to me rant)!
Julie & Hannah