Shih Tzu 15 yo, Cushings, Hypothyroid, not eating, indigestion,Gallbladder/Liver Canc

[Cushpup]

Please read my later post dated March 2, 2011 to understand the misdiagnosis and the frustrating rollercoaster ride until the Exploratory Surgery on Feb 28, 2011.

Thank you MODS- great job!




I just found this thread and am so glad I did.

I'm stumped. I have a 15 yo Shih Tzu mix. She has Cushings and Hypothyroid. She is on Soloxine and Trilostane since June 2009 ....and had been doing great until now. She always had a good appetite.

While she has been sick in the last few weeks, I have tried Pepsid, Carafate just in case her stomach was off. Those did not help, she didn't like those meds, so I stopped them.

My dog has a poor appetite for way over a month. She had a mild form of this lasting 3 weeks, 5 months ago and the she was fine until Jan 1.
I have been trying everything- cooking, chasing, cajoling, to get her to eat. She'll pick here and there for a couple of days with a lot of coaxing and then nothing, turns her nose away.

It seems that she had Pancreatitis at first. After the first week she started eating, then vomitted and stopped eating, some mucus in 1 poop, then the rest of poops normal. This cycle had repeated itself for 5 weeks, even though her bloodwork has improved. Her abdomen pain has gotten worse...

She's been examined. Had A LOT of abdomen pain upon palpation. She had 2 bloodworks, Urinalysis, ACTH, and an Ultrasound.
US-showed nodules on both adrenal glands....and other insig findings. Her Liver is just OK, consitent with hyperadrenocortisone.
The first bloodwork was consisitent with Pancreatitis(Amylase elevated, Monocytes, and Liver enzymes elevated). She was treated with Amox and Flagyl.
Second bloodwork was better other than still showing the liver enzymes elevated some. Nothing significant is showing on the bloodwork.

I'm concerned that it has been too long. She's lost weight. I've decreased the dose of Trilo and Soloxine a bit because of the weight loss. My Vet thinks I should take her off Trilostane at this age and let the cortisone make her feel better.

Here's what I'm concerned about:
-When she had her ACTH done 2 weeks ago, she was off Trilostane for 30 hours and her test came back "normal". If Trilo has a quick halflife, shouldn't her ACTH have come out in the higher range if she didn't get her regular dose of the meds on the day of the ACTH test? My Vet thought that Trilo may have a residual effect for a while and hence the normal ACTH. He's not sure. I hope she's not Addisonian because of the poor appetite...?
-Should I take her off the Trilostane? Won't her Liver go quickly?
-I hear gurggling in her stomach and she burps when she eats. That tells me that she is having digestive problems....is it too much cortisone, or too little?...or neither? Why didn't the US or the bloodwork show anything to work with, yet her abdomen is tender and she doesn't want to eat?
-I'm reading that Cushings dogs can have digestive problems because of too much Cortisone if not treated for Cushings, so why would I take her off Trilo?
-Does anyone have experience with such horrible loooong Pancreatitis/digestive problems? I'm reading that Cushings complicates Pancreatitis, but this is ridiculous.

I would appreciate any input. Ultimately, I need to decide to keep her on Trilostane or take her off as my Vet suggests. I'm just worried that Trilostane/Cushings is NOT causing this inappetance, but something was missed on the Ultrasound... or am I being impatient?

[Bichonluver3]

Hello and welcome. You have come to the right place. The experts will be along shortly. They will ask a LOT of questions but that is so they can give the best answers. They will also want you to post the results from all tests done.
The folks here are awesome and we all will support you during this journey.
Hugs,
Carrol & Chloe

[Cushpup]

I don't have the ACTH results on me other than they were normal.
They looked like results of a non-Cushinoid dog. The before and after were like in a normal dog. This was without giving her any Trilostane in the AM.

I'll post what was out of line going back to her bloodwork when she "was acting normal" (June 2010) to now:

Jun 2010. Here she was on Trilostane and Soloxine and Previcox but doing fine.
ALT 122 (normal=12-118)
ALKPhos 1122(normal 5-131)
Urea Nitrogen 56 (normal 6-31)
BUN/Creat 43 (normal=4-27)
Calcium 12.8(normal= 8.9-11.4)
Potassium 5.6 (normal =3.6-5.5)
Triglycerides 408 (normal =29-291)
T4, and CBC were fine.


Sept 2010, on Trilostane, Soloxine and Previcox. Appetite decreasing, a couple of softer stools. 3-4 weeks of lesser appetite, off & on. I made her eat. No weight loss. She began eating on her own.
ALT 147
ALKPhos 1136
Urea Nitrogen 38
BUN/Creat 38
Calcium 13.6
Cholesterol 360
Triglycerides 575
Lipase 833
CBC=normal, platelet count elevated.

Problem started Jan 2 2011
Took her off Previcox (This brought her her BUN and Creat to normal levels!) . Left on Trilostane and Soloxine. Tried some Pepsid and Carafate, Fentynal Patch... but discontinued.
Mid Jan blood (CBC/SC, T4,UA, ACTH)...and Ultrasound
ALT 235
ALKPhos 840
Calcium 13.2
Lipase 763

CBC =Monocytes 940 Normal(0-840)
All other tests within normal limits.

Feb 2 bloodwork:
ALT 254
ALKPhos 864
GGTP 15 (normal 1-12)
Calcuim 13.1
Potassium 5.6 (normal 3.6-5.5)

CBC= normal.

[Bichonluver3]

Great job! Hang in there. The experts will be by soon.
Hugs, Carrol

[mytil]

Hi and welcome to our site.

I am wondering if your dog is experiencing chronic pancreatitis - on-going. Have the electrolytes been tested again? An imbalance can cause some problems. IMO, any excess cortisol is not causing the digestive problems, and with the normal ACTH results normal, it is something else. Post those numbers when you get them.

Cushpups seem to be predisposed to pancreatitis.

Others with more experience with Trilostane will be chiming in shortly.

Terry

[littleone1]

Corky and I also want to welcome you.

Corky has been taking Trilo for 16 months, and didn't experience any of these issues. I do give him Pepcid AC in the morning with his food. I don't give it to him everyday anymore. I usually give it to him in 4 day cycles.

As has been mentioned, it would really help us if you can post the stim test results. Even though there was a 30 hour time period when the Trilo wasn't given, there are times when some furbabies have been off the Trilo for several months, and their cortisol levels stayed in the normal range.

I hope you will be able to get the stomach issues resolved.

Terri

[Cushpup]

Thank you all for responding.

Well....I've decided to take her off the Trilostane just for a little while to see if her appetite improves. I'm out of ideas and will listen to my Vet (he IS very good).

NO more testing. I draw the line and it's not for monetary reasons, but I've tried EVERYTHING and for a long time. I'm out of energy and patience. I have watched this dog like a hawk, cooked, begged, bribed her to eat. My nursing couldn't have been better...this is why I'm so upset. I am feeding her low fat things like rice, noodles, boiled chicken, turkey...Thee only thing left would be to open her up and do an exploratory surgery, but my Vet thinks that the radiologist is very thorough, so what would we be looking for? Arggggh!

I've tried Pepsid. She vomitted a few hours after taking it so I stopped. I've tried the pain patch thinking that maybe the pain is causing the low appetite, but she had a reaction to it in the form of sleeplessness, so I took it off....

Today, I gave her fluids 'just in case', or for whatever ails her... She's drinking fine and her poops are normal. She vomitted only 3 times in the 5 week period, and it was after she ate a bit more than a tablespoon at a time. The vomitting was a week apart. Just as she would be picking up on her appetite and eat a little, she would vomit. She has not vomitted since Jan 22nd.

The radiologist said that her pancreas didn't look bad. His words were: that doesn't mean she didn't have pancreatitis earlier, but now it looks ok (on Jan 20th).

I was hoping that someone who had a freeky experience like this could shed some light. Thanks, again ;)

[Squirt's Mom]

Some dogs can't handle Trilo. Have you thought of switching treatments?

[frijole]

I'm bumping this up hoping that Deb sees this to look at your bloodwork info - she's a med tech.

First off - it is my understanding that not all pepcid products are recommended for dogs. The one most of us use is Pepcid AC. Please let us know if that is what you gave as well as how much.

Pancreatitus is common in our dogs. I'm sure others with lots of experience will chime in on how they have dealt with it.

Regarding the trilostane - please do get us the reading that your vet called "normal". (the recent test) What is normal for a cush dog is not normal for other dogs so I just want to check to make sure.

We have seen dogs on trilostane that have all of a sudden "gone low" and the owner took them off of it and they stayed low/under control so I will be interested in seeing if any of the cushing's symptoms come back or not.

Trilo doesn't stay in the system very long so I agree that if you quit giving it the acth test should be higher. That is why it is important to get those results - all of them and have them on hand. Vets, their helpers, and the labs all make mistakes... better safe than sorry.

I'm glad you found us. Kim

[makita1996]

I will start by saying I am not an expert but I will say that the symptoms you described are exactly what I went through with Makita (prior to Vestibular disease)... I was told she had pancreatitis....did the pepcid and the flagyl (Makita never vomitted). Did some more test's..... had an ultra sound done and it turns out she had a benign liver tumor that had been growing at a slow rate. She never had pancreatitis it was the tumor that was causing the test results to be abnormal and the Vet said that is why she had good days and bad days....She was 15 and I made the choice to remove the tumor... Her appetite did come back...... she was picky about some foods..... The only suggestion I have (and please discuss this with your Vet first) was to give Makita a product called Pedialytes for infants that would help with her electrolytes.... it did help her get her appetite back....

[makita1996]

Is there a chance it could be an ulcer?

[Harley PoMMom]

Right now the only way to confirm pancreatitis is with a spec cPL test. The spec cPL test has more than 95% specificity and sensitivity at diagnosing pancreatitis.

Here is a link with info about the spec cPL test: http://www.idexx.com/view/xhtml/en_us/smallanimal/reference-laboratories/testmenu/innovative-tests/spec-cpl.jsf

Usually not but some dogs may get upset tummies on pepcid AC so there is another herb called slippery elm that you might want to try, but get approval from your vet first.

My boy, Harley, has pancreatitis so I do have some knowledge about this illness, if you want to know more, please do not hesitate to ask questions, ok?

Love and hugs,
Lori

[Cushpup]

Hi and thank you all for welcoming me. The peeps on this forum are awesome!

Makita's mom- I read your thread about Makita...and I'm so sorry for your loss. You were/are a great mom!

The ACTH test on Jan 21, 2011
Cortisol Pre 7.4
Cortisol post 11.0

Normal= 5.5-20.0

I stopped the Trilostane yesterday. I'll see how she does for a few days.

She had been on Trilo since June 2009 and seemed fine....except for that 3-4 week low appetite episode in Aug/Sept 2010.

Re: the US
-I believe an ulcer would show up on the US. The Radiologist said no abnormalities were seen in the GI Tract.
- Liver does have a small nodule, as many of her other organs do, but the Radiologist didn't see anything ominous to biopsy.

I think the Vet wants to see if taking her off Trilo will bring her appetite back, because the extra cortisone should make her hungry....if that's not it then I'm not sure what we'll do. Oh, giving her fluids yesterday didn't make any difference.

The irony is that she doesn't look bad. Other than turning her nose at food, most days she's playful. She drinks, pees normally. Lately (for at least 3 weeks) her poops are normal (when there is a poop from not eating much). Yesterday she didn't want to eat throughout the day, but at night she ate some plain spaghetti out of my hand. Then at the end she kind of turned her nose away and spit out the last one. Today back to not wanting to eat. She had a teaspoon of this and that. I do know that if people have liver problems their appetite can come and go...

[Cushpup]

Another thing:

I have Cyproheptadine compounded for her. It's an antihistamine used for stimulating the appetite. It's pretty harmless. They give it to old people.

I'm not sure if it interacts with Trilo, though. I know that it does with Seligiline, so you shouldn't give it to dogs if they are on Seligiline. It's something about one elevates, the other supresses the Serotonin level...

I don't want to mask anything so that's why I'm holding out with the Cyproheptadine.

[lulusmom]

Here's what I'm concerned about:
-When she had her ACTH done 2 weeks ago, she was off Trilostane for 30 hours and her test came back "normal". If Trilo has a quick halflife, shouldn't her ACTH have come out in the higher range if she didn't get her regular dose of the meds on the day of the ACTH test?


According the stim test results you just posted, your dog's post stim number is too high for a dog on Trilostane. For purposes of monitoring treatment, the normal ranges are irrelevant. The therapeutic range for a cushinoid dog on Trilostane is 1 - 5 ug/dl; however, if symptoms have resolved, the manufacturer, Dechra, says that a post stim of up to 9 ug/dl is acceptable. Your girl's post stim is 11. Did your vet tell you that the acth stim test looked good and that her numbers were normal? If so, then it is highly possible that your dog's cushing's has never been under control, which very well could have triggered pancreatitis. Believe me, this happens all the time. One of my dogs had a perfect post stim of 2.5 ug/dl and my old gp vet told me we needed to cut back on the meds because her cortisol was too low. I had to educate him on how to interpret an acth stim test for purposes of monitoring treatment. He was red faced and I decided to continue to let the internal medicine specialist treat my dogs. Do you have copies of the prior acth stim tests that were done? If so, can you post them for us?

Glynda

[Cushpup]

Lulusmom-

So as you know the results were:
Cortisol pre 7.4
Cortisol post 11.0

Then under the results it says the following:

Interpretation of ACTH Stimulation test:
Normal response to ACTH test:
CANINE: 5.5-20. ug/dl
FELINE: 4.5-15.0 ug/dl

Then it says a bunch irrelavant things.
Then it says:

*POST-LYSODREN:
Pre and post cortisol levels after Lysodren loading or while on maintainence Lysodren should be betwen 1-5 ud/dl.

Are you saying that the results being on Lysodren and/or Trilo should be the same???...so the results for pre and post are too high?

Maybe that would explain things...The radiologist said that she has nodules on BOTH adrenals. One nodule is really large....and they're both shooting out all this cortisone...difficult to control. That's where he thought the inappetance was possibly coming from. Hmmm....
Gawh, I hope I'm not doing more damage with taking her off Trilo.......

Thank you all for your help. I feel so badly for her. Keep those suggestions coming.

[lulusmom]

Yes, I am saying that the therapeutic range when assessing the acth stim test for dog on Trilotane is much the same as a dog on Lysodren except the numbers can be a bit higher with Trilostane, if all symptoms have resolved. Your dogs results are too high. Do you have copies of your dogs prior acth stimulations tests? I would be very interested to see the results. If your vet is like my gp vet and is limited in cushing's experience, I would suggest you get your dog in to an internal medicine specialist. If you let us know what area you are near, we may have a member or two who can provide you with a name. Otherwise, you can use the link below to search for one in your area:

http://www.k9cushings.com/forum/showthread.php?t=182

You did the right thing by discontinuing the Trilostane so don't beat yourself up for doing the right thing. You never give Trilostane to a dog that is sick and a cushdog who is not eating should be considered sick. Please let us know about the prior acth stim tests.

Glynda

[Cushpup]

Lulusmom-

As to you ans on the other thread-
You're the best. You were right about the ACTH results. Thank you.


My question to all the Trilostane users whose dogs experienced pancreatitis, did you leave your dogs on Trilo while treating the pancreatitis? My dog seems to be over the acute stage but still has the residual pancreatitis/digestive/inappetance complications for a long time.

I made an appt with an internist for next week, but in the meantime my vet(gp) suggests that I increase her Trilo because the ACTH results were too high. I took her off Trilo for a couple of days and she seems worse. No vomitting, no diarrhea, but no appetite (we thought the appetite would pick up being off Trilo). I know the Trilo can cause the appetite to get worse while its working, but my dilemna is which is better:
-More Trilo to correct the Cushings and the pancreatitis/ digestive problems will reslove.
-stay off Trilo and give it more days for cortisone to make he hungry.

I'm afraid she'll lose too much weight by next week....

Moderator's Note: I've have merged your new thread concerning trilo & pancreatitis with your little one's existing thread. We normally like to keep all updates/posts on a pup in a single thread as it makes it easier for other members to refer back to the pup's history, when needed.

[lulusmom]

Both of my dogs treated with Trilostane and if they vomited or lost their appetite, I stopped the Trilostane until they were eating normally again. Perhaps if you contact the specialist and tell them that your dog is not eating, they'll squeeze you in today or tomorrow.

[Cushpup]

Both of my dogs treated with Trilostane and if they vomited or lost their appetite, I stopped the Trilostane until they were eating normally again. Perhaps if you contact the specialist and tell them that your dog is not eating, they'll squeeze you in today or tomorrow.

Unfortunately, the good internist is out of town until next Wednesday.
There aren't that many good vets in my area...


Were you told to stop the Trilo?
I would think that stopping and starting Trilo would be bad in terms of body adjusting to Trilo all over again. Back in June 2009 I recall my dog adjusting to Trilo and Soloxine and she took a month or so to be normal. There was some appetite loss, legs giving out when I walked her, more drinking. It was strange. Then everything normalized and things were fine until once in Aug/Sept and now.

I would have never thought of stopping Trilo because I would have thought that having a constant Trilo in the system would be beneficial while treating other sickness. It is only now with this prolonged inappetance that I agreed to stop it for a couple of days.

Although she seems worse after stopping the Trilo so maybe her pancreatitis is worse...and I should resume the Trilo with a higher dose as my vet suggested.

I gave her pain meds and will give her fluids, and will try to force feed her baby food in the meantime...I guess.

[labblab]

I would have never thought of stopping Trilo because I would have thought that having a constant Trilo in the system would be beneficial while treating other sickness. It is only now with this prolonged inappetance that I agreed to stop it for a couple of days.

Although she seems worse after stopping the Trilo so maybe her pancreatitis is worse...and I should resume the Trilo with a higher dose as my vet suggested.

Hello from me, and I think you've asked a million dollar question here -- as to whether or not trilostane should be stopped when issues other than low cortisol are the likely culprits affecting appetite and digestive issues. It seems much more clear-cut to advise withholding trilostane when a dog is experiencing a transitory "upset." But especially when elevated cortisol itself may be the cause of the underlying issue, what are you to do? I do believe that you best punt to your own dog's veterinary specialist on that one, since your dog's entire medical profile needs to be taken into account. I'm really sorry that you will not be able to get in touch with him until next Wednesday.

I experienced a similar issue with my own Cushpup. He experienced intermittent episodes of diarrhea both before and during trilostane treatment. Prior to treatment, my IMS suspected that his uncontrolled cortisol might have been fueling the intestinal issue, and so we really hoped that the diarrhea would cease once his cortisol level came down. Unfortunately, the trilostane didn't really seem to make a big difference, so the colitis apparently had another source. But because it was a chronic issue, we still made the decision not to suspend his trilostane every time he suffered from a soft stool. We wanted him to continue to consistently benefit from the effect of the medication on his cortisol level.

I'm sorry not to be able to give you more help with your question. And to be honest with you, I'm not certain what I'd do in your situation. It is a tough one! :o

Marianne

[lulusmom]

My vet did not instruct me to discontinue dosing. I never put a pill in my dogs mouth before I learn everything I can about it. I already knew that a cushdog that is not eating is considered a sick dog and you don't dose a sick dog with Trilostane or Lysodren. Not eating is a sign of low cortisol, so if my dogs were showing any signs of tummy upset or no interest in food, I would take them off Trilostane for at least three days. I'd restart them when they were back to normal and watch them closely for signs that their dose may be too strong. That was never the case. Like people, dogs have bad stomach days.

Trilostane's mode of action is not like Lysodren so there is no cumulative effect. It is an enzyme blocker and it is rather short acting. Every dog is different but it's effects can start to wear off any time after 9 hours. We are not vets and we are not here to tell you what to do. We can only share our own experiences and provide you with as much information as possible so that you can be the best advocate you can be for your dog.

If you are torn as to what to do, you can contact Dechra, the manufacturer of Vetoryl (Trilostane) and ask them for their take on your dog's situation. If they think it is safe to start dosing again, they'll tell you. A number of our members have spoken to Dr. Tim Allen, a staff veterinarian for Dechra, and he has been very helpful. Here is a link with the contact information:

http://www.dechra-us.com/Default.aspx?ID=365

I hope this helps.

Glynda

[Cushpup]

Thank you. I will utilize the Dechra doc. Is that doc in the US or in UK?

You know, I'm not even 100% that her issues are from Cushings complications, but I think they are. Thanks to YOU Glynda, we know she was underdosed, so she needs to be adjusted, anyway. Hey, the internist may take me in a different direction. I strongly believe in 2nd opinions. A fresh perspective is always good.

I do know for sure that she started off with pancreatitis after a fatty meal Jan 1. Her initial bloodwork confirms that.

I'll explain why I chose to give her a larger dose of Trilo today.
Here's what I'm thinking:

I understand the concept of Cushings, the cortisone loop, some of the bloodwork. Although an argument can be made for stopping Trilo, whether its because the dog is sick, or to pick up the cortisone level hence the appetite, I am looking at the bloodwork and I see that MY DOG's liver enzymes are elevated. Most of the other things on the superchem are resolved. She's been off Trilo for 3 days and her appetite is worse. I can make a guess that too much cortisone is hitting the LIVER, and that's why SHE doesn't have much of an appetite. The only way to decrease that cortisone inflaming the liver is to up the Trilo dose...See her liver is just ok., consistent with a lot of cortisone hitting it over the years (Cushings) according to the radiologist.

I'm reading everything you all are sharing with me and I really appreciate it. It helps me reason things out in my situation...for now anyway.

[Harley PoMMom]

Most definitely pancreatitis can make a dog feel so ill that they do not want to eat and like I mentioned before the only way to get a confirmed diagnosis of pancreatitis is with a spec cPL test.

When I was loading my boy, Harley, on Lysodren he stopped eating. I thought he was loaded and took him in for a stim test and spec cPL test. It turned out that his cortisol was still elevated and his spec cPL test results came back at 900 (0-200).

Lori

[Cushpup]

Thank you all for your help.
It's important to learn from eachother, as we see that our Cushings/ Thyroid/ Diabetes (All Endocrine System) have various issues.

Just want to give you all an update after taking my baby to the IMS a couple of days ago. I also spoke to Dr Allen (Dechra).

My baby was diagnosed with IBD (Inflammatory Bowel Disease)additionally to the Cushings and Hypothyroid. IMO, it IS a "catch all phrase" for the digestive issues going on in her belly, and its very similar to liver or pancreas issues.... IF she indeed has IBD (it's a strong possiblity, but only time will tell)although manageable, it's a challenge to keep her weight up and without intestinal pain.

The IMS Vet said that the inappetance, the stomach noises, the intermitten loose stool and vomit, and with her looking "good" point to IBD. For me, and probably my baby, it's very stressful, because it will require A LOT of patience, dietary adjustments and meds to keep her comfortable, and her weight up. She's playful and goes for her walks, but I feel for her. I know what digestive problems feel like, myself.

Dr Allen was adamant that she is on too high of a dose and that her ACTH being done 30 hours post Trilo is high, but INVALID ( I already knew that)....so I lowered the dose as he suggested and will re-test the ACTH properly this time, and see if the some of the inappetance is due to Trilo overdose. My IMS Vet thought that the Trilo dose (IN MY CASE) was not an issue. I listened to Dr. Allen only because my baby lost weight since Jan 1(she went from 14 lbs to 10 lbs) so I can see where now the dose of 30mgs is too high. I lowered it to 15mgs.
We'll see what happens.

In the meantime I am stuck with a tough situation because the way you treat the IBD is with STEROIDS and Flagyl. Some foods irritate the IBD. IMS suggested that for now I leave her on Trilo....

IBD is very frustrating. I'm in the process of putting together all the possible meds and diet I need to have on hand for her. I have to be careful to not make her IBD worse, and the BALANCE is very tricky, without a cure. Although she seems ok for now, it ain't a pretty picture ;(

[Mackey's Mom]

Not that this will be of any help to you other than letting you know you are not alone.

My Maxwell has been treated with Trilostane for the past 6 years, and he also has IBD. Currently he is in "remission" and not taking any meds at all (although he will be retested soon as he is showing symptoms again of his cortisol levels being on the rise). I went round and round with my vet and then the IMS about proper dosage (and timing) for a 125 lb dog. I finally called Dechra (at the urging of a forum member) and was told to split his dose to twice a day and what dose was better for him at his size. The vets were not dosing him correctly and were not testing him correctly at the time. Thanks to everyone here, I was pointed in the right direction so I could be the best advocate possible for my boy.

His IBD (and allergies) are treated as symptoms present themselves...I cook for my 3 dogs, and have experimented over the years with store-bought dog foods and different recipes. Sometimes his tummy is okay, sometimes it is not -- we go day-by-day. Maxwell was diagnosed very young (3-4 years old) so he has done well to date. Our oldest dog (11) was recently diagnosed with Cushing's and we are having a difficult time with her -- she refuses to eat at times, refuses to take the Trilostane no matter how we hide it, or try to get it into her. She also weighs about 100 lbs. and when she clamps her jaws shut, there is no getting them open. We're working with the vet now, going to the IMS, and asking for help from this forum again.

Hang in there...when your baby has multiple health issues, and they intertwine, it can be very confusing, and treatment can be difficult. I personally do not know what I would have done without the help of the people here who have held my hand (and my boy's paw) through some very difficult times.

Hugs from Maxwell, Sophie and I (Lori) :)

[Cushpup]

Not that this will be of any help to you other than letting you know you are not alone.

My Maxwell has been treated with Trilostane for the past 6 years, and he also has IBD. Currently he is in "remission" and not taking any meds at all (although he will be retested soon as he is showing symptoms again of his cortisol levels being on the rise). I went round and round with my vet and then the IMS about proper dosage (and timing) for a 125 lb dog. I finally called Dechra (at the urging of a forum member) and was told to split his dose to twice a day and what dose was better for him at his size. The vets were not dosing him correctly and were not testing him correctly at the time. Thanks to everyone here, I was pointed in the right direction so I could be the best advocate possible for my boy.

His IBD (and allergies) are treated as symptoms present themselves...I cook for my 3 dogs, and have experimented over the years with store-bought dog foods and different recipes. Sometimes his tummy is okay, sometimes it is not -- we go day-by-day. Maxwell was diagnosed very young (3-4 years old) so he has done well to date. Our oldest dog (11) was recently diagnosed with Cushing's and we are having a difficult time with her -- she refuses to eat at times, refuses to take the Trilostane no matter how we hide it, or try to get it into her. She also weighs about 100 lbs. and when she clamps her jaws shut, there is no getting them open. We're working with the vet now, going to the IMS, and asking for help from this forum again.

Hang in there...when your baby has multiple health issues, and they intertwine, it can be very confusing, and treatment can be difficult. I personally do not know what I would have done without the help of the people here who have held my hand (and my boy's paw) through some very difficult times.

Hugs from Maxwell, Sophie and I (Lori) :)

Thanks Lori. Hugs to to you all,too. Yes, the posters here are wonderful.

How long has Maxwell been diagnosed with IBD and how many times a year does it become an issue?


I always have been cooking and/or adding fresh meats to the dry kibble. If they are allergic to something it makes the IBD worse. I'm not sure if mine is allergic/sensitive to beef. I know she's allergic to eggs. At one point she was chewing her front paw and I cannot recall if it was after beef, fish or pork, so I'm trying to stay away from those foods. Unfortunately, she would prefer beef.

I, too have purchased some venison, duck, turkey, sweet potato, and baby food for her. I'm reading the ingredients. TG she's drinking fine. I realize that this episode will take a while to heal, esp. because she got sick with pancreatitis after a fatty BEEF meal...and aggravated with BEEF every week, until I noticed that the stools were loose after it (4x). I will make sure that I have the proper medicines compounded so I don't have to chase her with huge pills.
Once I get myself organized and armed with the right stuff for her illnesses, I can deal with it better and we BOTH won't be as stressed.

Have you tried to give your 11 yo pooch the compounded Trilostane? Just so you know the compounding pharmacies can "shrink" many meds by compounding them as liquid, or other- Just ask them what your options are. That's a lifesaving thing for my pooch being 10 lbs. I try to keep the size of the pills and liquids to a minimum because she's so little. I prefer smaller amounts of liquid with a proper syringe, so I don't have to wrap pills esp when she doesn't have an appetite.

I had my Trilostane compounded for 100mg/ml so I give mine .15 in a syringe (15 mgs). That's like a tiny drop.

If you were giving your 100 lbs pooch let's say 1mg/lb, you would only have to give her 1 cc of my compounded Trilo. You can get yourself the FEEDING SYRINGES. They come in 3cc. Those syringes have a tip that fits in between the side teeth. Maybe the pharmacy would provide one with the Trilo (Mine comes with a 1 cc). You can easily lift the lip & put the syringe to the side of the mouth and get it in that way. Hold the mouth semi-closed gently so they don't spit it out. They have to swallow it.

I use a compounding pharmacy in AZ. They have been wonderful for me (I'm not associated with them), and seem to be much cheaper than my local one:

Roadrunner Pharmacy
711 E. Carefree Hwy Ste140
Pheonix AZ 85085
1-877-518-4589

M & M

[Cushpup]

MODS-
Please change the heading of this thread to:

Shih Tzu 15 yo, Cushings, Hypothyroid, not eating, indigestion,Gallbladder/Liver Cancer.

This forum is very educational. I want to say thank you to all for your input and support. The posters here are very intelligent and vigilant so I feel that it is my duty to share the outcome of my baby girl.

Synopsis of her problems:
Stopped eating abruptly, very little eating, or no appetite, digestive problems, loosing weight. Looked good otherwise. On Trilstane (Cushings)and Soloxine(Hypothyroid). Had very MILD form of a similar problem in Aug/Sept 2010, lasting approx 4 weeks, but things cleared up without any intervention. She still ate enough, and wasn't really sick. She had a dental done (looked like she wanted to eat but couldn't, or ate smaller pieces) , and we thought she may have had a little pancreatitis because her belly was little sore. The results of her tests before and after are in the above posts.

The nighmare:

Jan 1, 2011 ate a fatty meal (steak and potatoes). Although the fat was cut out and steak rinsed, still had a larger fat content than other proteins.
Jan 2, 2011 stopped eating for a couple of days. Some loose stool. Then she ate a little, off and on, for 2 months. It seemed more like she wanted to eat but couldn't. At times she would take smaller pieces of meat, take 2-3 nibbles and spit out the last one as if she was afraid to eat, or couldn't eat because "something" was blocking her food going down, or her stomach would turn as though she was nauseous.
Only at times it seemed that her appetite was lacking.

Early on ( Jan and early Feb) as she would pick up her eating toward the end of the week, she would vomit 1x a week (total of only 3 vomits, 4-6 loose stools in 2 months)when she ate a larger than 1 teaspoon meal at a time. She BURPED and had stomach noises, at one point in Jan. I tried PAIN relievers and various meds to aid the digestion, thinking if she were pain free she may eat. By the last week of Jan I had to force feed, a lot of this was because all the TESTS(US, bloodwork) were coming back ok. I was messing with the Trilostane dosage because as she was loosing weight, I thought the original Trilo dosage may have been too much... we did the ACTH incorrectly. I was waiting for a break.

On Feb 1 I took her to my gp Vet. She had A LOT of belly pain. He gave her an Amox Inj, Banamine inj, and fluids. She ate for 5 days, with still some spitting out of food at the end. But she ate enough to sustain her weight that week. Her eating ceased Feb 7th. I began force feeding her. She nibbled a bit here and there. Most days she did not eat on her own. I put her on Flagyl Feb 13th. Saw an IMS on Feb 15. His diagnosis was IBD because the US report and her bloodwork were essentially ok. He examined her briefly. He said: Keep her on Flagyl, continue with Trilo. This didn't sit well with me. I sarcastically called it a "catch all diagnosis"...anything in the abdomen can be involved...the liver, the pancreas, the GI tract . IMO, the owner is stuck with a dog without answers, not eating, and *something* is wrong in the belly.

Fast forward to Friday feb 25th. I'm sitting and thinking what could be wrong?! I scooped her up and took her to my GP and said: ENOUGH! We need to *hit or get off the pot. I told him that something IS wrong with her; the inappetance is NOT normal. Her heart is beating fast, which tells me she is either in pain, or something is fighting something, somewhere in her body. I've been torturing this poor baby, forcefeeding against her will, and it's not fair, and it's not right. I don't want to hear another Vet (3 Vets told me she looks good)tell me "she looks too good, it's NOT her time", as though I'm crazy. He listened, examined her. She was very painful in the belly....

She went in for an EXPLORATORY SURGERY mon, Feb 28th, and we found cancer of the Gallbladder and Liver. The Gall bladder was HUGE, and not emptying...I had her put to sleep.

Commentary:
The Radiologist misdiagnosed and/or missed(?) the Ultrasound/Gallbladder on Jan 19th. I questioned him about "an area" seen on the radiograph on the 17th ( a golfball-like thing near the stomach). He didn't know what it was....and went right into the adrenal nodules and Cushings, blah, blah, blah ( THIS information I took to my gp immediately and we started adjusting the Trilo!).
The gp and I looked at the radiograph and took notice. Although you couldn't really tell on a regular radiograph what it was. ULTRASOUND was the tool to use.

Another note:
When I went to my gp (he is very good, but admitted that he needed to get familiar with Trilo), I told him that my dog's appetite reminded me of a person with Cancer of the Liver...the xrays, US, bloodwork were done and not much was showing up. The RADIOLOGIST took us on a wild goose chase into the direction of Trilostane, adrenal Cushings, the complications....all because he missed a BASIC ORGAN-the gallbladder/Liver. My gp was stumped. The IMS didn't have an answer, other than IBD. I had a sick feeling all this time....

Finally, I got my answer during the exploratory surgery. ALL the pieces fit-poss pancreatitis at first setting off an existing CANCER-the bizzare appetite, the pain, the non-threatening bloodwork. Come to find out, many times with a Gallbladder disease they lose their appetite abruptly, belly pain, and the bloodwork shows some Leukocytes( in my baby's case-the Monocytes were intially elevated), ALkPhos, and ALT(liver enzymes) are elevated, otherwise things are NORMAL. The Biluruben gets elevated, which in my babys' case it did not, so the gp and I had nothing to go by. It is up to the ULTRASOUND to diagnose.

This makes me wonder how many other dogs can be misdiagnosed because the Vets NEVER think about something basic like a gallbladder attack in a dog. Many times they think PANCREATITIS. I'm posting this so all of you who have dogs with Cushings don't experience the TUNNEL-VISIONED diagnosis that everything is related to Cushings, because that's what basically happened to my baby. She was a victim of a BAD Ultrasound reading, steering us in the direction of adrenal Cushing complications, IBD and Trilo dosing. It was a Gallbladder/Liver cancer all along with one Gallbladder warning epsiode back in September 2010.

I hope this helps others. Love you all. Thanks. M

[Bichonluver3]

I am so, so sorry for the loss of your baby girl. You did everything within your power for her and you must find some comfort in knowing that. There was nothing you could have done about the cancer, even if you knew. Life is not fair and though we fight and fight, sometimes a higher power wins the war. You are an amazing mom and gave your baby the greatest gift you could - a peaceful, easy passage to the rainbow bridge where, one day, I know you will see her again.
Run free, little princess with all your newfound friends through the fields of heaven. May the sun warm your face and gentle breezes be at your back. I will look in the desert sky, tonight, for our newest, brightest star. Godspeed and God bless, sweet angel.
Love and hugs,
Carrol & Chloe

[Wolfpak]

Dear M, so very sorry about your dear fur-baby passing!
You were right to go with your instinct that something else was wrong. With our elder pups its particularly possible we may be dealing with multiple issues. The bad ultrasound data report truly sent you in the wrong direction.

Thank you so very much for sharing your experience, it is definitely worthwhile, particularly for those of us with elderly ones, to be aware that many other conditions POP up in these dogs in particular.... but this can happen at any age!
Given the immunosupression caused by cushing's, its likely our dogs are predisposed to cancer, as cancer is fundamentally a massive failure of the immune system, thus malignant cellular changes escape unnoticed by it, consequently these cells are not identified and destroyed.

I'm just so very sorry for your loss. How kind of you to take the time to tell about your experience, greatly appreciated!

[littleone1]

I am so sorry for your loss. My thoughts and prayers are with you. You did everything you could possibly do.

Terri

[Casey's Mom]

I am so sorry for your loss, your little one is now watching over you.

Many hugs,

[k9diabetes]

I'm so very sorry to know that your girl has passed away. It is so hard to make that decision knowing the pain it will cause you but the relief from pain it gave her. Godspeed to her.

Natalie

[Squirt's Mom]

Dear M,

In reading your post about your sweet girls tragic journey, I couldn't help but empathize with you. An IMS failed to note a splenic tumor in my baby but it WAS noted on the second U/S by another IMS 4 months later. The anger I felt toward that first IMS was lethal. If her arrogance had cost my Squirt's life - I don't know what I would have done. The fact that you are still out on the streets among the general population says that you are a better person than me.

You stated that you had "tortured" your baby - honey, don't you dare let such a thought take root! Everything you did, every action, every thought was fueled by your love for her and that love sustained your baby like nothing else could. Your love gave her life meaning, joy, purpose and security, and when she became ill, that love gave her the best possible chance for survival. You never tortured her - you simply loved her and fought for her to the very end. She knows this better than anyone.

Our deepest sympathies,
Leslie, Squirt, Trinket, Brick, and our Angels, Ruby and Crystal

[Cushpup]

Thank you all for your sympathies.

Leslie (Squirtsmom),
I'm so sorry that your baby had to endure the extra pain from the lack of diagnosis.

I would almost love to have a WARNING forum -do not take your pet to so and so.

My babys' journey was especially difficult to deal with, and I am still grieving... I stuck to the topic of Cushings on this forum. I didn't want to sound like a negative Nellie, but on the other hand I feel that if we don't inform eachother on forums such as this one, many more pets can die or suffer.

She had a rough beginning and an end, but her life in between was very happy. At 15 she still had her full eyesight and hearing. I took good care of her.

When I first got her (she came from a huge puppymill), it took 4 visits, and 2 Vet clinics before she got the correct diagnosis: she had lice, coccidia, Kennel cough, and PNEUMONIA. I kept telling them that she has "rales" in her chest when I carry her (she was 1 1/2 lbs). All the Vets were saying that she was fine, and that it was my imagination. By the fourth visit I got upset and demanded an XRAY. Sure enough, there it was- PNEUMONIA. Finally, we treated her correctly and she got better. Bells should have gone off at that time to seek a good Vet, but they didn't.

Three years later My poor baby had the WRONG SURGERY done on her hind leg back in 1999 by that original quack, a local Vet who should have his license revoked. He is practising and thriving. She suffered that surgery needlessly, and her leg was botched. I took her out of there as soon as I realized that his charming bedside manner clouded many peoples perception of him. He was/is incompetent.

During the exploratory surgery, my current Vet (IMO, tops in the area) went over every organ in her body, and he asked me WHO did her spay. I told him that it was the same butcher that did her leg. He showed me that when she was spayed the VET went through her PANCREAS with the suture material. He had sewn her pancreas to something. The suture material looked like Nylon, or something not dissolvable. It was a meatball job. I got weak in my knees... He said that she must have been in a lot of pain and he was surprised that her Pancreas didn't slough off and she didn't die!!!!!!!!! How the H* does one sew through the pancreas during a routine spay? This explained why she was growling after her spay, and I thought she was being overly sensitive to a little spay surgery. I was *basket case* after seeing the horrid spay job and the painful Gallbaldder.

All the pieces to the puzzle fit during that exploratory surgery way back from when the poor baby was born.
1)they couldn't diagnose kennel cough/pneumonia.
2)botched spay
3)botched leg surgery
4)missed Gallbladder/Liver cancer.
I told my current Vet that this experience has made me into a crazy, vigilant owner... He said he understood, and that "I" was right all along about my baby having cancer...As to the Board Certified Radiologist, my Vet thought that he was thorough, but this incident is giving him second thoughts about him. I told him that I could tell that the Radiologist has a High Resolution Ultrasound Machine, but I'm not sure he knows what he's looking at. He's another one of those Vets with a charming bedside manner....I'm starting to see a pattern. If you don't know your stuff, you dazzle them with your BS.

She was a resilient little dog. My baby is finally free of pain and that makes me feel better.

M.

[frijole]

M. Thanks for posting on Annie's thread. I just re-read your entire story and certainly the inappetance part is very similar. I have had multiple ultrasounds done on high res machines. She has an adrenal tumor and they too are saying it emits cushings like signals. I am going to go back thru her files re the gallbladder to see if there are any comments. Regardless I will be scheduling another ultrasound and give specific instructions to look at it. You might have solved my mystery... and I have been at this for a solid year. Regardless - your story is very helpful. Kim