Introduction-Long (15 y/o Shih Tzu)

[KFonseca]

Good afternoon all and thank you for having me.

My name is Karen Fonseca. My Bailey, 16lb., 15 y/o Shih Tzu, likely has Cushings. Apx. two months ago, I took Bailey to his treating vet due to hair loss. He sent us to a vet apx 2 hours from us for a second opinion and ultrasound. Lots of other tests were done, urine, xrays of the abdomen. Both vets suspected Cushings but said to wait b/f further testing due to how hard it will be on Bailey. Some hair loss was the only symptom Bailey had at the time.

I have had Bailey since 2007. When I got him, he literally had one eye hanging out of the socket and it was horribly infected. He had bugs (not just fleas and ticks) living in his coat. He was never allowed indoors.

Vet of course removed the eye and also found numerous BBs in Bailey at that time. Being used for target practice is just a small part of what was done to Bailey.

Because of his former life, Bailey never fully recovered emotionally. His first instinct when frightened is to bite. He will even try to bite me if pushed. I understand why he is like this and still love him with all my heart. Do not get me wrong, Bailey is a very loving dog and adores me. He just carries lots of baggage done to him by humans.

Bailey now exhibits a somewhat pot belly, and lots of hair loss. He does not have the other signs of Cushings--does not drink a lot of water, does not urinate often, is not always hungry, no skin infections. So vets said not to treat at this time or do further testing.

The hair loss is getting worse, so back to the vet. Low dose Dexamethasone was done yesterday, in addition to Free T4 for Thyroid, urinalysis, and lots of other blood work. We will not have the test results for a few days. To do these tests, we had to put Bailey under with a fast acting sedative. Muzzles do not work for Bailey. The full panel done at the vet's ofc showed all levels in normal range w/the exception of ALP (I think) which was 240.

Vet is concerned if we treat with Trilostane, what do we do about having to monitor Bailey's levels frequently. Bailey has a Grade 4 heart tumor on top of everything. Vet says he has a client who has treated her Cushings dog holistically with decent results. I have nothing against alternative care, but worry about what can be happening to Bailey inside his body that I cannot see.

My vet is in no way an expert on Cushings, but to his credit he is reading and researching like crazy trying to help Bailey. The vet who gave the second opinion used to practice in a large practice in CA and has a lot of experience with Cushings. There are no specialists w/i a 6-hour drive of where we are.

I really think Trilostane is the best for Bailey. My worry though is not being able to check his levels as often as necessary due to who Bailey is.

Bailey is spry for his age. If you did not see the hair loss and black pigmentation on his skin, you would never think Bailey was sick.

Any comments are very much appreciated.

Karen Fonseca

[Harley PoMMom]

Hi Karen,

Welcome to you and Bailey! So sorry for the reasons that brought you here but glad you found us.

First, I think you are just so wonderful for giving Bailey such a loving home, Bless You. Cushing's can be a difficult disease to get a confirmed diagnosis for because not one test is 100% accurate at diagnosing it and other non-adrenal illnesses can create false positive results on tests for Cushing's. The most common tests used to diagnose Cushing's are the LDDS and ACTH stimulation. With the LDDS test even stress can skew the results so I would be suspicious of any positive result from this test for Bailey.

To me, the symptoms Bailey has can be attributed to a thyroid problem. When the thyroid is not performing properly dogs can become aggressive and have hair coat/skin issues, so I will be anxious to see the Free T4 results.

Please know we will help in any way we can so do not hesitate to ask all the questions you want. ;)

I'm providing a link to our Resource thread where you will find a wealth of information about Cushing's and other endocrine problems including hypothyroidism: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10) Feel free to print anything out.

Hugs, Lori

[KFonseca]

Hi Lori,

Thank you for your warm welcome. Vet is very interested in results of Free T4 as well.

I am really hoping it is thyroid, as opposed to Cushings.

Thanks again for your response. Will post Bailey's results when I get them.

I am reviewing the files you sent also.
Karen

[goldengirl88]

God Bless you for taking this wonderful, mistreated, little baby into your home. What happened to him is atrocious. I am not familiar with heart tumors so I cannot speak to that. My only caution is just be absolutely sure he has Cushings before treating him as he has been thru so much. I am sure you can work something out with the vet if he cannot be tested as often. This poor baby has already had it so hard, my heart breaks to think of the abuse he suffered. You are wonderful for helping this baby and I hope all works out well for you both. Blessings
Patti

[Squirt's Mom]

Welcome to you and Bailey! :)

Bless you for giving this sweet boy a safe, secure home where he has learned about love and trust. You are an angel!

A point for your consideration should it turn out that he does have Cushing's - Lysodren is often less expensive to use and requires fewer tests that Vetoryl (Trilostane). Here's why. Once a pup is loaded on Lyso and the maintenance has started, the dose seldom needs to be changed. Most Lyso pups seem to do well on the same dose for a long time. On the other hand, Trilostane (Vetoryl) often requires frequent dose changes, up or down, and with each dose change, the testing schedule to monitor treatment has to start all over. Just food for thought. BTW - neither drug is "safe". ;) The main difference, other than the way the two work, is that if there is a crisis, Trilo is leaving the body sooner than the Lyso. Trilo is leaving the system in 2-12 hours; Lyso is just reaching its peak at 48 hours.

I'm glad you found us and like Lori, I'm looking forward to seeing those thyroid results.
Hugs,
Leslie and the gang

[KFonseca]

Hi Leslie and Tipper's Mom,

Thank you for your kind words. I feel so dumb. Bailey does not have a heart tumor, it is a heart murmur.

Taking Bailey was a no-brainer for me. He is a little angel, with sharp teeth :)

Karen

[addy]

Hi and Welcome,

My Zoe started too with mostly skin/coat issues. She also had on going colitis. She also came from animal control with a lot of baggage. They originally thought she was hypothyroid as well. She was 10 years old at the time, well, we think, we dont really know how old she is.

I waited a year to treat Zoe with Trilostane until her IBD was well controlled and I saw more symptoms. The vet visits were a worry but we learned how to use a muzzle and we made a game out of it with lots of clickers and jack pots and treats. So she puts the muzzle on very nicely when we go for testing.

I respectfully disagree with Leslie about Lysodren. The studies I have read indicate almost 50% off dogs will have to be reloaded the first year of treatment.

Has anyone done a skin scraping on your pup? Cush pups sometimes get frequent skin infections and it is not unusual for them to have skin issues, bacteria, excess oil,with dry skin spots, yeast, mites, etc.

I have to tell you Zoe was just about bald in April from skin issues although her cortisol was well controlled with Trilostane. Only after I started treating her skin issues did her skin improve and she started regrowing hair. Now even her rat tail is growing hair.

If you are not seeing other symptoms right now except skin issues and loss of hair, you might try to treat the skin issues without treating the cortisol, depending what the thyroid tests show.


Glad you found us.

[KFonseca]

Hi Addy,

Thanks for your welcome. Vet called just a bit ago. Bailey's thyroid, including Free T4, is in the normal range.

Vet checked Bailey's skin thoroughly when he was under yesterday. He said he found no infection, etc. He said we could do a skin scrape, but did not think it was necessary. What he did see was just a ton of lost hair. Baily has no sores at all.

I forgot to mention in my intro, but Bailey's coat has also gone from a golden color to light beige. It is also very dry looking. The hair loss is 99% on his neck, belly, back, and tail. His head and legs are fine.

His skin is turning black in the areas of the most hair loss.

If Bailey is positive for Cushings and we need to do more frequent testing, I will need to employ tricks, games, such as you have so that we can deal with him. Little bugger is fast!

I started giving Bailey Melatonin for his hair loss a few weeks ago. I have not noticed any change, but I am sure that it is too soon.

How often do you need to test Zoe's levels on the Trilostane?

It will always amaze what we humans are capable of doing to helpless animals. I am so glad you have Zoe.

Thanks again.
Karen

[frijole]

Like others I would be suspect of the ldds test results simply because other than the skin issues you don't have typical cushings symptoms. I would have an abdominal ultrasound done or the acth test before even considering treatment.

The other concern I have is the fact that your dog is 15 yrs old. No doubt if the cortisol is high it is helping to naturally treat arthritis. You treat the cushings I fear you will see arthritis symptoms instead. Something to consider.

Please do keep us posted. Kim

[My sweet Ginger]

Hi, Karen,
Welcome to this wonderful forum. Everyone is just amazing and so knowledgeable and incredibly sweet.
I'm new here myself and have been reading other threads as much as I can. A particular thread popped into my head while I was reading yours tonight. Her name is Angela and her baby's name is Lillo and the name of their thread is ' Lillo', it's on page 2 tonight. Please read their thread and see if you find any similarities between Bailey's and Lillo's symptoms because I think I DID. They went through so much to finally come to this diagnosis, it's called 'Alopecia x' and I was so happy for them when they finally did. Please, please also look it up online and I hope it will be helpful in some way because it could save you a lot of heartache ($ too) not to mention the possible torture for Bailey if their symptoms are the same. I really hope this helps. Song.

[lulusmom]

Hi and welcome to the forum.

What I'm trying to figure out is why your vet would put a 15 year old dog, with serious fear/anxiety issues, through a battery of tests to confirm a diagnosis of cushing's when the only blood abnormality is a very mild elevation in ALP, which could be normal for a senior dog, and only symptoms is hair loss and hyperpigmentation. :confused: Dogs with cushing's lose hair and experience hyperpigmentation but so do dogs with alopecia, that may never cause clinical problems for the dog. Pet owners, however, do seem to have a problem watching their dog go bald and their skin turn black. I can attest to that as I shared 11 years of my life with a tiny Pomeranian who was bald for eight of those years. She was diagnosed with cushing's at three years old and neither Trilostane or Lysodren grew hair for her. Unlike Bailey, she was hugely symptomatic so when all testing was consistent with cushing's, including a full adrenal panel done by the University of Tenn, starting treatment was a no brainer.

The goal of treatment is to remedy problematic symptoms and Baily has none so even if the LDDS test were consistent with cushing's, if he were my dog, there is no way I'd I would spend another penny on testing and I most certainly would not start treatment.

I know you are frightened by what you can't see going on inside Bailey right now but you should feel pretty good that a 15 year old, stressed out dog had such amazingly normal blood values. I can tell you that with the negligible increase in ALKP and no evidence of any symptoms commonly associated with cushing's, I would be hard pressed to think there's much going on inside Bailey that isn't associated with aging.

If the LDDS test is negative, it very well could be that Bailey could have elevated sex hormones, which could be the culprit for his hair loss. Melatonin would be the initial treatment of choice if you want to try to grow some hair, but be warned that efficacy is fairly low and it's not instantaneous. If you don't see results within three to four months, it's probably not going to happen. Honestly, if Bailey were mine, I'd buy him a sweater and enjoy every day with him. If you start to see any of the usual symptoms, then worry about a diagnosis and treatment. Just my two cents worth.

Glynda