Can anyone help Paris

[Paris and Me]

Hello, I am so very happy I found this site. My name is Cindy. I am a senior and a widow. My darling is a 10 pound poodle named Paris. She is 9 years old. And like everyone on this site, she is by baby love. About a year ago Paris had some hair loss. The vet checked her for Thyroid and Cushings disease. Everything came back fine. Borderline for Cushings. She continued to have hair loss,developed sores,blackheads and wanted to eat quite a lot. In Sept. she had an acth test and it came back high at a post of 34. She started on 5 mg trilostane and now on 10 mg. Her signs are not better and the vet said he can find no reason for her not getting better. Now she is having some back leg weakness and shakiness. I now do not kow the next step to take. If anyone can help Paris. I would be forever grateful.

[labblab]

Hello and welcome to you and Paris! I apologize that I have only a few moments to post right now. But my first question is to ask whether Paris has had a monitoring ACTH since starting on the trilostane? Given her weight, her current 10 mg. would be a reasonable starting dose, but every dog metabolizes the drug differently and she may simply need a larger dose in order to lower her cortisol sufficiently. That's why the monitoring testing is a very important part of the equation -- in order to help judge whether a dosing increase is is warranted. If you can give us the actual numbers for any monitoring ACTH tests, that will be very helpful.

Marianne

[Paris and Me]

Thank you for your reply. I will get copies of her acth test Monday morning. . I want to add that when I first took Paris to her vet before she was actually dignosed with Cushings, she had back leg crossing. Is this a sign of Cushing disease. I did wonder about that.

[labblab]

So in addition to that original diagnostic ACTH, Paris has had subsequent ACTH tests since starting on the trilostane? The recommended testing protocol is to test 10-14 days after treatment begins, and then again at the 30-day mark and every 90 days thereafter. If symptoms have not resolved satisfactorily and the cortisol level remains too high after a month at any given dose, then the amount of medication should be increased.

I am not aware of crossed legs being a Cushing's symptom. Hind leg weakness is common, however.

Here's a link to a publication that gives a lot of helpful info about treatment and monitoring:

http://www.dechra-us.com/Files/dechraUSA/downloads/Client%20Literature/Treatment%20and%20Monitoring%20of%20Hyperadrenocor ticism.pdf

Marianne

[PennysDad]

People here will be able to help you! They seriously know so much stuff!

Once Penny's dose got set, she has begun to improve so much!!!

I hope you figure it out and welcome!

[molly muffin]

Hello and welcome to the forum. Has Paris ever had an xray of her rear leg joints? There could be other reasons for the back legs crossing, and other than weakness in tendons and ligaments, joint issues could be another possibility.

Marianne is correct, the subsequent ACTH will tell us much about if cushings is a culprit or not in what is going on now, with the continued symptoms.

The other thing I would like to mention is that hair and skin are often the last symptoms to clear up in that they have to cycle through before they get better. This can take many months and months to happen and not all hair folicles come back at the same time. Some dogs get back a full coat and some never recover a full coat.

[judymaggie]

Welcome Cindy and Paris! Just wanted to add a thought about the crossed back legs. A possible cause could be disc issues in Cindy's spine. My Abbie showed this symptom when being treated for disc issues/pain in her lower back. X-rays are helpful to diagnose. Abbie had acupuncture and treatments with a chiropractic vet, the latter being especially helpful. I also have trained Abbie to use steps to get up to my (and her :D) bed.

[Paris and Me]

Thank you everyone for the support, encouragement and advice.I will ask her vet about a possible joint or disk issue. She does not appear to be in any pain. Would a problem such as these raise the cortisol ? But than,a spine or joint issue would not cause hair loss or sores. Now I am a worry wart so I wonder if Paris has two problems. My daughter lives out of state and sometimes its hard for me to make decisions about Paris.

[judymaggie]

Cindy: With regard to your concern that Paris may be dealing with more than one issue, I wanted to share my thoughts. I have fibromyalgia and it took me a long time to understand that not every issue/problem I had was related to, or caused by, the fibromyalgia. The same goes for our pups -- there are often concurrent issues.

Also, most dogs are very stoic about showing pain. It is often symptoms and a thorough vet exam that leads to a determination about pain. A vet will check each disc/vertabrae to see if the dog shows any discomfort. I thought Abbie's problem was with her neck as she has disc issues there but, during my vet's exam, she winced when he barely touched the lower spine on the left side.

[Paris and Me]

Sorry it took so long. Finally got the results of the last acth test in October. Pre was 3.6 and post was 8.1. She will go back in January. I asked about xray of spine and I was told ,we would talk about that when she comes back in January. He thinks it is from the cushings. Thank you to everyone who takes the time to help my Paris. Cindy

[labblab]

Thanks very much for that October ACTH result. Can you tell us what dose of trilostane she was taking at the time of that test? The test result shows Paris' cortisol was still too high for a dog still exhibiting symptoms of Cushing's. So she should have had a dosing increase at that time. Is that when she was increased to 10 mg.? Or had she already been taking 10 mg. at the time of that test?

Either way, since Paris is still showing symptoms, the the vet should not have waited until January to be retesting with an ACTH test. Without that testing, there is no way to know whether Paris' current dose is the correct one for her or not. Since she is doing poorly, the first thing to question is whether or not she needs another dosing change. She may do great once her cortisol actually falls within the desired therapeutic range for a dog being treated with trilostane. This desired range is lower than the "normal" range for a dog without the disease. Hopefully, your vet is aware of this difference.

Marianne

[Paris and Me]

The acth results of 8.1 are from the October acth test.Done around the middle of October. That is when Paris was put on the 10 mg. Her bloodwork was good as well as her urine. Blood pressure was mildly elevated and will be rechecked in January. Her hair and back legs are the most concerning. The sores have somewhat improved. Not as mean looking and as often. I can not remember if her vet said he has treated cushing dogs with trilostane or not. He usually uses another drug. Not for sure what it is. Sometimes my memory is not as good as it use to be.I do appreciate everyones help a lot. I wonder if I am capable of giving Paris the care she needs.

[labblab]

Gosh, I do think you are capable of giving Paris the care she needs! Look at you, you went to all the effort of tracking us down and joining our family! Lots of folks would never take the time to do that. It's clear how much you love Paris and it sounds as though you are following through with what your vet is telling you to do.

My biggest question at this point, though, is whether your vet's increase to 10 mg. has gotten Paris' cortisol level to the point that it needs to be. Since some of her symptoms are worsening, that would lead us to believe that her dose is still not exactly right. So I do think it will be important to take her in for her retesting as early in January as you can work things out. Until we know the results of her bloodwork, we are only guessing as to what may be going wrong. That labwork will really help us a lot.

So please hang in there! Paris is very lucky that she has a mom who cares so much about her. And we'll be here to help you sort through the test results just as soon as they are completed.

Marianne

[Paris and Me]

Thank you so much Sweetie. I do love her. She is a lot of company. Paris was my daughters dog. When she moved out of state,she could not take her. And she thought Paris would keep me from getting so lonely. She was 8 months old when I got her. I will ask her vet if I can bring her in next week for an acth test. I will also ask if I can get numbers written down on paper. Sometimes when they call me with numbers, I seem to not always get them right. I am glad now to have another family.

[Paris and Me]

Ohmy, I just read a question from someone on this site. Does a dog with Cushings only live about 2 years ? I think that is a good question to ask her vet.

[labblab]

I just now posted a reply on Daisy's thread re: that two-year life expectancy, so you can go back there and take a look. ;)

Marianne

[molly muffin]

As Marianne replied in the other thread, the 2 years was normally in response to perhaps a senior dog normally would have a couple years left, but we have had cushing dogs on treatment for many, many years and they lived out their normal life span.

If they can just give you a print out of the results of the ACTH that would be good. You can then keep records of her results.

I do think it is a good sign that the skin is getting better. Back leg weakness and problems is common with cushings, but can be caused by other things too.

[rml]

My Boston Terrier has shaky back legs and sometimes seems it is difficult for her to get going to walk. But, this is off and on, and most of the time she walks fine and runs and plays. She has had Cushings since the summer and is dealing with CC (Calcinosis Cutis), which has been very difficult to deal with. This past summer she was weak and had a hard time getting up. We took her in, and they did an x-ray and thought it was a disc. At the same time, skin sores started, so we had the vet take a look, and later had a biopsy and other tests confirming Cushings. So, I think there is a connection.

[Paris and Me]

Honey, I am so sorry your little little girl has CC. I hope she will get better. Also hope her little legs get better. Was it a disc? My little girl still has shakey back legs. I need to take her back to the vet. I have not been able to get out of the house lately.

[molly muffin]

How are you and Paris doing? are the sores continuing to get better?

[Paris and Me]

Sweetie Sharlene, thank you for your concern for me and Paris. Paris skin looks good. Her fur and back leg weakness have not improved much, if any. . Her last acth test was in October. I need to get her to the vet and do a repeat. Sometimes she fools me and I will find she spit her trilostane out.So I know she needs to go back. I wish the weather was not so cold.

[Paris and Me]

And my darling likes to eat a lot. Will eat my supper if I do not watch her.

[molly muffin]

Snarky isn't she. My Molly will try to spit out too. I have to watch to make sure she has taken her meds.
Definitely time for a recheck to see where her levels are. Might be she needs a dose increase if still trying to take food