Newly rescued senior foster- HELP!

[rescuemomma]

I just joined this group in hopes of some insite on where to turn/go next with my foster. I have a senior Silky Terrier yay was recently rescued from a neglectful home where after he lost the ability to use his back legs properly he was left laying in his own waste for over 6 months. He was a real mess when he came in with horrible skin infections from the long term constant exposure to urine and feces and had to have his belly and back end completely shaved to the skin due to tight matting caused by that. But Rex is a fighter and we are determined to try and make his life as comfortable as we can.

Upon arriving there where several huge warning signs that led us concerned there was more going on medically then we originally realized. His skin was thickened and hyperpigmented. Some of that may be due to the constant irritation. He was also obese. About 6 pounds overweight. Add to that a pot bellied appearance and the fact this dog drinks a TON of water, and having had Cushingoid dogs before I immediately began to suspect Cushings.

I'm unsure how to share pictures here so I can share his bloodwork but his ALK Phos was elevated making us further suspect Cushings. My Vet told me because of his history and condition he felt an ACTH stim would be a better option then the LDDS test and give us a better idea of what was going on. That was done a week ago. The results where very borderline. His pre was at the high end of normal ranges, and his post as just BARELY under what would have been considered conclusive for Cushings (20 being conclusive, and his post result was 19.7).

In the mean time we have also found out that he is not really paralyzed, he has full control of his bowels and while somewhat incontinent is fully capable of urinating on his own if taken out often enough. We got him a full support cart because his muscle weakness is severe and he was unable to use a regular dog cart. We have seen some improvement but still many signs very typical of a cushingoid dog. He is very restless much of the time and that has been worse since the ACTH stim.

My regular Vet who has been working with him has been out of town all week so I have not been able to discuss the next step with him. We did discuss before we did the ACTH that treatment options would be very limited for Rex due to age and overall condition. We know he is at least 12, likely older (he has no teeth at all, and his vet records from prior homes where all over the place on many things including his real age, so we really can only guess at his age at this point), and has not had a good past.

The restlessness is the biggest challenge right now especially at night. During the day when I can keep him busy he does somewhat better but at night he will sometimes whine and shuffle and struggle all night long, especially if he drinks all his water - which is a common occurrence. He is currently about 13 pounds (we've gotten about a pound off him so far), but probably drinks 32 ounces+ a day and gets worked up really fast if he doesn't have constant access to water.

So far on lab results other then the ACTH and the ALK Phos values his bloodwork has come back looking really good for a dog his age, urinalysis was clear other then being very dilute with a low PH which we're sure is a result of him drinking so much. Thyroid values where normal, no signs of bacteria, glucose, or ketones in his urine, everything has checked out pretty normal and we're not quite sure where to take it from here.

My Vet will be back Monday. I will be discussing with him then where to go next with Rex but I'm somewhat limited. Since he's a foster I have to get all expenses pre-approved. I have found out University f Tennessee does a more advanced adrenal panel with the ACTH stim and wish I had known that prior to doing his original ACTH. With as hard as that was on him, and the fact that a week later he is still a lot more restless from it I know my Vet is going to be hesitant to do it again, and even though I understand that they do a far more detailed adrenal panel then just the cortisol level checked in the original ACTH, the rescue is going to be very hesitant to approve the expense of a second ACTH stim as well.

The other concern is since my Vet and I are also so concerned about him being able to tolerate Lysodren well due to his overall poor condition is that I have no idea what treatment options we may have or how we can try and manage the symptoms without drugs. Would love any guidance on that. I will be discussing further with my Vet in Monday, but this is new ground for me. I know as a former vet tech we had a number of Cushings dog that regardless of dose did not do well with Lysodren, but even fewer who tolerated Trilostane.

Just feeling overwhelmed with this guy, he's a sweet old boy and his will to live is so strong still, I hate to give up on him, but also hate to see him like this, unable to relax, constantly drinking water, and anxious like someone over dosed on steroids constantly. But without s firm conclusive diagnosis of Cushings I really don't know what else we can do for him! HELP!

[Carole Alexander]

Welcome and wow! So good of you to foster this pup and what a challenge he is. Others who are expert will comment on the testing and treatment I'm sure. But I do have one thought: you mention the U of Tennessee. If you are near there, could the rescue call them and ask if they would pro bono evaluate this poor dog? Maybe you could get your local newspaper or tv people to do a feature story on him and how the rescue and you are trying to save him if you can only get a proper diagnosis and treatment. Just a thought and I wish I could help more. I know that Purdue, where my dog is being treated, does work with the local rescues in Indiana but I can offer no detail.

[Joan2517]

Welcome from me too...Jeez, that poor little guy. It breaks my heart to hear such terrible stories, but then there are wonderful people like you and it gives me hope.

Members more knowledgeable than I am will be along to try to help you sort all of this out. They will want to see actual numbers from the blood work, just the highs and lows with the reference ranges.

Joan

[Harley PoMMom]

Hi and welcome to you and Rex!

Oh, bless you for fostering this sweet boy and it was just terrible the way he was treated but now that he has you he will know how loving and caring a person can be.

As far as the tests, you can just type them within the body of your post and please include the normal reference ranges along with the units of measurements, we need to see only the levels that are abnormal. I'm assuming that the glucose was normal on the blood panel, right?

As you probably already know, there isn't one test that can accurately diagnose Cushing's. And the LDDS test is the preferred test when no other illness is present so I do see why the vet chose the ACTH stimulation test to perform. However with the ACTH stimulation test there is a small percentage of dogs that test negative for Cushing's but actually do have it. So, if feasible, I would have an abdominal ultrasound performed. An ultrasound can be a very useful diagnostic tool, as other abnormalities may be found on the internal organs, such as gallbladder mucocele, kidney issues, pancreatitis...etc. And if both of the adrenal glands are visualized and abnormalities are found with the adrenal glands, than the type of Cushing's may be determined. Dogs suffering from adrenal Cushing's will typically exhibit only one single enlarged adrenal gland, and a mass or a tumor may be visualized on the one enlarged gland. Both adrenal glands will typically be enlarged in dogs suffering from pituitary Cushing's. Our motto here is you get a lot of bang for your buck with an ultrasound.

The two medications that are mainly prescribed for Cushing's are Vetoryl/Trilostane and Lysodren/Mitotane, one is no safer than the other. These are strong drugs and both have some pretty scary side effects, however, adverse effects are minimized when the proper treatment protocols are followed. We have many members that are treating their cushdog with either Vetoryl/Trilostane or Lysodren/Mitotane and are experiencing success.

With Trilostane/Vetoryl it is recommended that the starting dose be no higher than 1mg per pound of the dog's weight and on the forum we have seen that when dogs are started out at that recommendation that ill effects are minimal. Also, with Trilostane if any side effects are noticed one can simply stop the Trilostane and an ACTH stimulation test may be required.

Lysodren's is usually given at 50 mg/kg/day, divided and given BID (twice a day). The most important thing with Lysodren is giving the dose AFTER the dog has eaten because a reduction in appetite is what is most noticed first so if any slight pause is seen or if the dog stops to drink some water or stopping in response to the owner's voice the Lysodren needs to be discontinued and an ACTH stimulation is done.

If the required protocols for each drug are followed, like I mentioned before, side effects are minimal.

Now, if clinical symptoms are not that bothersome to the dog or owner, some members have told us that Cushex and Adrenal Harmony Gold worked very well in controlling symptoms but only for a short time period. Unfortunately Cushex and Adrenal Harmony Gold have no controlled clinical testing whatsoever to back up their claims (we know this because we have contacted the manufacturers and we have been told that no testing has been done).

Another medication you may want to look into is Selegiline (Anipryl). However it's efficacy is not great. It really is only effective in dogs having a pituitary tumor in the pars intermedia lobe. Only a very small percentage of dogs have a tumor in the pars intermedia and efficacy in those dogs is questionable, depending on the progression of the disease. Even the developer of the drug, Dr. David Bruyette, who was also a short time member here, limits its use to dogs with very mild symptoms or pet owners who can't afford the cost of the ACTH stimulation tests that must be done to monitor Lysodren and Vetoryl treatment. We have had members report good initial results in dogs with mild or few symptoms but improvements were short lived.

Another option to discuss with the vet is Cabergoline. In one published study
Out of 40 dogs with PDH, 42.5% responded to treatment with cabergoline (0.07 mg/kg/week), with significant decrease in ACTH, alpha-melanocyte stimulating hormone (a-MSH), UCCR, and tumor size. Abstract can be found here: https://www.ncbi.nlm.nih.gov/pubmed/17910968

For the restlessness Melatonin may help with that. It had a calming effect on my boy, Harley so you may want to check with the vet and see if this something you can try.

Well it looks like I've written a novel here so for now I'll stop because I know how overwhelming all this information can be. I am sorry for the circumstances that brought you here but so glad you found us and we will help in any way we can.

Hugs, Lori

[rescuemomma]

Thank you everyone for the information so far - Especially Lori, your novel is very informative! I'll print your response out if that's ok and share that with my vet when I go back Monday.

Unfortunately I only mentioned U of Tenn because they're the only ones that seem to offer that detailed adrenal panel. I'm nowhere near there. I'm out in Utah, there is no vet school here, I'm kind of in the middle between UC Davis, Colorado State, and Washington State - And since I'm disabled myself and unable to drive, that's just out of the relm of possibilities for me to get to any of those 3 vet schools.

As a vet tech I've seen probably about 10% of dogs treated for cushings have adverse effects to the drugs, so I agree most tolerate them fairly well if dosed properly. HOWEVER the majority of those 10% where elderly dogs or dogs already in poor condition when diagnosed, and Rex is both, so I understand my vet's reluctance to start medications, but we will discuss this again on Monday and decide where else to go.

I have tried Melatonin for him for the restlessness, but I've seen zero improvement with it. I'm still giving it twice a day, but it doesn't seem to really be helping him at all so far. He's only been on it 5 days so maybe it needs to build up some, but I know with my dog with storm anxiety that melatonin helps I see it helping to calm her within 30 minutes of giving it so I'm not sure it's going to really help Rex.

Here are the values that where off on his labwork

ACTH stim
Pre - 4 (1-5)
Post HIGH 19.7 (8.0 - 17) *so this result is high, but the test said post results over 20 where consistent with HAC (cushings), and he's just BARELY under that.

UA
Specific Gravity - 1.013 LOW (1.015 - 1.050)
PH 5.0 LOW (5.5 - 7.0)

Chem panel
Alkaline Phosphatase - 213 HIGH (5 - 131) *so high but not insanely high
GGT 21 HIGH (1 - 12)

And yes glucose was normal at 116 (70-138). So towards the higher end of the normal range but still within normal ranges. He was fasting for bloodwork as my vet recommended. All other blood values where within normal limits except for PSL - But we're not concerned about that since he has no signs of pancreatitis. My vet said for whatever reason about 75% of the dogs he sends a senior wellness panel off on come back with a high PSL even with no signs of pancreatitis, so if pancreatitis isn't suspected he ignores that value.

[Squirt's Mom]

Hi and welcome to you and your sweet boy! :)

If I were in your shoes and in light of the ACTH results, I would not do any more testing for Cushing's right now. I would simply give him time to adjust to his new life, to learn that water and food will always be available, that clean living space will always be available, and that a loving touch is his over and over and over. The one test I would consider is an abdominal ultrasound but no other for now. That would let them see all his organs, or most anyway, to make sure there are no tumors, etc. Otherwise I would simply give him some time. I think you are on the right track with the cart and as he regains some strength in his legs and is able to move more his weight will probably drop some more. Good nutrition and solid TLC is what he needs most of all right now. So I would be loath to put him thru testing that may well return false-positives considering the stress he must be under both physically and emotionally.

Bless you more than words can express for taking him in and giving him a chance to learn what it truly means to be love and cared for as he should be!
Hugs,
Leslie and the gang

[judymaggie]

Hi and welcome to you and Rex! As others have said, you are an angel for fostering this sweet boy. :D

I would agree with Leslie and Lori that an ultrasound would make sense at this point and think Leslie's comments regarding giving Rex some adjustment time is spot on.

[rescuemomma]

Thank you everyone for the responses.

I'll discuss doing an ultrasound with my vet on Monday, I know they did a quick one when they did the UA to get urine on him, and to look for stones and things in his bladder, but not a very detailed, I think they mainly just looked at his bladder. Will discuss that further with my vet.

Normally I would wait longer before getting to concerned with a new foster. My challenge with Rex right now is that his symptoms are getting WORSE, not better the more he settles in :( The last 3 days now have been really bad, because the weather has been really lousy so he hasn't been able to spend any time really in his cart outside getting fresh air and is limited to the exercises I can do with him in my livingroom. He does do better when I can get him outside and "exercise" him (even in his cart, he can't really walk very far at all, maybe a few feet at best, but he loves just being out there and watching my other dogs play!). Especially the excessive drinking and restlessness :( Literally he went over 48 hours without sleeping. He cried all night, and just couldn't settle for a moment. Which of course can't be good for him, and as old as he is I worry about the toll all this restlessness and stress is going to have on his heart and overall health!

[Harley PoMMom]

I wonder if his restlessness is due to some kind of pain or discomfort? An option could be to add some tramadol at nighttime to see if it helps him to be more comfortable...just a thought.

Hugs, Lori

[rescuemomma]

I wonder if his restlessness is due to some kind of pain or discomfort? An option could be to add some tramadol at nighttime to see if it helps him to be more comfortable...just a thought.

Hugs, Lori

We have actually done that because we where having the same thought. Didn't make any difference. Even went up to some more powerful pain medications like hydrocodone to see if it was pain related and controlling the pain would help him relax. Nothing. So at this point we don't think the restlessness is pain related

[molly muffin]

Hi from me too. Did they do any spinal xrays, hip xrays, etc to see if there was an issue there that might be causing pain?
I'd lean to a thorough ultrasound too probably at this point. Looking at all internal organs, kidney, liver, gall bladder, intestines, etc and if no xrays have been done then I'd probably do that too.
This is all assuming the rescue will go for more testing, based on whats been done already.

[rescuemomma]

X-rays have been done and didn't show anything.

[molly muffin]

Well dang. Trying to think of anything Would he do okay in done water exercises? To help strengthen his back legs?
I just have to wonder how much trauma laying in his own waste for months. Not being looked after did to him.

[rescuemomma]

He' said getting hydrotherapy (water therapy) every day, massages, stretches, gentle exercise in his chair, anything we can think of to try to exercise him both mentally and physically :).

He is still battling skin infections to from being left laying in his own waste - he biggest challenge is since he does mkt have full control of his bladder, with him drinking excessively like this it is very hard to keep him clean and dry :(. Poor guy. Can't use a diaper or he gets urine burns because he literally can soak a diaper in under annhoir.

[molly muffin]

Poor little guy. You are doing absolutely everything already that I can think of to try and help him. If he can get some strength in those back legs, that would be a big help and I think you are doing everything possible for him.

[Harley PoMMom]

I've read somewhere that if you can get them to walk backwards it helps to strengthen those rear legs.

[rescuemomma]

He can't walk at all. He has a cart and we've been working on tha but even his front legs are weak. A few steps is as far as he's gotten. Poor guy has no muscle mass. None. Anywhere :(.

Had a long talk with my Vet yesterday - has anyone tried Anipryl? It doesn't treat Cushings but when I was looking it up it looks like it can be useful to manage the symptoms but the reason my Vêt even suggested it is we are pretty sure that Rex also has Canine cognitive disfunction - AKA doggie Alzheimer's. We notice he is a lot worse in the evenings and nights. So we're consisering to trying him on that and seeing if it helps him.

[Squirt's Mom]

My Squirt was first put on Anipryl (Selegiline) when she was first diagnosed with Cushing's and it did help her for about 9 months....a LONG time for this drug to help a cush pup. But she was not normal so.... ;):D Kinda like her mom! :p As she aged she also developed dementia and we tried the Anipryl again for that but it didn't help her as much as an OTC product no longer available sadly. Since that is no longer an option, I would most certainly give the Anipryl a shot!

[judymaggie]

Hi! One suggestion re dementia -- I started my Abbie on Senilife (primarily an antioxidant mix) and I saw significant positive changes with regard to her awareness of her surroundings and less of that vacant look. The manufacturer recommends a trial of a couple of months before giving up on it. I actually saw changes within a few weeks. I purchased it on Amazon -- best price I could find and, as I recall, there were no shipping charges. The Senilife is a small tube -- I cut off the end and squirted the insides into her food and mixed it up.

[rescuemomma]

I'll have to look into some of these options. The restlessness and excessive drinking are our biggest issues, and we can't find any medical reasons to explain them - So my vet feels even the excessive drinking even might be a result of the anxiety and restlessness caused by canine cognitive disfunction, although we do think he's likely a very mild Cushingoid dog, his test results are high but not QUITE what would be consistent with cushings so we're choosing not to treat the Cushings itself, but rather see if we can help with the restlessness and anxiety and see if that helps make his other symptoms more managable as well. Not giving up on this gut without exhausting all our options for improving his quality of life!

[westcoastflea1]

as much as i dont want to bring this up if it saves your dog from any unnecessary tests, medications, stress, then i feel i should.
my daughters japanese chin winston had Degenerative Myelopathy
several vets said it was just old age creeping up needless to say they wrong
near the end winston would cry at night.
if your dog does have dm you have rescued him in the middle of the disease see below

Owners of dogs with degenerative myelopathy may notice one or more of the following signs as their dog’s disease progresses:

FIRST:
Dragging of the rear paws; knuckling-over on the rear toes
Sores on top of the rear paws
Abnormal wear of the rear toenails
Lameness; limping (starts in the hind end; progresses to the forelimbs)
Spastic, long-strided rear movement
Difficulty jumping, running, rising or walking
Balance and coordination abnormalities (ataxia)
MIDDLE:
Muscle wasting of the hindquarters from disuse and neurogenic atrophy; mild to progressively profound
Incomplete paralysis of the hind legs (paraparesis)
Complete paralysis of the hind legs (paraplegia); inability to stand or walk
Incontinence (urinary and/or fecal)
Urine scalding
Bed sores
END:
Incomplete paralysis of all legs (tetraparesis)
Complete paralysis of all four legs (tetraplegia)
Difficulty chewing or swallowing
Difficulty breathing
Affected animals usually become incontinent late in the course of the disease, although they do not seem to be painful. In fact, one of the key clinical features of canine degenerative myelopathy is the absence of any localizable spinal pain.

your vet has given you the same instructions that would have been given if your dog had dm im referring to

exercise,massage stretching of the affected limbs hydrotherapy etc.

Have a dna test done. it will let you know if your dog has any one of several diseases, dm being one. i would also have a uccr test done that is the first test that should have been done to diagnose cushings
take 3 days morning urine that have been kept in fridge mix together
drop off at vet and say you want a uccr test done it will tell whether he is cushings or not PERIOD. NO GUESSING GAMES. even if he is cushings his numbers are not high and ruling out dm or something similar should be your priority, no reason to subject your dog to anymore acth tests or put him on vetoryl. see if you can get a medication to help stop frequent urination . get dna results back discuss with vet and go from there. im sorry to bring this up and hopefully im wrong i just felt it was the right thing to do

[rescuemomma]

We've ruled out DM. Other then the muscle weakness he has none of the symptoms. There's thousands of things we COULD test for, but reality is, he's an old dog, and at this point, managing symptoms to improve his quality of life for whatever time he has is all we really are looking to do. If he where a younger dog a firm diagnosis may matter. But in a dog his age that's been neglected most of his life, we just want to make his end of life as comfortable as we can. There's no reversing this severe of muscle wasting. We'd love to see some improvement and are already seeing it, but I doubt he'll ever walk again even with a cart, but the cart allows him to feel more normal so he can enjoy watching the other dogs and interacting more. There is no treatment for DM, so spending the money to find out when muscle weakness is the only symptom he has and we can explain that dozens of different ways, it's just not worth spending the money since it wouldn't change what we're going to do for him anyway.

[Harley PoMMom]

I do believe with our elder dogs quality of life is paramount and making them comfortable as possible should be the focus, so I certainly understand the reluctance in doing more testing since this would be added stress for Rex.

I think the one thing that may help him the most is getting that extra weight off of him and from your first post I gather that you are already trying to do this. Does he have a normal appetite or one of a cushdog?

Hugs, Lori

[rescuemomma]

Definately one of a Cush dog. I'm adding canned pumpkin and fiber to his food to help him feel more satisfied with the amount I give him. The weight is coming off slowly but we still have a ways to go. I agree getting the weight off will do a lot to help improve his overall comfort and quality of life.

[Harley PoMMom]

Many of have found that frozen green beans and carrots help with that hunger, and man, do those cushdogs have an appetite. :eek:

[rescuemomma]

Ya but they're higher in sugars then the pumpkin and they all serve the same purpose LOL. Sugars make getting weight off even harder so I usually use pumpkin instead of green beans or carrots.

[westcoastflea1]

well thats a relief that they have ruled out dm i have to agree with others that quality of life is most important, sounds like that is priority to you which is awesome good luck to you.