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Old 03-15-2012, 05:36 AM   #1
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Default zowi has a yeast infection in ears / scary rx combo

hello all.
my dear zowi has been doing great for the past 4 months and her cushing's has been controlled to "exactly where we want to be" according to her dogtor. march 1st she went in for her 6 month checkup. she had a full senior workup, bloodwork, including checking her thyroid, etc. her dr said that zowi looks great and all of her labs show that she is "strong and stable." zowi was 10.9 pounds back in spetember. after a diet change and addition of new meds she is down to a healthy 9.2 pounds! all great news!!! but now this...

last sunday night i noticed zowi scratching her right ear and rubbing her head on the floor and furniture. she allowed me to look at the left but wasn't too happy when i checked her right ear. i couldn't see any problems but took her to the dr on monday. problem was that her regular dr is not in on monday or tuesday so we had to see someone else which had me very concerned with all of my girl's conditions.

microscopic cytology revealed a yeast infection. they did a thorough ear cleaning which left her shaking her head like crazy for a few hours. poor baby. she got an antibiotic/antihistamine injection and i'm giving her 1/4 of a 25mg benadryl to calm the itching per dr instructions. she was prescribed illini ear drops, a med that usually has the steroid dexamethasone in it but the pharmacy made zowi some without the dex mixed in, as a cushing's patient should not be given meds containing steroids. she has been getting the drops once a day. the part that has me so worried is that she was also prescribed ketoconazole! it is an anti-fungal med but can also be used for the treatment of cushing's. it is a last resort med for cushing's as it is known to frequently cause liver damage. I AM VERY CONCERNED WITH THE COMBO OF THIS ALONG WITH HER TRILOSTANE. the dr assured me that it should not be a problem but agreed that i need to closely monitor her as is it possible that her cortisol could get dangerously low using both meds concurrently. i was honestly so concerned that i waited until i could speak with zowi's regular dr yesterday (wednesday) morning before giving the keto. she explained there's not an alternative unfortunately and has given both concurrently to other patients with no problems. i told her i hadn't started it yet and she said that was fine but for lack of a better solution, to start the med so that's what i did. i am certainly not one to agrue with the vets or not listen but i was worried because this dr was not familiar with my girl and wanted to take the better safe than sorry approach. zowi will get her 2nd dose today although i do not feel totally comfortable with this protocol. i want my baby girl better but certainly don't want to cause any further harm to her. i also posted on the cushing's site i am a member of and did receive a response from a lady who went through the same situation with her mini poodle and she did not have any problems with the combo. i also double checked with a human pharmacy asking about interactions and was told that as long as the keto is only given temporarily it should be ok. there would be great concern if it was permanent. so zowi is on a very low dose of ketoconazole (25mg once a day) for 8 days and will have her infection rechecked march 26th. i am watching zowi constantly and so concerned right now, i hardly slept at all last night. i know you guys understand completely!

does anyone have any advice or alternative ideas that i could discuss with zowi's dr? or opinions on this protocol? i sure hope this clears up quickly. zowi has pretty much stopped the scratching and rubbing, so i am very happy that she is comfortable right now. sorry this is so long as usual lol. thank you so very much!
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Old 03-15-2012, 07:00 AM   #2
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I'm familiar w/ this protocol bc we tried Keto on Wylie for a while (atypical Cushings)...he did fine on it; but Lysodren (trilo) ended up being the most effective for him. Keto does have some history of causing liver issues, but it is still an excellent med when used correctly and you know what you watch for. Wylie had no effects at all when he was on Keto.

Now, as far as the chance for excessively lowering her cortisol....you do keep steroid at home, right? With Cushing dogs, you should always have a bottle of just-in-case steroid at home (I think we have 10mg pills or something?), to be used if your dog was suddenly showing very low cortisol symptoms. I've never had to use it, but it's a key emergency med to keep on hand for Cush dogs...just in case.

I hope she feels better and better. Hugs to you both!
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Old 03-15-2012, 07:46 AM   #3
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I don't have experience with this. Just want to say that I hope Zowi's ear infection clears up quickly!
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Old 03-15-2012, 07:59 AM   #4
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thank you ann! i thought i remembered you posting about wylie occasionally having some skin issues previously and of course because it's fairly common with a cushing's pup. did wylie ever have to take ketoconazole and lysodren at the same time?

yes, i do have some prednisone (pills) on hand for emergency only that i was given at the time zowi started her trilostane. thanks for mentioning that, you're right it is key. we do always watch for signs of overcontrol but especially now that she is taking 2 medications (ketoconazole and trilostane) concurrently that can both lower her cortisol. as far as just being on the trilostane alone zowi has not had any side effects and has always had a good appetite and no upset stomach with the med which is very important as you know. i am just concerned that taking both meds at the same time puts us at a much higher risk of addisonian crisis right now and zowi's dr agrees that is a concern. i wish there was a better way.

thanks for your response and well wishes for my girl! we appreciate it very much! hugs to you and yours as well!
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Old 03-15-2012, 08:00 AM   #5
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thanks for the well wishes linda and i hope so too!
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Old 03-15-2012, 02:59 PM   #6
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You and your little ones are in my heart and my thoughts. I hope Zowi gets better soon. With your love, devotion, and careful monitoring of her, I am confident that she will.
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Old 03-16-2012, 06:11 AM   #7
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Quote:
Originally Posted by zowiandnikasmom View Post
thank you ann! i thought i remembered you posting about wylie occasionally having some skin issues previously and of course because it's fairly common with a cushing's pup. did wylie ever have to take ketoconazole and lysodren at the same time?

yes, i do have some prednisone (pills) on hand for emergency only that i was given at the time zowi started her trilostane. thanks for mentioning that, you're right it is key. we do always watch for signs of overcontrol but especially now that she is taking 2 medications (ketoconazole and trilostane) concurrently that can both lower her cortisol. as far as just being on the trilostane alone zowi has not had any side effects and has always had a good appetite and no upset stomach with the med which is very important as you know. i am just concerned that taking both meds at the same time puts us at a much higher risk of addisonian crisis right now and zowi's dr agrees that is a concern. i wish there was a better way.

thanks for your response and well wishes for my girl! we appreciate it very much! hugs to you and yours as well!
I think Wylie was on Keto and Lyso at the same time for a bit. But, it was more bc we were decreasing one, while starting the other. I didn't see any signs of him heading toward an addisonian crisis.

What was her last post-test? Maybe you have more wiggle room if her post number was high-normal...?

Another thing...if you're super worried, you could talk to the vet about lowering the Lyso just during Keto treatment. It's a short duration...and lowering the Lyso temporarily shouldn't really make significant changes. If you're really scared about this combo, it may be worth asking your vet about this.
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Old 03-16-2012, 01:19 PM   #8
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Quote:
Originally Posted by Wylie's Mom View Post
I think Wylie was on Keto and Lyso at the same time for a bit. But, it was more bc we were decreasing one, while starting the other. I didn't see any signs of him heading toward an addisonian crisis.

What was her last post-test? Maybe you have more wiggle room if her post number was high-normal...?

Another thing...if you're super worried, you could talk to the vet about lowering the Lyso just during Keto treatment. It's a short duration...and lowering the Lyso temporarily shouldn't really make significant changes. If you're really scared about this combo, it may be worth asking your vet about this.
thanks again ann. glad to hear that wylie never had any problem, that is a bit of relief. zowi's last post result for cortisol was 67.2 ng/ml with a normal range of 65.0-174.6 ng/ml but she did at one point go down to 49.6 without any signs of overcontrol so possibly there is some wiggle room? (we use u of tenn for monitoring so this is not the usual measurement where normal would be from 1.0-5.0 and i'm not sure how to translate to ug/ml.)

you mention a very good point about lowering the trilostane temporarily. especially with the weekend approaching, i think i'll try to reach zowi's dr today and see if i can give her half the trilostane dose at least just until monday if not until the keto is gone. can't hurt to ask and i will follow whatever she says to do. zowi has had 3 doses of keto, thankfully with no problems so far so the worrry has lessened some but i'm definitely not letting my guard down. 5 days to go....

thanks again so much for the input and for sharing your experience, i appreciate it very much! hugs ~ carrie
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Old 03-16-2012, 01:30 PM   #9
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We have a Golden Retriever who get ear infections all the time, and after many different medicines that did not work I finally found one that did. It is called Zymox, you can get it with the steroid or without. It is fairly inexpensive and does not require a prescription. I get it on Amazon I usually get a 4 oz bottle for about $25 but the one without the steroid I think is a little cheaper. You can buy smaller and larger sizes. It has triple enzymes in it, along with a few other things. It works great, my golden has been ear infection free now for about a year and for us that is a milestone.
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Old 03-16-2012, 01:34 PM   #10
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Quote:
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You and your little ones are in my heart and my thoughts. I hope Zowi gets better soon. With your love, devotion, and careful monitoring of her, I am confident that she will.
aaww lisa you are so sweet. it is great to hear from you! you and john and your furry angels are also in my heart and thoughts and i always always wish you all the best!

zowi has pretty much stopped the itching and shaking so she is doing better. on the 26th they will recheck everything and hopefully it will be all cleared up. she has been doing so great the last 4 months, so much more comfortable and energetic! she can keep up with her little sister pixie who is about 22 months old now!

thanks so much for the well wishes and we hope all is well with you! hugs~carrie
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Old 03-16-2012, 01:54 PM   #11
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We have a Golden Retriever who get ear infections all the time, and after many different medicines that did not work I finally found one that did. It is called Zymox, you can get it with the steroid or without. It is fairly inexpensive and does not require a prescription. I get it on Amazon I usually get a 4 oz bottle for about $25 but the one without the steroid I think is a little cheaper. You can buy smaller and larger sizes. It has triple enzymes in it, along with a few other things. It works great, my golden has been ear infection free now for about a year and for us that is a milestone.
thanks for the info, i appreciate it! glad to hear that your golden has been without an ear infection! i will definitely ask zowi's dr about using this, especially the ear cleanser. this might have been what they used to clean her ears at the dr's office with? i would also have to be absolutely sure that there are no steroids in it. cushing's pups are prone to skin, ear, and other infections so good to know about this!
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Old 03-16-2012, 07:25 PM   #12
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Hi, Carrie & Zowi. Ted's sending his "sweetheart" get well soon wishes. Sad to think his little love hasn't been feeling well. Prayers from us xo
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Old 03-17-2012, 02:47 PM   #13
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Hi, Carrie & Zowi. Ted's sending his "sweetheart" get well soon wishes. Sad to think his little love hasn't been feeling well. Prayers from us xo
hello corrinne and ted! i told zowi that she got love and well wishes from her sweetie and i know that it made her feel better. zowi is such a little trooper! she really dislikes the ear drops but shes so sweet and lets me do it anyway. poor baby, it makes me feel terrible. i did get justin to do it today so i think from here on out it will be his job. hehe.

she has been doing great otherwise, so hopefully we will be able to clear this up and have no more problems! nice to hear from you!!!
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Old 03-17-2012, 03:35 PM   #14
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I don't have any experience with cushings whatsoever, but I do have a dog that has chronic yeast infection issues. We have never given injectable antibiotics or antihistamines for it. And we have never given oral antihistamines.

Is there something wrong with Otomax or mometimax (may contain steroids, don't know)? Zymox has a formula available with and without cortisone. I've never even heard of using oral keto for a yeast infection in ears. Not saying it doesn't work, just that it sound like a huge thing to do over a minor issue.

Don't know how steroids in ears (like the good form of zymox) affects a cushings dog systemically. Vet says absolutely not?

Just looked it up. Otomax looks like it does contain a steroid. I think zymox may work if you get the one without. Something to talk to your vet about. Most vets don't use it yet. Then there is another very new product. Blanking on the name. It's like a caulk that the vet can put in and it stays there releasing a drug. Don't know the active ingredients, but might be worth a look.
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Old 03-17-2012, 03:50 PM   #15
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My late Molly who had Cushings as well as many other problems had to take Keto many times. She would get bad yeast infections on her feet and ear's. We had to have the Keto compounded at the Pharmacy for her. But she did really good on it. Just like you anything that had steroids in it was a no, no. That made it so hard at times since we were limited with what Rx's to give her at times for certain issues.
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