Frustrated and worried from afar
 

Hi, everyone. I'm new here and am hoping this community might be able to educate me and help me develop a list of questions for my boy's next vet visit. A little background to begin:

In 1997 I was an angst ridden fifteen-year-old who cried for three days before my parents caved and went to the pet store to rescue the little Yorkie I was already calling "Toto." (I'm hoping this won't turn into an argument about how we acquired him as it was a long time ago and we weren't educated about puppy mills, etc.)

Fifteen years (and half my life) later and here we are. I'm a "grown up" who moved to California and Toto is a senior who lives with our mom in Florida. He's lost his hearing and can't see very well but my mom swears he still wags his tail for "cookies" and likes to go for short walks.

For at least the last year he has had major issues with barking relentlessly. Day or night, even at 3:00am. Mom says he is constantly wanting to be fed. In the last year (maybe longer) the vet diagnosed him with renal disease and his food was switched to something for seniors, much to his dismay.

My mother has been talking about his skin condition for several months now and I have been checking in with her every day for the last few weeks. He has always had sensitive skin issues but lately his itching and little bumps have gotten worse. He has skin discoloration in the form of dark spots. The vet had her buy a special shampoo a few weeks ago and she bathes him every few days but she says it doesn't seem to be letting up.

The vet mentioned that Toto "might have Cushings" but from what I know he offered no tests to diagnose it. Currently my mother is trying to give him homeopathic "remedies" on the advice of my aunt. To say that I am skeptical of the homeopathic treatment regimen having any kind of effect would be a vast understatement but my mother swears it has helped him with other things before. It's a losing battle so I no longer argue with her about it. She is his primary caregiver and does everything she can. She loves him just as much as I do. She even knows him better since I have lived across the country for the last five years.

She says he won't let her hold him for very long but that he has been pretty good when it comes to the baths (meaning he doesn't put up a fight or struggle). He sleeps on a pillow in her closet. He sleeps a lot. He needs to pee in the middle of the night and when he barks and wakes her up she takes him out.

I want to be respectful of my mom because of all the work she does to care for him and all the love she gives him in my absence. But I don't get the sense that she has been pushing the vet to give him a proper diagnosis.

I am hoping that this community can help me put together a list of questions for her to ask (or present to) the vet when she takes Toto in. She will go this weekend or first thing next week. I want the vet to be more definitive as to what is going on inside of my dog. I know Toto doesn't have a lot of time left but I want to make sure that he isn't suffering. I want to make sure he is never in pain. And I want to make sure that I go home to be with him and spend time with him as soon as I can. Especially if he is about to seriously deteriorate.

I appreciate any help you are willing to give and any kind words you might have to say. Again, I know he's lived a long life and that we are lucky to have had him and loved him for so many years. He has given us so much joy and I want to make sure that in the end we do right by him.

Thank you in advance for your contributions to my first post. I have to go to sleep now. I will be out during the day but I will do my best to check in when I can.

I don't really know what questions that need to be asked, but I am bumping this so hopefully someone who can help will see it. I know it has to be hard, getting information from afar, and the thought of Toto declining has got to be really miserable for you. Good luck in getting some answers and post updates when you can. Good thoughts for Toto's comfort and health going out...:)

First, WELCOME :)! So very glad you found us.

And omg, as I was reading the first 5 paragraphs I thought "she needs to check for Cushings"! This was especially apparent for me when you said the little line "he always wants to be fed". That is a red flag sign of Cushings, bc their cortisol is elevated and just like with humans, when our cortisol is high...we want FOOD. My Wylie has Atypical Cushings, so I'm always keenly aware when people describe a certain symptom group. Cushings is SO often missed by generalist vets bc it's a very complicated disease that has generalized symptoms that can appear to be almost anything. A good vet will suspect Cushings after a certain point, so it's great that your Mom's vet even mentioned this.

If it were me, I'd definitely check for Cushings. The first step is a Cortisol Creatinine Ratio Urine Test - that test is *not* firmly diagnostic, but it's the first step bc it's way cheaper than just jumping on in and doing the major Cushings tests. The CC Ratio Test will at least point you in the direction of whether or not you need to proceed to the next step of actually doing the Cushings test. If the CC test is positive (elevated), then most vets suggest an ACTH Test and an ultrasound of the adrenal glands. If that test is positive and if the clinical signs of Cushings are present, you treat for Cushings. If that test is negative, you keep looking. If that test is borderline, THEN you need to send blood to the Univ of Tenn Endocrinology Lab - they're the preeminent center for dogs w/ Cushing, truly an amazing place. They can diagnose (your vet cannot) Atypical Cushings. And btw, many people's vets will suggest they go to a Vet Internist when diagnosing Cushings, bc it's a very complex disease and is often best managed in the diagnostic stage by an Internist. Just keep that in mind.

Tell your Mom that if it *is* Cushings, it truly DOES need to be diagnosed bc otherwise she will have a dog with continuous miserable skin infections, ear infections, hair loss, loss of muscle mass all over, insane hunger, increased water drinking and increased peeing (!!!), dog may develop a pot belly, lethargy, heat intolerance, thinning of skin all over, leaching of calcium from bones and about 20 more symptoms I'm not thinking of. When cortisol is elevated, it throws off EVERYthing in the body...it's a powerful little chemical. Do these symptoms sound like him?

Given his age, again if it were me....I *might* not get the ultrasound. If the ATCH was positive and the clinical symptoms present, then from there I'd probably just go ahead and treat. In other words, if money is an issue for your Mom - the thing to consider not doing (based only upon strength of results of the other tests) is possibly the ultrasound.

Has his thyroid been checked and has he been checked for Diabetes? Those are both things to check in and of themselves, but also bc they can go hand in hand w/ Cushings too, esp hypothyroid.

Also, I'd get his skin tested ASAP bc untreated / undiagnosed Cushings dogs are notorious for rampant skin infections, and even if he isn't Cushings - it still sounds like a possible infection. You don't want that infection going any further, bc they can really wreak havoc. The vet can do a quick skin scraping and look at it under scope - he will quickly be able to see if there is bacterial overgrowth; if there is, it's likely pyoderma (staph intermedius) and should be treated w/ Simplicef. If fungal is suspected too, then he'd grow out a sample in culture and you'd get results in about 10-14 days.

Cushings is not easy to diagnose or treat. If a kiddo has Cushings and you begin to treat - it can take a long while to get the med titrated. The meds are harsh - and you have to start slow, ramp up, and then do the ACTH test again to see if the dosage is controlling the cortisol. If it isn't, then you have to increase med, wait 6 wks, and ACTH test again. This can go on for quite a while, as you can imagine.

I've probably barraged you with enough info to bore you to tears already so I'll leave you w/ some Cushings links that I think are good, in case you want to do more reading:

Here is a link to UofTenn's endocrinology lab (only if needed later).

This is my fave Cushings overiew.

This is a yahoo group for Cushings; I don't post there, but I def recommend joining if Toto has Cushings bc the archives are AMAZING. There is a ton of info there, so try not to get too overwhelmed. I had a long learning curve in really understanding Cushings, and this is typical of other pet owners who are dealing w/ Cushings. It's a very complex disease, so it takes a while for things to gel.

Please stay in touch and let us know what happens; if you have any other questions, don't hesitate.

What a great posting of info Ann just gave you! I know that will help.

I just wanted to say Welcome to the forum and I will keep toto in my prayers. I know it has to be hard on you being so far away during this. I love how you are approaching things with your mom...you obviously love and understand that it is even harder on her having to handle the issues. Your love for your mom and for Toto shines thru. Very nice to meet you!

I agree, Ann did a wonderful job of giving info. I wanted to welcome you and your pup to YT. I will also keep Toto in my prayers and you as well. You definitely come to the right place!

Ann,

Thank you so much for your detailed response. I now feel better equipped to approach the situation. When I get home today I will go through all of the information and put together a list that will (hopefully) not overwhelm my mom. Thank you for taking the time and for caring about my boy. I will update you and the rest of the kind people in this forum as things develop.

I can't respond to everyone now but I am deeply touched by the love and compassion of this community.

Praying

Sending prayers....

I am so sorry that I have no advice, your post has had me in tears and I can only imagine the worry you are having right now. It would seem you are a very caring and intuitive person with a very close relationship with your Mother. No matter what your age, your Mother is trying to do what is best for everyone and is probably overwhelmed with trying to make decisions for this little one.
If you feel she is not demanding enough of the vet is there any way that you can both bring this baby to the next appointment, so you can be the demanding, persistent, I need a diagnosis one?
I wish you all the very best and hope you can keep us updated, I know that so many here will be thinking about you.

Thank you, thank you, thank you for bumping my post. I know I'm a newbie and don't have a lot of "cred" here so it means that much more that you took the time to help. I will make sure to post updates when I am able.

Ann,

My mom said that he has never been diagnosed with a thyroid issue but that she wouldn't be surprised. She became overwhelmed by some of the questions I asked when I spoke with her this afternoon and I wasn't even working from your list directly. I was asking about his eating patterns today and his behavior in general.

She mentioned that he did not finish his breakfast this morning. He left half or maybe a little bit less than half. He did the same thing yesterday and it's unlike him. She said today he slept a lot. While I was on the phone she broke up a Milkbone cookie for him. He used to break them up himself but Mom does it for him now to make the chewing easier. She set it down in front of him and he sniffed it and walked away. That, to me, is a massive red flag. He lives for the Milkbones.

I am getting the sense that he may not have much time left. Mom says his breathing patterns haven't changed but I told her to look out for that since I have done some reading and it has been mentioned as a major sign of the end (if I'm wrong, please let me know).

I will be looking at flights tonight and booking something for early this coming week. I need to see him and give him whatever love he's willing to accept at this point. He doesn't like being touched a lot because of his skin condition but he might make an acception for me a few times. I just want him to smell me again and feel me there. I also want to be there for my mom to talk about the reality of the situation. Perhaps we will take him to the vet together but I'm not sure how openminded she would be about that.

I don't know how close he is to the end but I really hope to make it back in time to bestow some love upon him. I'm getting over a cold and I'm wondering if I'll be good to fly by Tuesday evening. That would be ideal.

Thank you again. Let me know if any of the new info I shared strikes you in any way. And please say hi to Wylie for me. What a lucky pup to have a mom so loving and educated. :)

Misty,

I am going to fly home as soon as I can (possibly Tuesday night) and if my mom is open to going to the vet together I will try to make that happen. Thank you for your kind thoughts and support.

Welcome. My pom had Cushing's and had all of the symptoms you mentioned. She had those black spots, the excessive hunger and thirst and needing to go out during the night. Ann's post gives you all the information you should need to get Toto checked for Cushing's. I hope your Mom in receptive to getting him tested and treated. Please keep us posted.

You're so welcome :).

Aw, your post is so heartfelt and it makes me realize, once again, how unfair it is that these precious little beings have shorter lives than we do. They give us such unconditional love. It's very hard to think of them aging, or watch them aging...when you want them there forever.

That is indeed strange that his eating is suddenly a bit off. And yes you're very correct - when dogs avoid their food, it's a big red flag that something is wrong. It does sound like he has something else going on here, but it's hard to say if it's just a little, quick tummy bug/issue...or something bigger. His age, as you know, causes all those additional concerns like you mentioned above (ie, how much time he has left).

I'm so glad you're able to fly home and see him and your Mom. It must mean so much to your Mom bc I'm sure she's overwhelmed and wants to do the right thing both by Toto and by you. A trip to the vet would be great, bc at least then the vet could give some guidance as to whether or not they think Toto has a lot of time left, or not...it can be hard to judge those things though. The vet could help with the skin condition, so that may give him some relief while you're still there and able to hold him. A steroid shot may give him more immediate relief too (in addition to an antibiotic, if that's what the skin needs).

I hope the trip goes well, please let us know what happens if/when you can. As for that Wylie man, I am indeed lucky to be 'owned' by him :p!

OP I just wanted to add my thoughts and prayers. Our boxer had Cushings and although this is a Yorkie forum everyone was amazing in helping us especially Ann she is absolutely wonderful! I hope you are able to get answers from the vet I know it's frustrating.