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A Max Update

Posted: Thu Sep 22, 2016 11:30 pm
by maxs_mommy
I realized it's been awhile since Max's last update. He's 10 1/2 now and the cushings is doing a number on us all. I wonder sometimes if Addison's would be easier to manage but I don't want to go down that road. Last fall we did anipryl and it helped a lot until he built up a tolerance. Then we increased the dose until we were maxed out. Now we're on Trilostane and trying to get the dosing right. The trilostane is helping and it's not. Some symptoms are better but his energy is markedly decreased, even to the point that he's sometimes refusing walkies, which are usually a source of great excitement. We're still fiddling with the dose and testing his acth levels monthly (which you would assume is akin to abandonment and torture to hear him tell it). I found a local compounding pharmacy to put his meds in a beef chew and, thanks to the folks on the K9 Cushings forum, learned that 2x/day dosing offers more control than 1x. Hopefully the house-soiling can come back under control. Nothing wakes you up faster than stepping in a puddle of pee as you stumble without contacts to let the dog out in the morning. I'm hoping we get this stabilized very soon.

Because of the trilostane and his newly minted, mostly functioning immune system, his allergies have been on full swing. He's been to the ophthalmologist several times in the last month because his eyes looked like he's been stoned for a week straight, no ulcers though, thank goodness. Usual course of treatment is steroids but since that defeats the trilostane we're doing a combo of Doxy and Niacinamide, which I had never heard of but apparently mimics the immune effects of steroids without actually increasing the hormone levels in his body. We're on this for the indefinite near future. I'm not really sure what long-term doxy effects are in low doses (50mg/day) but I don't have a good option otherwise. Costco pharmacy will let you sign your pets up for a discount card which really helps. We've discontinued the cyclosporine for now. I really have to hand it to his ophthalmologist, she's fabulous. If she were to go into GP I'd be hard pressed not to switch. She thinks out of the box but pulls no punches getting symptoms under control and fixing the root of the problem. We see her way too much.

In the last month or so Max has gone mostly deaf and I haven't figured out the hand signals he knows so there's a learning curve there for me. He can hear high noises if they're sustained over about 5 seconds or so but low pitches are gone. His hind end is also trembling and going out from under him a lot more. There's a constant twitch, even in sleep and jumping on things is a lot harder. Any recommendations for pet stairs? He had an adjustment last week, with only one sacral spot out of joint, plus one cervical and one shoulder adjustment. Maybe accupuncture? I feel like I'm throwing things against a wall to see what sticks. I'm also reasonably sure I'm on track for a "Thanks for being a top 10% customer" christmas present again this year. *sigh* Thank dog the vet still takes my calls though they know me by voice I think.

I'm horrible at this old dog thing but I don't know any other option. Getting old is hell but you'd never know it if you asked him. Max snoozes when he wants, gets treats for showing up and not eating cat barf, chooses the walk route and is still chasing bunnies out of the garden. It's good to be Max.

Re: A Max Update

Posted: Fri Sep 23, 2016 1:02 am
by JudyL
I'm glad you are continuing to find ways to manage his condition including the dosing of the medicines. I've found that to be very important with all of the meds for Cinnabon. I've been charting it out and really thinking about the effects of each and when the optimal time to give each one for maximum benefit or to minimize side effects.

It's definitely draining at time caring for these aging dogs, at least it is for me.

About the doxy and niacinamide, ChiChi was on both of those for her autoimmune issues. She took the doxy for almost 7 years, and while it can be upsetting to the GI tract like any antibiotic, she never had a problem with it. I gave it with a meal or a small amount of food, and some of the time I didn't give probiotics either. At the end of her life she did have some ulcers in her mouth and probably in the esophagus and maybe the stomach, but that also could have easily come from the increaseing kidney values too and not necesarily the doxy.

She was also on the niacinamide until she developed all the microfractures of the cornea over the entire surface of both eyes that was from dry eye issues, and I found an article that said that a side effect in humans is dry eyes. I just did an online search and found the site - it was from the Mayo Clinic. It also says that it can cause inflammation of the cornea. Of course, my (old) regular vet thought I was crazy and wouldn't listen to anything I said if it was info I'd read on the internet and snottily asked where I'd read that tidbit. There was a lot of silence from her when I told her I knew to read only reputable sites and where I'd found the info. She still didn't believe it even after I dropped off a printout of the article. Thank goodness I had a great opthalmologist. I don't remember if he agreed that the niacinamide was the culprit for her eye troubles or not, but we decided to stop using that and see if her AI problems got worse without it, and they didn't so I never started it up again.

Here's that page, if you are interested: ... B-20059838

Re: A Max Update

Posted: Fri Sep 23, 2016 10:26 am
by JudyL
Hi Ashley, since our chat last night I had a chance to look up Chi's meds. She was originally put on the niacinamide and then the doxy after the biopsy. The eye problems surfaced about 7-8 months later and that is when I took her off the B3. I didn't notice any slip backward so I can't say that the B3 was really helping since she was on the doxy too. Initial eye ointments were cyclosporin and vitamin A ointment for the mineralization, dosages tweaked as needed later on depending on the vet's evaluation. At a point near the end when we treated another ulceration, she was on cyclosporin, Ketorolac, and Tobramycin abx drops, and the vitamin A was discontinued at that point.

Maybe some of that will help you or someone else. If you'd like more details on the frequency of dosing, I do have all of that, but didn't think that would be overly helpful as it seemed to be tailored to her individual needs and situation.

Re: A Max Update

Posted: Sat Sep 24, 2016 12:54 pm
by LisaT_II
Yeah, the doxy/nia is a powerful combination. Each time I've used it, I've always tapered off the niacin and stuck with. The doxy, though some dogs may need some extra niacinamide. I've had all my dogs on this mix for various immune system problems, you might play with the dosing down the road.

Baking soda can help if there is any acidity caused by the doxy, but separate them.

I like the stairs that are foam. The ones I have are very sturdy, I got them off ebay years ago, but I see specials come through groupon from time to time. I have a hard firm plastic set with carpet that all my dogs hate. I also have some plastic put together short steps, and those work for my 20 pound dog. But the foam ones I think are better for their joints.

Re: A Max Update

Posted: Wed Sep 28, 2016 11:43 am
by MaisyPancakes
Thanks for the update, Ashley! I hear you with old dogsā€”it is really effing HARD! I'm so glad you like the ophthalmologist! Liking the vet helps tremendously. Do you see a rehab vet for his owies? (Sorry, I can't remember anything...) If so, (or maybe even your regular vet might do it) trigger point therapy might help with Max's spams. It can be painful during the procedure, but it can immediately release some stubborn and painful spasms. My rehab vet has done it for MP a few times when we came in with big knots that was making her gait even weirder. They just use acupuncture needles for it.

Doxy apparently has some anti-inflammatory functions and is sometimes used for pain management, so it might be helping him in that way, too. We talked about possibly doing that (my rehab vet prefers Minocycline) with MP, although not sure now. Has anyone mentioned cannabinoids for Max?

For steps, I've noticed MP likes wider ones that aren't too hard, but with less give than regular foamy ones. I'm looking, too. Someone not on ODO suggested cutting up insulating foam "sheets" and covering them up, which seemed cheap and promising.

Re: A Max Update

Posted: Sun Oct 23, 2016 3:30 pm
by Jen
Poor Max, he sure is lucky to have you. I don't really have anything useful to say, but I hope you get it all stabilized quickly.

Re: A Max Update

Posted: Sun Oct 23, 2016 4:13 pm
by connie
Old dogs are hard, and chronic ailments are hard. Put the two together, and it's like you've got a constant, permanent nagging worry in the back of your mind and your shoulders are a bit tight all the time. :crazy:

It sure does increase your store of knowledge, though! Ignorance may indeed be bliss, but we don't have that option. Keep on going, Max, you're a fine old fella and I'm sure you'll be a fine old fella for a good while longer. :love:

My topic of the week: probiotics! Foods that have them are needed by dogs who take abx regularly, or infrequently at high doses.