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Ask Dr. Michael Salkin Your Own Question

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog
Satisfied Customers: 23846
Experience:  University of California at Davis graduate veterinarian with 44 years of experience.
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My westie is 14 and 2 days ago suddenly took a change..He

Customer Question

My westie is 14 and 2 days ago suddenly took a change.. He became lethargic, straining to poo but only passing tiny amounts. He peed in the kitchen both nights which he never does. He does have cushings disease and is regulated by vetoryl - he was just checked and his levels were stable. But unfortunately due to us ordering his pills online and there having been postal strikes in the area he missed his pills for 3 days. We got increasingly worried when he hadn't eaten in a day and a half and was being sick after passing faeces so last night we took him to our local vet. Although he was concerned he said he wasn't dehydrated and he was keeping some food down and their was only the 2 episodes where he was sick both after straining. He is peeing a lot and his penis is hanging down a little. Our vet felt it was an infection of some kind possibly urinary. Gave him an injection and some antibiotics to take with us. Today he has done a better sized poo hasn't peed anywhere in the house and has kept his food down and although he has slept in his bed most of the day he has been more awake and watching all of us. He had a temperature as well which he said suggested infection. Now I know he's old and he's not going to be around forever but I'd love to know you're thoughts. I haven't been able to eat in 2 days because I'm worried sick and although he's made small improvements do you think I should hand tight and wait a little longer to see how he gets on before jumping the gun and seeing the vet again - he seemed reasonably confident it was an infection.. I'm just sooooo worried - he is my baby! And this all happened suddenly Tuesday he stole food out the cats bowl - by Wednesday he had completely changed! Please help!


Since I wrote this he has shown some signs of improvement he's now up and walking about - seems a little weak - although that's not surprising! He seems to be holding food down and is keen to eat his favourite things although he's still a bit sleepy.


I suppose I have to remember it's only just coming up for 48hours since he saw a vet and this all takes time right? 

Submitted: 3 years ago.
Category: Dog
Expert:  Shantal-Mod replied 3 years ago.


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Expert:  Dr. Michael Salkin replied 3 years ago.
Aloha! You're speaking to Dr. Michael Salkin
I can only apologize for keeping you waiting for so long. Fever and inappropriate urination in a Cushingoid dog certainly does suggest urinary tract infection. You should see a demonstrable and positive change in Fergus within 72 hours of initiating therapy. It sounds as if he already is nicely remissing.

I'd be pleased to continue consulting with you if you wish but I do realize that I'm rather late to the party and so if you wish to close your question please click the help link at the bottom of your page and customer support will facilitate your wish.
Customer: replied 3 years ago.

Thank you for your reply.


He has started to come out of his bed although he's a bit shaky on his legs although our vet told us it takes long for an older dog to bounce back especially a Cushing dog.


Is there any point I should get more worried?

I don't want to jump the gun, he's making progress all be it slow.


I assumed because he was straining it was something to do with his digestive tract the the vet thought infection...


Expert:  Dr. Michael Salkin replied 3 years ago.
It's my pleasure. Curiously, I've seen more cases of Cushings than most other vets because I studied with the researcher who discovered o'p'ddd (mitotane) - the first and still used drug for addressing Cushing's.

Please note that urinary tract infection can nauseate our patients (and people). Concomitant gastrointestinal distress (vomiting and/or diarrhea) is relatively commonly seen. In addition, the same bacteria found in the urinary tract may be affecting Fergus's gastrointestinal tract. Thankfully, the same antibiotic that was prescribed should cover both body systems.

His cortisol levels were normal and so I'm not concerned that he's been overdosed with trilostane and has become Addisonian. I believe his shakiness is directly related to the fever and malaise of his infection and as long as he progressively improves as he's doing there's no reason for him to see his vet so soon again. Conversely, if he backslides don't hesitate to have him seen. In spite of normal cortisol levels we need to see that his sodium and potassium levels are normal. It's possible (although unlikely) to have normal cortisol levels and yet abnormal electrolyte levels that will then cause weakness and gastrointestinal symptoms. Cushingoid patients are fragile and infections need to be addressed promptly and thoroughly. Be sure that his urine is rechecked two days after the course of antibiotics is done. We need to ensure that his urinary tract has been sterilized.

Please continue our conversation if you wish.
Customer: replied 3 years ago.

He was off his vetoryl for 3 days and after this he went down hill but pur vet said this was due to his immune system being suppressed.


They didn't actually take a urine sample as he was so fragile when he saw the vet he could barely walk.


They assumed it was an infection and because of the symptoms it was assumed it was a UTI.


if they've got it wrong will the antibiotic still sort him out?


when he first got ill I thought his kidneys had packed in or something but thw vet seemed sure it was an infection??



Expert:  Dr. Michael Salkin replied 3 years ago.
Being off the Vetoryl makes an Addisonian crisis very unlikely. Stopping the administration of the Vetoryl is just what we do if we suspect the gastrointestinal distress and weakness of Addison's. It's true that excess cortisol levels are immunosuppressive and so presumptive antibiotic therapy is prudent - even if a UTI wasn' confirmed. His fever and inappropriate elimination support their use. It's still important to check his urinalysis - either now to make sure that the antibiotics are sterilizing the urinary tract or two days after the course of therapy is completed to ensure that the urinary tract is sterilized.

I would have no objection to performing a basic diagnostic panel of blood/urine tests rather than simply a urinalysis. You're quite aware that Cushing's affects all of our patient's body systems. Please continue our conversation if you wish.
Customer: replied 3 years ago.

We had been away for the weekend and last night was the first of us seeing him for two days.

he managed to climb the stairs to sleep in our bedroom.


When I took him out for a walk he did his poo almost immediately! And then did a very small one at the end of the drive then didn't really want to walk?


Does his need to poo suggest something different?


He is also still not really retracting his penis - however it's not become trapped or anything. He ate a whole bowl of food then climbed back into bed... Could it still be he is still recovering? Am I still too quick off the mark?



Expert:  Dr. Michael Salkin replied 3 years ago.
As long as his poo looks normal I'd consider his defecating tp be normal. His regularity may be altered due to his illness.

Paraphimosis defines the inability to retract the penis. It's caused by neurologic disorders and entrapment. If his penis can retract, however, I'd consider it not being kept in his prepuce to be due to overall weakness.

His eating well is a good prognostic sign but he's overall still weak and so should have repeat testing performed as determined by his vet.

Thank you for updating me.
Customer: replied 3 years ago.

It's smaller than usual and the first one is usually solid, then the next are usually very soft - but it's the difficultly he has to go that worries me.

The vet thought him not being able to retract his penis was just weakness.


What else could it be? A gastrointestinal bug?


We've decided if he hasn't improved anymore by Wednesday when the antibiotics end we'll take him back to the vet.

Expert:  Dr. Michael Salkin replied 3 years ago.
Thank you. His lower bowel is still inflamed. He's not constipated but, instead, has an urgency to defecate due to the inflammation. His antibiotics were prescribed to address an infection but some antibiotics can promote diarrhea. Can you tell me, please, which antibiotic you've been administering?

Yes, I'm concerned that the same bug in his urinary tract is in his lower bowel. Your plan is sensible.
Customer: replied 3 years ago.

Hmmmm... I can't remember it's name.

Pink round tablet comes in a red foil - I'm sure that doesn't help! I'll find out for you! He's had it many times.


well see because they never tested for a uti could it just be his lower bowl is inflamed and no uti?


I'd take him back right now - but I'm a worrier and he's my baby!


He has had a lot of infections in his anal glands but the vet said he felt very empty when he felt him - would he still feel this if his lower bowel was inflamed?



Expert:  Dr. Michael Salkin replied 3 years ago.
I suspect it's potentiated amoxicillin (amoxicillin/clavulanic acid). It's a good choice for urinary tract infection but does have the propensity to cause gastrointestinal distress.

Sure...if a UTI were never confirmed, his symptoms could be solely GI-related. UTIs are very common secondary to Cushing's however.

Yes, the pain of anal gland infection would still be noticed and evidenced by scooting and licking his bum.
Customer: replied 3 years ago.

See he's not been scooting or licking his bum. But I thought they would have picked up on an inflamed bowel at the start.


Maybe he has both... If the antibiotic doesn't help will they try a stronger antibiotic? He is still keen to eat - when you take him treats out he's looking at you for one!


is bum was acting like this when he went to the vet except his pops are a bit firmer now.


He also seems to be passing a lot of wind?



Expert:  Dr. Michael Salkin replied 3 years ago.
An inflamed bowel (colitis) is assumed when vomiting and/or diarrhea is present. It's not a specific diagnosis until we scope and biopsy our patients - something inappropriate to consider at this time.

Perhaps, but if he doesn't improve additional diagnostics are more appropriate rather than throwing another antibiotic at him.

His flatulence is a symptom of gastrointestinal distress. It would be prudent to check a urinalysis and see if evience of infection is present. If not, stopping the antibiotic may be more helpful than continuing it. We have to let his vet determine the course of action.
Customer: replied 3 years ago.

I'm worried it could be more serious such as liver or kidney failure.. He just had an ACH stim test for his Cushings 10 days ago - do they usually test liver and kidney function at the same time?


the vet didn't seem to think his liver and kidneys were the answer?


It's so strange that 10 day's ago they said how well he was looking for an old dog with Cushings and now he seems so different!


I'm so worried about him - he is my best friend!

Expert:  Dr. Michael Salkin replied 3 years ago.
Not necessarily. It would be prudent to have those tests performed periodically in any Cushingoid dog.

Your vet is the best judge but will need biochemical testing to confirm his/her thinking.

I understand. Don't hesitate to have him checked. You know Fergus better than anybody.
Customer: replied 3 years ago.

Are his symptoms a sign if these? Our vet didn't seem to think so.

I'm worried by leaving him till the antibiotic finishes we could be letting him get worse?


After all 14 is pretty old for a westie isn't it?


thank you for all your help so far!

Expert:  Dr. Michael Salkin replied 3 years ago.
You're quite welcome.

The symptoms of hepatic or renal insufficiency would fill the page you're looking at.

Your worry should prompt re-evaluation of him. We have to be aggressive when addressing Cushingoid dogs.

14 is past life expectancy (11-13 years). Every day is a gift at this time.
Customer: replied 3 years ago.

Okay, I'll take him back to his vet tomorrow. Perhaps his time is up but I won't let him go without a fight!


Hopefully it will be treatable.


I will update you when I've heard. I'll have everything crossed for him!

Expert:  Dr. Michael Salkin replied 3 years ago.
Sounds good. Speak to you soon.
Expert:  Shantal-Mod replied 3 years ago.

I hope all is well with Fergus.

Please remember to rate the answer given once you are satisfied. You can ask follow-up questions at any time for no additional charge.

Thank you,

Customer: replied 3 years ago.

He has picked up in the last few days.


we spoke to the vet at length rather than just raking him down and she suggested not to bring him yet but to wait and see.


Since then he has improved so we're just waiting to see his improvement over the weekend.


Thanks for your help!!

Expert:  Dr. Michael Salkin replied 3 years ago.
What a good update! Thank you for taking the time to do so.

Keep me posted, please.
Customer: replied 3 years ago.

She suggested the antibiotics might have upset his stomach and that his eating is a good sign.


Since then he has retracted his penis and started to roll over to have his belly rubbed!

he's also chasing the cat again - always a good sign.


Our vet suggested its very stressful for dogs to go to the vet so just wait and see if he continues to improve.


We may not be out of the woods yet but it's nice to see him more himself!


We are to speak to the vet again on Monday as poos are still a little soft but her feeling is that this will improve in time of he's had an upset tummy.


will update again soon! Thank you!

Expert:  Dr. Michael Salkin replied 3 years ago.
Nothing but good news. Hope to speak to you soon.
Customer: replied 3 years ago.

I don't want to jinx it yet after all he's an old dog. Especially a dog with Cushings. We most certainly aren't out of the woods!


But for now he seems more like himself - will update again soon.

Expert:  Dr. Michael Salkin replied 3 years ago.
Sounds good.

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