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Dr. Altman
Dr. Altman, Veterinarian
Category: Dog
Satisfied Customers: 12806
Experience:  Practicing small animal veterinarian for 18 years.
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Dear Dr. Altman, you assisted us with answering a question

Resolved Question:

Dear Dr. Altman, you assisted us with answering a question last December regarding our miniature daschund and her treatment for cushings disease. She had been prescribed Trilostane 10mg so we contacted you for your opinion on the correct starting dosage. You advised us to start low which we did and the dose stayed at and settled at 10mg daily.
I am now concerned about a problem we are having with Poppy as she is now losing her hair around the outside and the tips of her ears.
Can you help?
Submitted: 3 years ago.
Category: Dog
Expert:  Dr. Altman replied 3 years ago.
Dr. Altman :

Welcome! I am Dr. Altman, a licensed veterinarian and I am happy to answer your questions.

Dr. Altman :

Glad to hear that the cushing's is well controlled

Dr. Altman :

This can be a sign that the cushing's is not controlled anymore and rechecking values might be warranted but my first inclination would be to run a thyroid panel on her to rule out hypothyroidism which is common with cushing's disease

Dr. Altman :

Signs can be similar to cushing's including weight gain, thinning coat (which can begin with the ears), lethargy, increased panting

Dr. Altman :

CLICK HERE for signs of hypothyroidism

Customer:

Thank you for your reply. I didn't get to explain the whole effects of the problem.

Dr. Altman :

OK please let me know what other information you would like to supply

Customer:

The ears are affected both inside and out. The inside seem to appear as small scabs but the outside is losing fur at a fast rate now and in places there is no fur at all. This problem does not seem to irritate her at all, but we have noticed she is lethargic, doesn't want to go out and her skin seems to be baggy and her fur is thinning as you say.

Dr. Altman :

So testing with a full thyroid panel is warranted

Dr. Altman :

She is also at risk (being a Daschund) for vasculitis which tends to show up on the ears as well

Dr. Altman :

It is uncommon but does require a biopsy to diagnose so if the thyroid panel is normal that would be my next recommendation

Dr. Altman :

In the meanwhile I would start her on a fish oil supplement if she isn't already on one

Dr. Altman :

Fish oil with 500-750 mg EPA & DHA daily

Dr. Altman :

It will not have an effect immediately on helping promote healthy coat, taking 2-4 weeks but it is something that might help regardless of the underlying cause

Dr. Altman :

It can be a human formula as well, not necessarily a pet one

Dr. Altman :

Does this information make sense? How else can I assist you both?

Customer:

We have mentioned this to the vet twice now and he just says he is not concerned and the ear problem is like

Dr. Altman :

So sorry your vet is not taking this seriously. One of my primary recommendations is to be Poppy's advocate and simply say this test is needed. Please run it

Customer:

Is likely to be a side effect of the Trilostane and he doesn't want to do any tests at the moment as he says it's nothing to be concerned about. I am not happy with his assumption and don't like her having patchy bald ears and scabby. We were prescribed fuciderm gel as a precaution but this has failed to do very much and the problem is worsening. I was going to go go to another vet for another opinion then thought about you and would prefer your help and input.

Dr. Altman :

That is very kind, glad you came to me. Any concern for a patient should be taken seriously and not brushed off and it frustrates me when I hear someone is not taking your concerns to heart since you know your pet best

Dr. Altman :

I would do a thyroid panel and consider rechecking the cushing's to see if it is still controlled

Dr. Altman :

If the bloodwork is unremarkable then it is time to biopsy the areas on the ears

Dr. Altman :

If it is with your regular vet or with another via a referral...

Dr. Altman :

Can I assist with any additional questions or clarify anything else for you today?

Customer:

We do have another dog and his ears are fine. So just to make this clear, she should be feasted for thyroid? Would this be caused by an under of over active. I have under active myself. If it is negative and shows as ok should we have the cushings checked afterwards then? And then if that is ok we should have the ears biopsies. Is that all in the right order. Our vet is a bit of a man who doesn't like to be told to do anything, so if he gets a bit angry we are saying this, should we change vet. I just want to know exactly in what order to do it all. Also what is vasculitus

Dr. Altman :

This would be hypothyroidism or under active thyroid gland and please make sure they do a full thyroid panel, t4, free t4 by equilibrium dialysis, tsh. Yes, if your vet is not open to possibilities then I would find another one to help you. Diagnostics and medicine is constantly evolving and we need to be open to other possibilities that are not in our original plan

CLICK HERE for a handout on vasculitis. Vasculitis is inflammation of blood vessels resulting in compromise of blood supply to affected areas. The inflammation is due to overstimulation of the immune system by many possible causes including infections (bacterial, viral, fungal, or tick-borne diseases), drug or vaccine reactions, tumors, and autoimmune diseases (especially systemic lupus). In many cases, an underlying cause cannot be determined.

Customer:

So is it important that the ears are investigated as a matter of urgency, the fact that the cause may not be found is probably why he doesn't want to do anything about them. Should we insist it is done also as the thyroid. Just remembered the vet wanted to increase her treatment for cushings a few months back, but we had to take the dose back to 10 as it made her very unwell and lethargic. Anyway thank you for your help that gives us a direction to go forward with, in your opinion do you think the ears can be treated and healed so they go back to normal?

Dr. Altman :

Yes once a diagnosis is found then treatment can begin to resolve the signs you listed

Dr. Altman :

Please let me know how things go with your vet and any questions you have once you have received the results

Customer:

Thank you Dr. Altman, in your opinion tonight would you consider the ear problem being caused by the cushins medication? I thank you for all your help and advice, will it be okay to come back to you for further advice and help if we have problems here with out vet? I will keep you updated with the progress as we go along anyway.

Dr. Altman :

It could be due to the trilostane or more likely from the cushing's that it sounds like is not fully controlled. Yes please feel free to contact me regarding any further issues with Poppy. If I am not on-line when you contact me please be patient, I am on-line most evenings (except Wednesday) Mountain Standard Time in the states and Sundays

Customer:

Ok thanks again and goodnight from us as it's bed time here! Regards sue & mark

Dr. Altman :

You are welcome, good evening :)

Dr. Altman :

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