Dog with possible myotonia associated with Cushing's

[lehughes]

Hello Laurie,

I was hoping you could help me out. I just saw a patient that started trilostane treatment for pituitary dependent HAC in the last month. He was diagnosed with Cushing's a year ago and had been on some supplements and Robaxin but since starting the Trilostane, he was taken off them and has gotten worse in his ability to ambulate. His muscles show increased tone to where I cannot fully flex his pelvic limbs and his gait is stiff and stilted. To lay down, he will just fall over. To get up, he pulls with his thoracic limb and drags his pelvic limbs until he gets enough momentum to get his PLs under him.
The owner's goals are to improve his mobility, especially in getting up, since his dad is 89 years old and this dog is 30 kgs!
Have you had any success in helping these guys with their ability to relax their muscles and ambulate better?

Thank you,
Dr. CL

[lehughes]

Hey C.,

So, I’ve not seen one that sounds quite this challenging!

But if the dog you describe was in front of me, I think I’d dial back to ‘function’ versus getting caught up with the minutia of what would relax muscle tone. Just a wee shift of thinking.

So, I’d almost look at the case as if it were neurologic with extensor spasm. Use neurological reflexes to get flexion of the limb (i.e. utilize the flexor withdrawal)… and since the dog is able to walk - use it in standing. So, in standing dig a finger or thumb into the webspace of a foot to try to get a flexor withdrawal to simulate taking a step. You could do the same by using your e-stim under the pad of the foot (and the second electrode up on the back of the dog… just as somewhere to ground it) and get a flexor withdrawal, stepping action. Do one foot at a time or if you have a machine that alternates, set one channel up for each foot.

I’d also work on basic walking function on a land treadmill or UWT, trying to get the dog to do some higher stepping. I put one finger in front of each tarsal joint, and as the dog’s leg moves backwards into late stance phase, I let my finger run down the metatarsals so that at the end of the stance he picks it up a little higher to ‘step’ with that leg. You might have to do one side at a time if he’s really compromised.

Additionally, think of simple health / conditioning. Any exercise is good exercise.

Can he do a mini sit to stand - to a stool? No worries if not… just thinking out loud and out of order!
Following a treat and doing figure of 8’s?

Like I said, anything is good. Don’t think so much about ‘fixing’ it as much as working on function and how you can keep him going in general. I’ve found that these Cushing's dogs can’t really put on any kind of muscle… so you want to simply maintain what they’ve got!

Oh! And likely treat the compensations (i.e. His T/S and front end is likely sore and tight… spend some time on those areas for pain management, might help as well.)

I hope this helps to get your thinking in just a slightly different direction and gives you a new way to approach this patient that will hopefully do some good!

Best of luck!

Laurie

[David Lane]

I've only seen it once, and it was a difficult case. Pain control was easy, and as with LEH's response, we concentrated on trying to improve functional mobility. It was years ago and I forget specifically what we did, but only had limited results. The person best able to affect outcome is the endocrinologist/internal med person who is charge of medication. I wasn't sure based on the original question if the dog had seen an internal medicine specialist yet, but if not, I would recommend that.