Please help, Tansy - 12 yr old female

[merrtay]

I am glad you are out there!

I have a 12 yr old spayed female pound hound, looks kind of like a giant beagle. Had her at the vet who took one look and thought Cushings. I am sure she has it. We often wondered if she was diabetic due to fluid consumption. She started urinating all over the house about a year ago. We had just had to put down two dogs, (seizures, bone cancer, 13 yr old husky mix siblings)and brought another hand-me-down into the household, so I thought it was stress and age. We have been treating her thyroid for years, and that is in good shape.

She has always been a real oinker. Last 4 or 5 years she started breaking dishes by doing miraculous gymnastic feats to pull down food. And she eats everything! Last winter she started panting constantly, which worried me, but she seemed pretty unchanged in other ways. She has always had the pot belly as well as terrible ear and skin problems. The treatments were causing her so much discomfort, we finally let it all go, and she is more comfortable, though her ears are awful to see. She has skin tags and tumor-like growths that are fluid or something. It is all cosmetic,so we have let it go.

She is a wonderful dog, but she is almost 13. I can't afford an expensive disease. We already treat the urine issue, and she does well, at least well enough that I don't need to consider putting her down.

So can anyone give me some guidance? What do I watch for? I don't want to lose her, I always assumed with all of her problems that I would not have her this long. Mostly I don't want to see her suffer. I am hoping I can still have her a long time, even though she has slowed down a little, she still seems happy and comfortable enough. So what can I expect? How do I know if she is suffering? When Basil had her seizures she seemed so terrified, and I could do nothing but stay with her and know that if she could hear and sense me, at least she was not alone. I don't want Tansy to go through that, but I also don't want to say good bye too soon.

Please respond and let me know.

Thanks,
Merrianne
confused:

[Roxee's Dad]

Hi Merrianne,

I would like to welcome you and Tansy. You mentioned that the vet suspected cushing's. Were any test performed to confirm this diagnosis? Bloodtest, LDDS, ACTH stim test?

Do you have copies of the results? If yes, please post the abnormal results along with the reference ranges. If not, ask your vet to provide you with a copy, they should be happy to do so.

The symptoms you describe sure sound like cushing's but you should have a confirmed diagnosis before starting any treatment.

The others as I affectionately call them have an abundance of experience and are quite knowledgeable and will be by to help you sort through this. Having the test results posted will give us a headstart.

So hang in there and keep checking back.

[frijole]

Glad you found us. My dog has been treated for cushings for 3 years and she will be 16 in December. First thing is to determine if your dog has cushings.

Have you had any bloodwork done? Tell us as much as you can! Kim

[gpgscott]

Welcome Merrianne, and Tansy,

If she is a cushpup she will most likely benefit from treatment, but you need some tests.

Please read the earlier responses and let us know what you have had done so far.

There is much reason to believe that some medical intervention will help Tansy.

Scott

[MiniSchnauzerMom]

Hi Merrianne,

Welcome to you and Tansy from me also! John and Kim have aready asked you some important questions and not to sound like a "broken record"...but....again, Tansy should have a confirmed diagnosis of Cushings via tests, not just symptoms, prior to starting treatment.

Looking forward to your response and would love to see a picture of your "pound hound". :D

Louise

[StarDeb55]

Merianne, I would like t welcome you & Tansy, also. I am assuming that your vet did some basic bloodwork such as a senior wellness panel or comprehensive metabolic panel. Could you post just the abnormal results, along with normal range & reporting units? I'm a medical lab tech with 29+ years experience, so I'm used to looking at these kind of numbers.

If all your vet has done is basic bloodwork, those results, along with Tansy's symptoms can give a vet a "suspicion" of Cushing's, but proper diagnostic testing has to be done to get a confirmed diagnosis. One of the easiest things you can do is a urine creatinine:cortisol ratio. You can collect the urine at home, preferably the first "pee" in the morning before Tansy eats. You only need a couple of teaspoons at the max. This is what is termed a "rule out" test meaning that if the test comes back negative or normal, you are not dealing with Cushing's. A positive or elevated result indicates that Cushing's is possible, but further testing is required.

It is difficult to make a decision to treat our senior pups, I really understand as I faced the same decision for my then, 13 yr. old Shih Tzu about a 18 months ago. Harley has been doing well with his treatment, so I'm glad that I went ahead. I was really wringing my hands about the decision as Harley is my 2nd Cushpup. I had lost my 1st Cushpup, Barkley, to lymphoma in 9/06, so you can see that I, too, have been hammered hard with vet bills over the past several years. The good news is that Barkley's treatment for Cushing's was very successful as he was treated for nearly 8 years, crossing the bridge at 15.

We are here to help in any way we can, so please keep us posted.

Debbie

[merrtay]

Thanks to all of you! I am not savvy enough to move pictures from phone to computer, so Tansy is not available on line. Maybe I'll try to scan a photo.
I have test results, and will give you the ones that are not normal:

TEST Tansy's Reference Range
Alk Phospatase 1389 10-150
alt (sgpt) 488 5-107
ast(sgot) 87 5-55
ck 459 10-200
ggt 22 0-14
amylase 1660 450-1240
lipase 808 100-750
cholesterol 772 112-328
neutrophil seg 82 60-77
rosinophil 1 2-10
absolute lymphocyte 845 1000-4800
absolute rosinopohil 65 100-1250

The vet warned me that this would not be definitive, but if you guys could see her, and knew her behaviors, you would have not doubt.

Tansy is about 70 lbs, shorter than our lab but not by much. She has the face and ears of a beagle, and a real broad stance in the chest. She has a belly the size of Kansas. The pigmentation on much of her skin has gone black, her ears look like she has elephantiasis. She has an umbilical hernia, about the size of an egg, but it has never changed. She has lots of skin tags and odd growths that just seem to come from nowhere, I just spotted a new one on her chin. The "masses" that she has are about egg size, not mooshy but not solid, and they can be shifted around, like they are under the skin. She has other growths and protuberances, and I must really love her, cause I am making her sound like a hag!

All of her dermatological stuff is benign. Her fur started getting coarse and thinning years ago, but she still has a full tail, and her coat seems to cover where it ought to.

Tansy has managed to eat a chicken carcass or two in her life, and I think she just inhales. I honestly got to the point with her that I have had to say that if she eats something that kills her, it serves her right. The only place I can keep garbage is on top of the fridge. Nothing is too old or too stinky for her, and if she is at the park, she can locate all edibles within a couple hundred yards. Honestly, if she ever steals my husband's salmon again, this whole discussion could be moot.

Her ears have been a problem from early on, part of the problem was that her "sister", (husky mix), Basil started licking Tansy's ears as soon as they got stinky. Tansy loved it, I guess it was soothing, but it made the problems worse. We caved after trying and failing to treat it for 4 or 5 years, and I think she has been much happier. She never got used to the bathing and cleaning and medicating. It is embarrassing to let the vet see how bad it is, but she almost never scratches anymore. I thought she might lose her hearing, and she might have some loss, but she can still hear the fridge. Her eyes are becoming pretty cloudy, but the vet said it is not glaucoma or cataracts. What does that leave?

I don't know if she is getting arthritic. She still jumps up into our Tahoe,which I can barely do. We moved to a house with hardwood floors, so she scrabbles around a bit, and jumps on the bed less, but she still seems so do what she really wants to. Plus the bed thing changed a lot last year when she started leaking.

It seems like she never pulls her head out of the toilet, and the only time she is not hunting for food is when she is asleep. The panting was something I noticed this last winter. I haven't seen it lately, but I suspect it will come back with the cold, and the fireplace going.

What other symptoms are there? I think there were one or two that she does not have. But that's about it.

Funny thing is that I went through a stressful summer 08 because I found out that I have growths on my adrenals. Prognosis will be unpleasant if they ever start producing their little mix. But so far, so good. It does allow me to relate a little to what these dogs go through, and what the difficulties are of treatment.

Well, I hope you can offer some advice. I don't want to mislead anyone. I cannot afford to treat a 12/13 year old dog. I don't know if I would do it if I could. I sure don't want her under anesthesia, that would be a tough call for any reason. With Basil, she had the seizures, and we would walk into the vet and she would immediately improve. But they lasted longer and became more frequent, and I think she was terrified. I did not have enough time between them to try to make her understand that I love her.

River, the male husky mix, was a libidinous old scoundrel. He had a limp, off and on, for most of his life. But it became very painful and the vet verified that he had bone cancer. The bone broke shortly after, and the guy just kept on ticking. If he had been a little younger, and if his sis had not just died, I might have considered him a likely candidate for a happy three-legged dog. But Riv had surely had the cancer long enough that it was systemic.

One of my greatest quandries, fears, and sources of guilt is trying to achieve the balance between quality and time. I am afraid we might have kept River a little too long. All of my husband's kids wanted to say goodbye, and no one wanted to pull the trigger. I'm glad I'm the step. I can say what I think, that they need to stop thinking about themselves.

Well, to make things more interesting, I have lost and gained two kitties in the last couple of years, as well. One of my kitties was so sick, but it took so long for him to get there that I didn't realize until I had new kitties, and remembered what they are like. Gladly the kitties were 16 and 18. When I was a kid, cats that old were unheard of.

Thanks to all of you, I really want to be aware of her condition and what signals I might anticipate. It is funny, I have always worried about her, because she never complains. She is the nicest dog in the world.

[merrtay]

I know there a lot of words here, but can you guys please look at these results for me? I just saw 3doglover's post, and sure know how he feels. The blood test I just had, along with Tansy's regular shots and thyroid test, (which I had to have), was $230.00. That is not too bad, given the whole package.

[StarDeb55]

Merianne, the one thing on the general lab results that really catches my eye is the fact that Tansy has a severely elevated amylase, along with a slightly elevated lipase. This may indicate that pancreatitis is developing, probably from all of the "bad things" she has managed to swipe to eat. I would absolutely bring this to your vet's attention as pancreatitis can make a dog seriously ill very quickly, & may even be lethal.

When it comes to the other lab results, Tansy has the very typical elevations in her liver function test, alk phos, ALT, AST, & cholesterol which are extremely common in our Cushpups. In fact, a severely elevated alk phos is usually one of the first things that will make a vet suspicious about Cushing's. There is a screening test for Cushing's called a urine cortisol: creatinine ratio that is not terribly expensive. If this test comes back within normal range, you ARE NOT dealing with Cushing's. If the test comes back elevated, all that means is that Cushing's is a possibility, further diagnostic testing is needed.

Left untreated Cushing's disease can cause multiple organ failure due to the overproduction of cortisol from the adrenal glands. Cushing's also causes depression of the immune system leading to repeated infections that may be hard to treat. Again, those repeated infections may have serious consequences. Most things I've read & heard say about 2 years left untreated, & untreated will, in all likelihood, lead to things like heart & kidney failure, liver failure, etc. I asked my vet with my 1st Cushpup how long without treatment, the response was about 2 years. I was also told that untreated Cushing's is a slow, ugly death.

Even though you say that Tansy seems to be happy & isn't uncomfortable, I don't know. With such a ravenous appetite, & to feel the continuing need to eat, & that your starving constantly, I'm not so sure that is exactly happy. I'm not doubting your word as you know her best, but I wanted to point this out to you.

I wanted to point this link from our important information section to you. You will find a lot of information about possible financial resources to help with vet bills.

http://www.k9cushings.com/forum/showthread.php?t=212

Debbie

[merrtay]

So Debbie, do you think she does feel hunger to that degree? Is it like her blood is tricking her belly?

[merrtay]

Also, I know some about human pancreatitis, my dad had it. It is not something I want to see any creature go through. Do you know if that damage is reverseable?
I am also wondering how expensive the 3X/yr test is. I could give something up for the $10 per week, but I still have to get to that point.
I went back to school this year, living on student loans, hubby's social security, and part time work. It is not easy, and you guys might be blowing some of my illusions.
I have never expected a large dog to live much past 12 or 13 years, and actually feel lucky that I still have her.
Merr

[StarDeb55]

Yes, the elevated cortisol levels are what is making the pup feel so ravenously hungry.

Pancreatitis literally means an inflammation of the pancreas. The inflammation is most frequently caused by an infection. Usually, when this is caught in time, & treated properly, I believe there is no permanent damage, but I am not a vet.

Debbie

PS-When it comes to the 3x per year test you mention, I assume you are talking about an ACTH. The frequency of doing this test would be dependent on what drug is used to treat, lysodren or trilostane. I have never used trilo, but I can tell you the testing required to monitor trilo is a lot more frequently at the beginning than lyso. You also have to have the electrolytes checked on a regular basis when using trilo. With lysodren, you go through a period where you are giving the medication to your pup 2x daily, this is termed a loading phase or loading dose. Once the dog shows symptoms of being loaded, you do an ACTH to verify that the cortisol is now within range which is 1-5 for our Cushpups. Assuming this test is within range, you go to maintenance dosing which is the same amount you were giving daily, but now you are giving this dose split over 2-3x during the week. At the end of one month on maintenance dosing, you need to run a repeat ACTH to confirm that you are using an appropriate loading dose. If the 30 day test is ok, then you may only need an ACTH 2x per year as long as the cortisol results remain stable. This would all be dependent on how Tansy does & what your vet wants to do.

[Harley PoMMom]

Hi Merrianne,

Welcome to you and Tansy from me and my boy Harley, who just recently celebrated his 13th birthday!

Initially this dratted disease is expensive to diagnose, but after you have a confirmed diagnosis, the treatment for your cush pup can be affordable.

My boy Harley has PDH (Pituitary Dependent Hyperadrenocorticism) and Atypical Cushings. His treatment is different because his cortisol is normal, but he has a sex hormone called estradiol that's really elevated. This is why a proper diagnosis is vital.

This elevated estradiol hormone predisposed Harley to high blood pressure, which he has to take medication for. It also wrecks havoc on his liver, pancreas, gall bladder, and spleen, these all showed up on his ultrasounds. His pancreatitis, as of right now, is being controlled by his diet.

These amazing people here have years of knowledge and experience about Cushings under their belts. They lovingly share it all with anyone who asks for their help. They have helped my boy Harley and me tremendously and I know they will do the same for you.

Hugs.
Lori

[Squirt's Mom]

Hi Merrianne,

Welcome to you and Tansy! :)

Imagine that you are driven to do something over and over and over again, you want to stop, you are tired of doing this but just can't seem to make your body come to a halt, you keep on doing this thing even tho you had rather be doing something, anything, else. In no time you are physically and emotionally drained and start to suffer dire consequences of the body and mind. This is what is happening to our cush pups when the cortisol is running rampant in their little bodies. The cortisol causes them to feel hungry all the time and drives them to seek anything edible, or even slightly edible, even tho their belly is full to bursting. They are obsessed with food. The extra weight, fat, pushes the organs into unaccustomed places, impairing their functioning. The cortisol causes them to feel the need to pee all the time so they become dehydrated; to counteract the dehydration, they are driven to drink just as they are to eat. Cortisol is a stress hormone, one of the "fight or flight" hormones, so on top of the drive to eat and drink, they are constantly in the "fight or flight" mode which makes them restless, nervous, especially at night, so rest is hard to come by. After a time of this behavior, the body simply cannot keep up with the demands the cortisol is putting on it and organs begin to fail - liver, heart, kidneys, ect - the stress is just too much. Unfortunately, this doesn't happen quickly; it is a slow, painful, debilitating death.

Here is a link describing what happens with an untreated pup:
http://www.k9cushings.com/forum/showthread.php?t=195

I am not trying to scare you or force you to treat Tansy, but I do want you to understand what you are asking of her by not treating, IF she does have Cushing's. That is still an "IF". ;) But based on the very strong signs you have given and the fact that she already has one endocrine disorder, I think the odds are pretty good that she does have Cushing's of one form or the other. So you do need to be aware of what will be happening to her as time progresses.

There are some things you can do that might make her feel a little better but understand they will not be treating the cortisol, which is the main culprit in Cushing's. Check with your vet before trying any of these things! Milk Thistle can help the liver and gall bladder as can Burdock. Astragalus can help with inflammation plus digestion and boost the immune system. Melatonin can help to lower the cortisol, tho only very slightly, and can help to counteract the hyper feeling caused by the cortisol. Flax lignans or crushed flax hulls can help with other hormones connected to Cushing's that cause the same signs and problems as the cortisol. Salmon oil and Vit E can help with mobility as can SAMe and glucosamine condroitin. There are other things out there to try as well, but these are the ones I am familiar with. Again, check with your vet first!

You do not want to start Tansy on these supplements/herbs willy nilly as they can be powerful in their own right. I would look at the melatonin and lignans first then slowly add the others if needed...but only with the guidance of your vet. Also understand that this is like putting a bandaid on a gunshot wound - it may help a bit but the damage is still going on.

I am glad you found us and hope we can help you and Tansy walk this difficult path you have been forced to take. It is obvious how much you love her and want to help her, and I hope we can be of some assistance and support for you. This is a tough disease to face even in the best of circumstances and I am so sorry you are having to face it with added difficulties. Please know we are here for you anytime and will do what we can to help you and Tansy.

Keep your chin up!
Hugs,
Leslie and the girls