Help - Link between Cushing's and pericardial effusion?

[rkmerkel]

Hello Everyone.

I am in need of some help. It is my first time posting to this forum. I am very concerned about Ginger, my nine-year old Wheaten Terrier. Ginger has had a rough go of it in the last year. In March 2009, she experienced her first episode of pericardial effusion, where fluid built up between the lining of her heart and the heart itself. We could not find any reason for it, and the fluid was drained out. She felt much better, but since then things have been tough. Six month later she had another episode of pericardial effusion, and once again it was drained. About two months after that she started exhibiting a lot of strange symptoms, and it took us a month and a lot of vet and specialist visits to determine she had a pituitary mass. At that time, she also was tested for Addison’s/Cushing’s, and was found to tend toward Cushing’s, probably because of the mass.

To make a long story even longer, I took Ginger to Washington State University in late January 2010 to have a one-time radiation therapy to reduce the size of the tumor. Miraculously, it seemed to work and she really started to improve and seem like herself, though she was never really quite the same dog after the first episode of pericardial effusion. The vets at WSU did inform me that she could start to show some Cushing’s signs as the tumor started to shrink.

Well, two weeks ago, the fairly good health record was broken when Ginger again experienced pericardial effusion and was once again drained. I thought maybe she’d be ok for about six months, since that seemed to be the pattern, but just yesterday, two weeks later it happened again. Tests were run and there was no sign of any heart tumor, though the vet can’t rule out cancer of the heart lining without doing a biopsy – quite invasive. I am told that another possibility is that Ginger is a dog who has idiopathic pericardial effusion, which can just occur for no reason.

Needless to say I am beside my self with worry, and not sure what to do next. Before making any next steps, I’d like to ask for anyone’s advice on this. Specifically, I’m wondering if there could be a link between pericardial effusion and Cushing’s. I asked the vets and they say they aren’t aware of any. I have not had Ginger tested for Cushing’s again, but her vet said that if she did have it, a lot of times the treatment is worse than the disease and if the dog is happy, it’s better to let them be and learn to work with it. So, Ginger is not a confirmed Cushing’s case, though she does show signs, and she is not on any medication.

Like other people on this forum, Ginger is my only baby and she is the sweetest girl. She has been my best friend for the last five years, since I adopted her. I want to make sure I am doing everything for her. I don’t want her to suffer, and though she is ok for the time being, I am worried to death about the next episode of pericardial effusion. Can anyone offer any advice, or share any experiences like this? I really appreciate that there are good people out there who want to help – thank you for taking the time.

Becca - Ginger’s Mom

[Harley PoMMom]

Hi and welcome from me and my boy Harley.

I only have a minute to post but wanted to at least welcome you both to our family. Also you may have wondered why your post was not immediately visible at the time that you wrote it. That is because your membership approval process has not yet been completed. Until that happens, there will be a delay between the time that you write your replies and the time that they are actually posted. Please check your emailbox (or spam folder) for a communication from us to which you need to respond. If you don't find anything, let us know.

Love and hugs,
Lori

[rkmerkel]

Hi Lori, thanks for the welcome. I received an email that provided a link to click on to activate my membership. I clicked on the link and I was directed to a page that said my activation was complete. Not sure if there was another email that I missed?

Becca

[AlisonandMia]

Hi Becca and welcome to you and Ginger.:)

Your membership is now approved so from now on all your posts will appear immediately.

Cardiac effusion is not a normal Cushing's symptom at all. As I understand it, really-late stage untreated Cushing's can lead to heart failure due to wasting and weakening of the heart muscle but this is really the only way (that I know of) that Cushing's specifically affects the heart. For this to happen the dog would almost certainly have had the disease for years and would have many, many other signs and symptoms and be very unwell and debilitated in many, many very obvious ways beside the heart issue. It is, of course, possible for a Cushing's dog to have some sort of heart disease and because most dogs with Cushing's are older it is something that we see from time to time - but I've never heard or read anything that links heart problems Cushing's.

I just Googled "pericardial effusion dog" and found this: http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/11219.htm and this: http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2002&PID=2533


One possible cause of pericardial effusion in humans is hypothyroidism. I don't see any mention of this in either article so I guess this isn't the case with dogs - but it might be worth asking about. There is a fair overlap between symptoms with Cushing's and hypothyroidism in dogs so it is something that should probably be checked out - if it hasn't been already. Radiation treatment of a pituitary tumor can also trigger hypothyroidism.

The treatment for Cushing's (in a dog with the disease) is not "worse than the disease" as long as it is done right (and that is most important) and many, many dogs have benefited immensely from treatment. However, you don't want to treat a dog for Cushing's if you are not sure "beyond reasonable doubt" that it has the disease because treating the disease, which involves lowering the cortisol level by medical means, will likely make a non-Cushing's dog very ill indeed (because of too low a cortisol level). With Ginger having other medical issues I think it is possible that she does not in fact have the disease - other illnesses and stressors can cause false positives on tests for Cushing's. Generally it is a case of "if in doubt don't treat" - you can always start treatment if and when it becomes clear later on that the dog does indeed have Cushing's. It is not a disease that needs to be "caught early" and, strange as it may seem, it is usually (but not always) better to start treatment once the disease is established and stable and many vets will want wait a while for symptoms to become clear and pronounced before putting the dog on one of the Cushing's medication.

From what I've read it is possible for a dog to have a pituitary tumor that doesn't cause Cushing's - some are just non-functional masses. Non-functional means the tumor doesn't actively secrete the hormone that overstimulates the adrenal glands and so don't cause Cushing's - it can however cause neurological problems if it is large enough just as a functional pituitary tumor can. I have no idea how common non-functional pituitary tumors are in dogs - but probably more common than anyone knows.

What symptoms of Cushing's has/does Ginger have? Common symptoms are increased drinking and urination, increased appetite, lethargy, restlessness (particularly in the evening), panting and feeling the heat (seeking out cool places to lie is very common), muscle wasting and weakness particularly in the hind quarters, frequent infections especially skin infections and urinary tract infections, hair loss, pot belly and just generally looking "old". Most dogs will not have all symptoms - but most will have 3 or 4 at least.

Usually when radiation treatment of pituitary tumors is done it is a course of radiation (at least 8 - 10 treatments and I think sometimes more). Has any imaging (MRI or CT scan) been done since the treatment to see whether the tumor has shrunk? Usually the aim of the treatment is to shrink a large tumor that is causing neurological symptoms rather than the cure the Cushing's. Many dogs that have had radiation treatment do need to continue on their Cushing's medication as the radiation doesn't usually stop the pituitary tumor producing too much of the hormone responsible for stimulating the adrenal glands to produce too much cortisol.

It sounds like Ginger and you would really benefit from the input of an Internal Medicine Specialist (IMS) both with regards the possibility of Cushing's and the pericardiac effusion. Did you see an IMS at Washington State University? Maybe following up with them would be a good idea.

Alison

[rkmerkel]

Alison,

Thank you so much for the thorough response! I appreciate all the information. I have scheduled an appointment in a few weeks at WSU to get Ginger checked out, and hopefully I can see a few different specialists at that time.

In the past year, I had noticed a few of the Cushing’s symptoms in Ginger, although I didn’t really realize it at the time. And, it was strange because at some point, I guess when the tumor started to grow larger, a lot of her symptoms started to go away. Anyway, in the last year Ginger had a very increased appetite and was chubby, she HATES the sun and heat, and seeks shade like crazy, and she was leaking urine a little at night. Then, around the holidays, she stopped being interested in food and lost a lot of weight and she stopped leaking urine. She was also very spacey and depressed. That’s when we discovered the tumor, and had it treated.

The doctor who treated the tumor said that as it started to shrink, Ginger might start to become Cushinoid again at some point, and to keep an eye out for that. Though I haven’t noticed anything super obvious yet, I have noticed the leaking coming back again a little, and the sensitivity to sunlight is extreme. Also, around the time of the tumor, Ginger was shaking quite a bit, and now it has mostly stopped, but seems to come back a little when she is excited, like about to eat, or when I first get home from work. So I’m not sure what all of this means, but I suppose that’s why it’s a good idea to meet with an IMS.

The radiation therapy that was done on Ginger was a one time deal, as there is a special program at WSU for pituitary tumors of a certain size. They were able to give her a one-time dose of 15 Gray (I probably didn’t get that right, but hopefully you guys know what I mean), as that has proven to be effective in most dogs treated similarly. Then, I have the option of doing another dose at some point in the future if I feel like the tumor symptoms are coming back.

So that’s where we’re at. I will let you all know what the doctors at WSU have to say after the appointment. In the meantime, let me know any other thoughts. Alison, I really appreciate your message and your welcome, thank you very much! You have given me some really good insight.

Becca

[Franklin'sMum]

Hi Becca and welcome to you and Ginger :)

Did Ginger have "laser knife" radiation treatment? Is that why it was a one dose deal?

Best to you both,

Jane, Franklin and Bailey xxx
________
YAMAHA R15 (http://www.yamaha-tech.com/wiki/Yamaha_R15)