possible Cushings - 9 yr old newfy

[sue]

Hi:

My 9 year old newfy has been drinking a lot lately and urinating a lot. She also seems somewhat lethargic and under the weather. In the fall she had lost a lot of weight and the vet was worried, but nothing showed up in her bloodwork. Then she had a bad case of diarhea which finally cleared up after some flagyl and a bland diet. I switched dog foods and she gained the weight back, but now this. The vet specialist we saw when she had the diahrhea and had lost weight thought she had inflammatory bowel disease or cancer, but we did not want to put her through any invasive tests. Now my vet suspects Cushings disease. The urinalysis supposedly showed some bacteria & my vet is treating her for an infection with batryl. The ultrasound showed enlarged adrenal glands & a mass on her liver. She collapsed after the ultrasound with an arrythmia and almost didn't make it. I believe she collapsed because of the lack of water and food for so many hours before they gave her the ultrasound. Her liver enzymes are elevated. I am very confused. The vet is not recommending the test for cushings as he feels the treatment is too risky and complicated at her age. I would like to go a holistic route due to her age. I live in CT near Hartford. Does anyone know any good vets experienced with Cushings or any good holistic vets? Or does anyone have any other suggestions. I am not confident with my vet's diagnosis or lack of diagnosis.

[labblab]

Hi Sue,

I am so sorry that your girl is doing poorly right now, but I am really glad that you have found us. First off, if she does indeed have Cushing's, I do not think her age precludes her from receiving effective treatment. We have many "seniors" here who are enjoying improved quality of life as a result of care for their Cushing's. However, it sounds as if the diagnostic picture is still muddled for you at this point. From what you have told us so far, my biggest concern relates to the liver mass that was seen on ultrasound. Does your regular vet suspect cancer?

Were you happy with the specialist whom you saw previously? If so, I do think it would be wise to pursue further diagnostics about that mass since that may be the biggest health issue for your girl at this moment. Cushpups can and do develop liver irregularities that may resolve with treatment, but I believe you need to find out whether the mass is instead an unrelated tumor. Also, the diagnostic blood tests for Cushing's can return "false positive" results when a dog is suffering from a different, unresolved illness. So even if you were to decide to pursue Cushing's testing, I do believe you will want to first establish that there is not another underlying health problem involved. There are several pieces of your dog's diagnostic puzzle that are worrisome including the initial weight loss, the collapse after the ultrasound (that is unusual), and the liver mass.

If you were not happy with the specialist, let us know, and perhaps one of our members in your area can help with some additional referral suggestions.

Marianne

[Cushpup]

Hi Sue,

Welcome.
Do you have any bloodwork to post?

I'm not into holistic medicine for Cushings, so I cannot comment on that.

Who is your Vet in the Hftd area?

I'm not a fan of IBD diagnosis. It's a 'catch all phrase" while anything can be going on in the belly. See my long posts under:
15 yo Shih Tzu, Cushings, Thyroid....Gallbladder/Liver Cancer.

I just lost my baby due to an Ultrasound Vet misdiagnosis in the Hftd area.

I'm not saying (I'm not a Vet) the following is what your newfy has, just commenting on the possibilities:

Being lethargic can be from having a bladder infection. Hopefully as the antibiotics work, your newfy will perk up.

The enlarged adrenals, and elevated Liver enzymes may point to Cushings, but can be other things, too.
Did your Ultrasound Vet do a biopsy of the mass on the Liver?

Did your newfy have a complete bloodwork done: Superchem, CBC, T4, UA, before your gp suggested the ACTH?

When they're drinking a lot, urinating a lot you think of kidneys going, or Cushings, Diabetes....and other.

[lulusmom]

Hi Sue and welcome to the forum.

Most dogs are pretty senior when they are diagnosed and unless a very senior dog is simply too debilitated to tolerate the medication, treatment is a definite option. Symptoms are a huge component of a cushing's diagnosis and a cushing's savvy vet will usually not pursue a diagnosis in the absence of symptoms. Aside from the increased drinking and peeing, which can be attributed to a uti, which your girl has, she really doesn't seem to have any other symptoms. Perhaps it's a bit more than age that is making your vet hesitant to recommend further testing. FYI, diarrhea and inappettance are not on the list of usual symptoms associated with cushing's.

Initially, we ask a lot more questions than we answer because we need a good handle on the dog's history if we are to provide you with meaningful feedback. The more information you can provide, the better. To start things off, can you get copies of the bloodwork and post only the abnormal values here? Please include the normal reference ranges and reporting units, i.e. nmol, ug/dl. Also, can you get the urinalysis as well and let us know if your vet checked the urine specific gravity? If so, please post the results as well.

I can't help you with holistic vets but I did find an internal medicine specialist in Hartford that you may want to consult with. You'll probably need a referral from your vet and he should be happy to give you one.

Dr. Kenneth E. Knaack
Veterinary Specialists of CT
Address: 993 N. Main St.
W. Hartford, CT 06117
Phone Number: (860) 236-3273 -
Fax Number: (860) 236-3275
Website: www.veterinaryspecialistsofct.com

Glynda

[sue]

Thanks everybody for responding. The vet specialist we saw was Dr. Knaack when Sophie had lost all the weight and then had diahrrhea. He had suspected inflammatory bowel disease or cancer, but did not really encourage further testing due to her age. He did mention that he could do an endoscopy, but felt that due to her age if it was cancer there would not be much we could do about it. But now she has gained weight back (after I changed dog foods) and no longer has diarhhea. I plan on picking up Sophie's records to get values on everything.I know she had a urinalysis, blood work, and ultrasound. I don't at this time know "numbers". I will post values once I get them. She has been on thyroid medication for a few years now. They rechecked the thyroid and said the numbers are where they should be. My vet does not think that Sophie's main problem is the liver mass. Appreciate all the knowledge out there from everybody.

[lulusmom]

Sue, if you want some additional suggestions for specialists, there is the Cornell University Veterinary Specialists in Stamford, CT.

http://www.cuvs.org/

If you would like to check out other specialists, you can use the link below to do your own search.

http://www.acvim.org/websites/acvim/index.php?p=3

[ktzndgs]

Hi there! Sorry to see you here. I too have a Newf. Mine is 8 years old and was diagnosed last May. Your dog is not too old to be treated for Cushing's as our Newfies live to be 12 or older these days!

Who did the ultrasound? Your vet or a specialist? You know they found enlarged adrenals. They also found a mass on the liver? Was the mass checked again to see if it's still really there or has changed? I agree with Marianne and think it would be a good idea to follow up on that to find out where you need to start.

If it's appropriate I suggest you insist on the blood test and have it sent to Tennessee. I honestly found I spent an awful lot of time and money thanks to vets trying to make a diagnosis without using the proper tools. It took many months of chasing after all sorts of things before the Cushing's diagnosis was made.

I've found that I'm sometimes referred to a specialist only for diagnosis but treatment is then done by my local vet. My experience with Cushing's is that's not a great idea unless your vet is very familiar with the treatment an IMS would recommend. My regular vet believes in treating Cushing's only one way - no flexibility - and he and his staff are not really acquainted enough with the disease.

I see a holistic vet with my girl but don't know of a holistic treatment for Cushing's. I know some people decide not to treat for it but that's based on the severity of the disease in your dog.

You sound as though you're sort of all over the place right now. That's where I was too. Try to find a good internal medicine specialist who can walk you through all of this.

FWIW Macy has been having a lot of trouble lately. She was diagnosed with IBD via multiple biopsies when she was 2 years old. I thought the Cushings and meds were making her IBD worse so have pursued that *but* during my last visit with the IMS he said it's not unusual for an older dog to begin to have symptoms of IBD while having Cushings as well but the two are completely unrelated. He said it can come with age. He seemed to be saying a lot of things are blamed on the Cushings and often untreated as a result when they're actually separate issues. It looks as though it's going to turn out that Macy has a spinal problem and the IMS said that if the trial of meds we're using now to help perk her up doesn't help he's going to recommend an MRI and refer me out.

If you aren't completely comfortable with what the specialist you saw at first told you don't hesitate to go elsewhere! As you talk to people you'll find someone you'll be more comfortable with. Your local Newf club might have some ideas for you even if you aren't a member. Are you on Newf L? It's a great way to get lots of referrals fast or just to check on a vet and find out if they're any good.

Kathy

[Kim]

Sue,
My male Newf was diagnosed with malignant adrenal Cushings last June at age 11. He had an adrenalectomy in August. In November we was diagnosed with pituitary Cushings. (First time the Washington State University Veterinary Teaching Hospital had seen this.) He has radiosurgery on the lesion on his pituitary in December with abatement of symptoms within three days. At his last ACTH stimulation test he had no Cushings. At his last ultrasound he had no masses. He will be 12 in two months. He is doing great. The healing process has been lengthy but worth it. He walks on the beach every day, eats well, and even almost plays with the puppy.
Kim

[jj68]

Sue,

Here is something I experienced with one of my dogs. Maybe some of this might be helpful to you.

I have an 11 year old german shepherd/golden retriever mix. He went through a long period of refusing to eat, weight loss, vomiting several times a day, and lethargy as a result of all that. I switched his food because I thought he was just tired of the old food. It took several tries, but I finally found a food he would eat. As a result of all the food changes he had lots of diarreha as a result. After he ate the new food for a couple of weeks, he stopped eating again. He also continued to vomit and lost alot of weight (10 pounds and he is normally 75 pounds). He had previously been diagnosed with atypical cushings, but that had nothing to do with his eating and weight issues.

After lots and lots of testing (ultrasound, bile acids, blood work, etc) the specialist suspected IBD and recommended a surgical intestinal biopsy. I could not bring myself to do that to an 11 year old dog. However, my vet had done a urine analysis and found Johnny had a UTI (which the specialist knew but dismissed since it was a free catch sample - we had run into a false positive urine test before so the specialist had a valid reason for wanting to dismiss those results). My vet had the urine cultured and found ecoli. We treated with a 2 week course of cephalexin (not my vets first choice, but Johnny started having blood in his urine on Christmas and I made the decision to use cephalexin since I had some on hand). Johnny got a little better, but still was vomiting his food even 9 hours after eating. We did another urinalysis and found the ecoli levels had dropped, but were still present. We did a 30 day course of amoxycillin and Johnny is doing just fine. No more vomiting, he is eating well, put the weight back on, and has all his energy back. So it seems that UTI had some very powerful symptoms that none of us expected. Since it has cleared up all Johnnys problems are gone. My vet told me that sometimes UTIs are just stubborn and can need up to 6 weeks of antibiotics to clear them up. She also said that amoxycillin is the preferred antibiotic for UTIs.

Hopefully your dogs problem can be cleared up as simply as mine, I know how frustrating and upsetting it is when you are trying to figure out what is wrong.

Good luck.

Jill