ribbons, my miniature schnauzer

[nancy barbrey]

ribbons was just diagnosed @ ncsu vet school here in raleigh. adrenal profile done by Dr Jack Oliver @ univ tenn diagnosed her with atypical cushions. Her left adrenal gland is enlarged which may be indicative of primary adrenal tumor. Ultrasound being repeated today to compare to one done a mos ago. if surgery is indicated, does anyone have a dog that has successfully gone through surgery & cured? ribbons is almost 11 yrs old, & just recently diagnosed with heart disease. no CHF symptoms displayed by ribbons. she is on analapril for ht. ribbons is also gnawing at her paws and parts of the pad are peeling. she is limping and having to continuously wear an e collar. so sad. vet school doesnt know why. xrays done,soaking and one paw tested pos for staph, on clavamox but no change is noted. anyone been through this ?
ribbons problems:mitral regurgitation,left atarial enlargement, 2 hepatic masses believed to be glycogen after aspiration, increased liver enzymes, proteinuria, increased bun, anemia,nucleated rbc's, chewing on paws, limping rt front and occasional rt rear, double ear infections, severe periodontal disease & just had 14 teeth extracted, unilateral left adrenomegaly, increased thirst,urination,&hunger, vulva irritation. ribbons was a healthy dog up until one mos ago when our hm vet detected a heart murmur and referred her to vet school for work up. she has developed all these symptoms in one mos. in one mos she has gone from a happy playful dog with lots of energy to extreme weakness and fatique! please help

[StarDeb55]

Nancy, welcome to you & Ribbons! I'm at work right now, so don't have much time to post. I noticed that you had made your introductory post in the "how to" forum. I have moved your post to the main forum, "Canine Cushing's Questions & Discussions", which is where members discuss their pup's history & diagnosis, & can ask for input from other members.

Debbie

[frijole]

Hi ! Schnauzer lover here. I had one with cushings and another one they thought had cushing's but she has an adrenal tumor that we believe is a pheochromocytoma.

That is a whole lot of change in a month. Is Ribbons on any meds? If so, what?

Adrenal surgery can be very complicated and must be done by vets that have done alot of them and so being at a vet school is a good thing. Yes we have had members that have successfully undergone the surgery.

Not all dogs are candidates - it depends upon where the tumor is located, right or left adrenal, and how involved the vena cava is. Your vet should be evaluating this thru the ultrasounds. Normally prior to performing the surgery they put the dog on medication.

Certainly an adrenal tumor can wreak havoc and result in the symptoms you describe. Find out as much as you can about the location of the tumor, the size etc and let us know.

I'm sure those that have been thru this will chime in. Hang in there. If you haven't yet done so you might check out our reference section where there is tons of info. Start out with the easy stuff, ask us questions and then dig deeper... that way it isn't so overwhelming.

Kim

[nancy barbrey]

this has been a long mos since ribbons was diagnosed with atypical cushions. she is a pt at the ncsu vet school here in raleigh,nc and the atypical c was diagnosed by dr oliver at tenn. ribbons has most all the symptoms: elevat liver enzymes, abnormal bun,proteinuria, anemia, nucleated rbcs, 2 liver masses thought to be glycogen after aspiration, wbc was elevated, is that assoc w cushions? left enlarged adrenal glad which we thought might indicate adrenal tumor but when we went back to have a second ultrasound, both adrenals were normal in size. baffled the vet school! the most unusual thing about ribbons is she was limping alternating limbs and chewing her paws. one of her paws cultured a staph infection and was put on clavamox. her paw pads actually started peeling off and she has had to wear e collar to prevent chewing. she also had other infections, like periodontal disease, double ear infections, vulva infection. has anyone heard of all these infections being caused by cushions? she also developed hypertension this mos. the vet school first wanted to put her on a loading dose of mitotane then decided on a maintenance dose since her cortisol levels were only slightly elevated. all her sex hormones were high except estrodiol. they changed their minds again and are treating her with melatonin and flax hulls w lignans. how long before any lab value changes? anybody experiencing the infection problems in their dogs ? any advice?

[lulusmom]

Hi Nancy and welcome to the forum.

I'm sorry for the circumstances that brought you here but I'm glad you found us. We do ask lots of questions initially because getting a complete picture will help us provide you with more meaningful feedback. So to start us off, can you respond to the following questions:

1. Besides what looks like a compromised immune system which has left Ribbons open to a variety of infections, what other symptoms associated with atypical cushing's does she have? Increased appetite? Excess drinking and peeing? Loss or thinning of coat? Pot belly? Muscle wasting and weakness?

2. Do you use a hormone cream?

3. Can you please post the actual values of the blood abnormalities you posted, to include the normal references ranges.

4. Was Ribbon on any medication currently and prior to diagnostic testing? If so, please let us know the name and dose.

We have only had one or two members with dogs whose vulvas were quite large. As I recall, they were diagnosed with atypical cushing's but they were fortunate because the cause was the pet owner's hormone cream that they applied to their arms or other areas that came in contact with the dog. One owner applied the cream to a different area and the other discontinued it all together.

I am a little suspicious of the atypical diagnosis, simply because it is usually the estradiol that is what I call the demon sex hormone that causes a lot of the same symptoms that are commonly associated with typical cushing's. The odd thing is that Ribbons estradiol is normal. :confused:

Anemia and nucleated rbcs are not associated with typical or atypical cushing's so I think it is possible that something else is going on with Ribbon. The one condition that comes to mind which usually involves huge hormonal imbalances is Systemic Lupus Erythematosus (SLE). If you check out the link below, I think you'll see that a good number of the abnormalities and symptoms you list are listed as symptoms for SLE. Swollen vulva, swollen gums/infection, lameness and infected pads are all symptoms of this disease.

http://www.petplace.com/dogs/systemic-lupus-erythematous/page1.aspx

If Ribbons was my dog, I would discuss this possibility with the vet school and ask them to do an Antinuclear (ANA) test. This test is positive in a whopping 90% of dogs with SLE. This is a rare condition and I know from experience that not all vet schools are well versed in all endocrine disorders.

Glynda

P.S. SLE is much worse than cushing's and I really hope that Ribbon does not have it but if she does, the sooner you get her on steroids and appropriate antibiotics the better she will feel.

[frijole]

Nancy, I have merged your original thread so that all of your story is available for everyone to read. It makes it easier to answer questions, especially as time goes by.

Kim

[frijole]

Nancy,

My dog Annie has an enlarged vulva and she is a schnauzer and her story is long and remains somewhat of a mystery. We believe she has an adrenal tumor called a pheochromocytoma. She has some but not all of what you have described including intermittent high blood pressure, heart murmur, licking of leg (off and on), leg issues that come and go (though they are now pretty bad most of the time).

By chance did the ultrasound show any tumors on the adrenals? I assume the US was/were done on a high resolution machine - it does make a difference.

I can understand why the vets are stumped. Glad you are at a vet school though. I agree with Glynda - doesn't sound like cushing's to me. Kim

[lulusmom]

Kim, I believe the first ab ultrasound showed one enlarged adrenal but a second ab ultrasound showed normal adrenals which has the vet school stymied.

[nancy barbrey]

[QUOTE=lulusmom;52549]Hi Nancy and welcome to the forum.

I'm sorry for the circumstances that brought you here but I'm glad you found us. We do ask lots of questions initially because getting a complete picture will help us provide you with more meaningful feedback. So to start us off, can you respond to the following questions:

1. Besides what looks like a compromised immune system which has left Ribbons open to a variety of infections, what other symptoms associated with atypical cushing's does she have? Increased appetite? Excess drinking and peeing? Loss or thinning of coat? Pot belly? Muscle wasting and weakness?

2. Do you use a hormone cream?

3. Can you please post the actual values of the blood abnormalities you posted, to include the normal references ranges.

4. Was Ribbon on any medication currently and prior to diagnostic testing? If so, please let us know the name and dose.

We have only had one or two members with dogs whose vulvas were quite large. As I recall, they were diagnosed with atypical cushing's but they were fortunate because the cause was the pet owner's hormone cream that they applied to their arms or other areas that came in contact with the dog. One owner applied the cream to a different area and the other discontinued it all together.

I am a little suspicious of the atypical diagnosis, simply because it is usually the estradiol that is what I call the demon sex hormone that causes a lot of the same symptoms that are commonly associated with typical cushing's. The odd thing is that Ribbons estradiol is normal. :confused:

Anemia and nucleated rbcs are not associated with typical or atypical cushing's so I think it is possible that something else is going on with Ribbon. The one condition that comes to mind which usually involves huge hormonal imbalances is Systemic Lupus Erythematosus (SLE). If you check out the link below, I think you'll see that a good number of the abnormalities and symptoms you list are listed as symptoms for SLE. Swollen vulva, swollen gums/infection, lameness and infected pads are all symptoms of this disease.

http://www.petplace.com/dogs/systemic-lupus-erythematous/page1.aspx

If Ribbons was my dog, I would discuss this possibility with the vet school and ask them to do an Antinuclear (ANA) test. This test is positive in a whopping 90% of dogs with SLE. This is a rare condition and I know from experience that not all vet schools are well versed in all endocrine disorders.

Glynda

P.S. SLE is much worse than cushing's and I really hope that Ribbon does not have it but if she does, the sooner you get her on steroids and appropriate antibiotics the better she will feel.

[nancy barbrey]

glynda, thank you so much for your helpful info. i read you reply this afternoon and ribbons is going in tomorrow morn for a blood draw for ANA. ribbons does have increased thirst, hunger, and urination. no hair loss, muscle weakness or pot belly. I dont use any hormone creams. the only prior meds is gastriplex, she has a hx of mild pancreatitis about 3 yrs ago when the nutritionist at the vet school put her on a low fat diet.up until one mos ago, ribbons was completely healthy acting. our hm vet heard a ht murmur and sent us for a heart work up.
the following are all abnormal lab values we have received:
wbc 12.03H 4.39-11.61
RBC 4.71L 5.7-8.01
hemoglobin 10.8L 13.8-20.3
hematocrit 32.7L 39.2-55.9
platelets 807H 190-468
packed cell volume 31L 39-58
plasma protein 8.3H 6.1-7.5
lymphocytes .241L .594-3.305
monocytes 1.203H .075-.85
anemia(PCV 34%)
thrombocytosis 808%
BUN 40H
ALP 2157H
ALT 82H
GGT 169H
Amylase 1585H
proteinuria: +3 protein, +4bumin, Spg 1.056 UPC:6.82
Adrenal panel from Tennessee:
cortisol-pre 57.3 2.1-58.8
cortisol-post 203.4H 65-174.6
androstenedione-pre 1.18H .05-.57
androstenedione-post 7.12H .27-3.97
estradiol 49.0 30.8-69.9
estradiol-post 51.1 27.9-69.2
progesterone-pre 0.24 .03-.49
progesterone-post 2.78H .1-1
progesterone-17 Hydroxy pre .20 .08-.77
progesterone-17 hydroxy post 12.50H .4-1.62
aldosterone pre 26.6 11-139.9
aldosterone post 172.2 72.9-398.5

got back a repeat culture today between foot pad: still showed staph, been on clavamox for two weeks and will continue for 2 more weeks. vulva still slighly enlarged and crusty, she is still licking it therefore still wearing e collar,
pads still peeling but not limping the last 3 days. good news!

thank you soo very much for helping me search for anything to find out what is wrong w ribbons.

current meds: gastriplex, enalapril.plavix, clavamox,amlodipine,melatonin,flax hull lignans

[lulusmom]

Hi Nancy,

I will be interested to hear about the results of the ANA. I just read up on that test and there is a common thread between this test and the diagnostic tests done to diagnose cushings.....even if positive for the disease, you can't confirm a diagnosis without a lot of other components, such as blood and urine abnormalities and physical symptoms. Oy! How much sleep can we possibly lose? :D

http://ahdc.vet.cornell.edu/sects/clinpath/test/immun/ana.cfm

[StarDeb55]

Nancy, Glynda asked me to stop by & take a look at Ribbons labwork. I agree with Glynda that are things going on with Ribbons that aren't usually associated with cushing's. I will limit my comments to the labs. Ribbons is definitely anemic, & with the increased platelet count that indicates to me that something is affecting her bone marrow. By any chance, do you have any other labwork that was done prior to this batch that I make a comparison. I would be specifically interested in seeing the RBC count, hemoglobin, hematocrit, & platelet count. The other interesting thing is Ribbons specific gravity on her urine is within normal range, if not slightly high. Our cushpups normall have a very dilute urine meaning the SG is low as they can't concentrate their urine as their kidneys are working overtime, & they drink such huge amounts of water to try to keep up with the kidneys. I have not read the whole thread, but please remind me id the enalapril being used to try to help with kidney function? The BUN is elevated, but the more important value is the creatinine when it comes to kidney function. If you have that result, could you post it, along with a value called the BUN:creatinine ratio, if it was calculated. If the ratio wasn't reported, don't worry, I can calculate it myself. Right now, I think an ANA titer is useful as Glynda has suggested. The questions I would have about an ANA is that in people there are a number of autoimmune problems that will show an elevated ANA titer, including lupus. I don't know if the same holds true in our canine friends. I would also ask the vet school about the anemia & thrombocytosis as this is concerning to me for some type of primary bone marrow involvement. Just to let you know I'm a medical lab technologist with 30+ years experience, so looking at these numbers is nothing new for me. I also like to remind folks that I am not a vet. I simply try to put some of this "technical lingo" in easier to understand terms, & point them in the right direction of what questions that need to be asked of their vets, IMO. I've also got plenty of cushing's experience as I have, now cared for 2 boys who had the disease.

Debbie

[nancy barbrey]

Hi Nancy and welcome to the forum.

I'm sorry for the circumstances that brought you here but I'm glad you found us. We do ask lots of questions initially because getting a complete picture will help us provide you with more meaningful feedback. So to start us off, can you respond to the following questions:

1. Besides what looks like a compromised immune system which has left Ribbons open to a variety of infections, what other symptoms associated with atypical cushing's does she have? Increased appetite? Excess drinking and peeing? Loss or thinning of coat? Pot belly? Muscle wasting and weakness?


2. Do you use a hormone cream?

3. Can you please post the actual values of the blood abnormalities you posted, to include the normal references ranges.

4. Was Ribbon on any medication currently and prior to diagnostic testing? If so, please let us know the name and dose.

We have only had one or two members with dogs whose vulvas were quite large. As I recall, they were diagnosed with atypical cushing's but they were fortunate because the cause was the pet owner's hormone cream that they applied to their arms or other areas that came in contact with the dog. One owner applied the cream to a different area and the other discontinued it all together.

I am a little suspicious of the atypical diagnosis, simply because it is usually the estradiol that is what I call the demon sex hormone that causes a lot of the same symptoms that are commonly associated with typical cushing's. The odd thing is that Ribbons estradiol is normal. :confused:

Anemia and nucleated rbcs are not associated with typical or atypical cushing's so I think it is possible that something else is going on with Ribbon. The one condition that comes to mind which usually involves huge hormonal imbalances is Systemic Lupus Erythematosus (SLE). If you check out the link below, I think you'll see that a good number of the abnormalities and symptoms you list are listed as symptoms for SLE. Swollen vulva, swollen gums/infection, lameness and infected pads are all symptoms of this disease.

http://www.petplace.com/dogs/systemic-lupus-erythematous/page1.aspx

If Ribbons was my dog, I would discuss this possibility with the vet school and ask them to do an Antinuclear (ANA) test. This test is positive in a whopping 90% of dogs with SLE. This is a rare condition and I know from experience that not all vet schools are well versed in all endocrine disorders.

Glynda

P.S. SLE is much worse than cushing's and I really hope that Ribbon does not have it but if she does, the sooner you get her on steroids and appropriate antibiotics the better she will feel.



dear glenda
just got ribbons blood wk this morning with a pos ana anitibody! thanks to you i immed had her tested. u were right, all her symptoms fit w lupus, was it a mistakened diagnosis of atypical cushions? the ana was a low pos result. how did the #2 vet school in the country miss this test, i spent $5,000 on every other test the mos of march! dont know anything about lupus yet: which form does she have? and how to treat? my reg vet has never had a dog w lupus, but we both agree to start her on a steriod today and repeat labs soon. you may have just saved riibbon's life. if you hav time to talk, may i call u?

[nancy barbrey]

i would like to thank this web site & esp glenda for your lifesaving advice. the ANA test you encouraged me to hav done came back today pos. not a real high pos but still indicates lupus. she may not even have cushions even after the adrenal panel @ tenn. thank you debbie for also looking at her labs. ribbons may indeed have systemic lupus with all her symptoms & labs. you glenda prob saved ribbon's life! the #2 vet school in the country here in ral missed this blood test, we spent $5,000 the month of mar having her tested at the vet school & they missed lupus!!! i understand lupus is rare and now the question is finding out who has experience treating dogs with this disease. which drugs to use and dosage. my reg vet today put her on prednisone and a topical steroid/antibiotic for her crusty itchy vulva. her pads are still peeling but not limping, my short term goal is to get her out of this e collar that she has been wearing for a mos. glenda if you can advise me on drugs in combination and dosage please do or if you know anyone i can consult on this. Again, you really did probably in fact save ribbons life. may god bless you!

Moderator's Note: Nancy, I have merged you update on Ribbons into her current thread. We, normally, like to keep all posts on a pup in a single thread so other members can refer back to the pup's history, when needed.

[StarDeb55]

Nancy, prednisone is probably a start. The only other thing I can suggest is that you need to be looking for an IMS who possibly specializes in rheumatology/autoimmune diseases. I don't know if any internal medicine specialist actually would do this, but maybe someone has a specific interest in this area. I would think that the vet school can help here. If they don't have someone on staff, perhaps they can refer Ribbons out to a private vet.

Also, please do keep us posted on what you find out about Ribbons, & how her lupus treatment is going. Since this is so very rare in dogs, I know a number of us would be more than interested to hear how things progress for both of you.

Debbie

[Sabre's Mum]

Hi Nancy,

I don't have a pup with SLE ... but have one with who was diagnosed with other immune mediated illnesses - IMHA and SRMA. I joined two yahoo groups and I do know there are a few people who own dogs with SLE. I can't remember which forum has the SLE dogs - http://pets.groups.yahoo.com/group/K9Auto-ImmuneSupport/?yguid=338270381 the other group is http://pets.groups.yahoo.com/group/CIMDAsupport/. The groups will give you advice and experience what they have done with their dogs. Generally dogs start on very high doses of prednisone which is tapered off over a long period and also other imuno suppresive drugs are added in the mix eg azathioprine or cyclosporine.

All the best
Angela and Flynn

[lulusmom]

Hi Nancy,

I sent you a PM but also wanted to post here. You need to get Ribbons in to see a board certified dermatologist familiar with autoimmune skin diseases. You may have been dealing with the internal medicine department at NC State which is why they didn't pick up on SLE. I think I found somebody at NC State University that has a lot of experience with autoimmune diseases. His name is Dr. Thierry Olivry and he is a Professor of Immunodermatology. He certainly has excellent credentials. It appears that you can make the appointment without a referral from your vet. Here's the contact information. Good luck and let us know how it goes.

http://www.cvm.ncsu.edu/vth/clinical_services/derma/autoimmune_clinic.html