Sable - 11 yr. old w/ Cushings and SARDS

[sablesmom]

Hi, I am Sablesmom and we had our medium mixed breed dog Sable dx'ed with Cushing's a month ago. I am the one that went online and figured out what was wrong.

It is vet induced Cushings. He admitted it and he cried and hugged her and was very upset. He missed a lot of things we had questioned him about, like her eyesight and drooling and repeated skin infections, weakness and drinking excessive water and weight gain. We were lucky that she does not have diabetes or anything more serious, but sudden acute retinal degeneration (SARDS), took her eyesight quickly, so we are dealing with the cushing's and her blindness.

She seems to be responding to the Anipryl (selegiline HCL) in that her drooling is better, she is not eating and drinking as much and she is less swollen and moving better. The drooling was caused by a slightly enlarged heart pushing on her esphogus or pain or stress or all three. She is taking tramadol for pain, two thyroid pills a day, and Marin for liver support. Has anyone treated a cushing's dog with Anipryl and can you tell me the results?

Has anyone dealt with SARDS as a part of Cushing's and if so, do you have any advice? We are heartbroken right now as she is my therapy and companion dog for depression and social phobia. Our son is 35 and she is our baby.

We don't care about the therapy part, we just want her to get well and be happy again. Any advice or suggestions will be greatly appreciated. We live in a small southern town where the choice of providers is not large, but we did get a specialist from Birmingham to come up and see and test her about the SARDS. Thank you so much for any help you can give us, especially about getting her engaged in any type of play or activity. I think she is depressed.

[lulusmom]

Hi and welcome to the forum.

I am so sorry that Sable is having such a rough time of it at the moment. It is very confusing for a dog to lose sight in such a short period of time.

You mentioned that Sable has vet induced cushing's. It sounds like you mean iatrogenic cushing's brought on by prescription steroids. Is that correct. If so, traditional cushing's drugs are not necessary as the remedy is to simply wean the dog off of the steroid. Can you clarify why your vet feels responsible?

I have read everything I could get my hands on about SARDS and while it is believed there is a connection between cushing's and SARDS, nobody has ever been able to establish what that connection is. It is known that some dogs with SARDS will develop symptoms associated with cushing's before they lose their eyesight but I believe almost all dogs will become symptomatic shortly after losing their sight. Some vets do not recommend treating for cushing's as there is a good possibility that the symptoms will go away over time.

Anipryl is one of only two drugs approved for treatment of cushing's however, it is the least effective of available treatment, approved or otherwise. A very small number of dogs with pituitary based cushing's will have a tumor in the pars intermedia lobe of the pituitary and it is only these dogs that Anipryl will help and even then, there is no guarantee. It has not effect whatsoever on dogs with adrenal tumors. Which form of cushing's does Sable have? Which tests were done to diagnose her and can you post the results of those tests?

Like I said earlier, it is confusing for a dog to lose their sight so quickly but the good news is that dogs are much better at adapting than us humans. Also good news is that we can help them adapt to being sightless. Here are a few inks to sites that can probably help you help Sable.

http://blinddog.info/msgbd/
http://pets.groups.yahoo.com/group/blinddogs/

I am so sorry the circumstance that brought you here but I'm very glad that you found us. We're here to help in any way we can and the more information you can give us on Sables medical history, the better able we will be to provide more meaningful feedback.

Glynda

[Squirt's Mom]

Hi Sablesmom and welcome to you and Sable! :)

My Squirt was initially treated with Anipryl (Selegiline) and did very well on it. She had very mild signs and it helped her for nearly 9 months - much longer than it does for most pups.

With SARDS the already often confusing picture can be even more so. Once we see the test results and understand why you and your vet feel this is a "vet induced" condition in her case, we will be better able to advise you. However, if she were mine, given the SARDS, I would continue with the Anipryl, if you are seeing an improvement in her signs, for right now. It can give her, and you, a bit of relief while determining if she does have conventional Cushing's or the Iatrogenic form.

Please know that many of us, myself included, fully understand the angst this diagnosis can bring with it. I was a total basket case when Squirt was first diagnosed...and stayed that way for quite some time - until I found these wonderful, knowledgeable folks here. The more I learned, the calmer I became (I can't really use the term "sane"! :p) and I am sure the same will be true for you, too. Please ask any questions you may have and we will do our best to help you understand. Also, know you can talk to us at any time. We are among the world's best hand-holders! I know from experience! ;)

The most important thing for you to know today is that you and Sable are not alone on this journey. We will be with you every step of the way.

Hugs,
Leslie and the gang

[sablesmom]

Hello Glynda and Squirt's Mom,

Thank you very much for the warm welcome.

Sable has no andrenal nor pituitary tumors. The vet gave her large amounts of steroids over a period of years, first for allergies, then for skin conditions, then for what he thought was joint problems.

He did not taper her down off of them, with use, as he should have.

They gave her an ACTH (I think I have that in the right order)test which took several hours, to verify that she has cushings. I also read that if it was vet induced, you just wean them off steroids, but she was not currently on them when the cushings was brought up by me.

So, I too, did not understand that. But the vet and my husband cried and the vet said he did not mean to do it to her and how sorry he was. When the SARDS was confirmed a week later he was devasted.

I would think because he always blew us off when we told him we were concerned about her eyes, and other symptoms of Cushings he should have caught. We knew something was wrong.

One eye looked a little withered and the other a little protruded. Because she still had a flinch response, the vet told us she had cataracts but was ok and could still see, which the specialist told us she did not have at all.

In any case, we believed him when he said he was responsible, he was very fond of her and very upset.

About the meds, we researched Lysodren, Trilostan and some others that are not used in the US. Both of the vets in the practice felt that since she was elderly and we had caught it fairly early, we should use the least toxic drug we could, which was Anipryl. I can not get a straight answer out of them about which type of cushings she has, they duck the question altogether.

I know Anipryl is used for cognitive problems in dogs, but the female vet is a recent grad from Auburn, and she said that is what they are recommending now as the drug of first choice for cushings, even though not all dogs will be a responder to it.

I am not sure how many cases of cushings this practice has actually seen and treated. I am disabled myself and my husband usually takes her to the vet. I have many questions I would like to ask them directly. They say they know she has no tumors, and x-rays have been done.

The only result they could find was that her heart was enlarged slightly and pushing on her trachea. Blood work showed her liver enzymes were elevated, hence the Marin for liver support while she is in treatment for cushings.

She has always had allergies, but the bacterial skin infections and joint stiffness and oddness about her eyes were only apparent in the last few years. He tried several to do a biopsy on her skin condition several times. He even used a new injectible anti-biotic. It would clear up...just to return. Over and over.

She has always had the best vet care we could give her. All of her shots, Heartguard, Frontline, quality food and the best of ear, eye and nail care. She was a very healthy dog, except for her allergies, most of her life.
Just the last year or so she has gone downhill very quickly.

The SARDS may or may not have had anything to do with the cushings. Maybe it is just bad timing.

I am an ex-medical asst, EMT, EKGT and PA. My husband's sister is a doctor so we both have medical backgrounds and have done as much research on both Cushing's and helping a blind dog as we can. Right now we are still so new at this and need all the help we can get.

When she feels a little better I want to get her interactive toys so she is not just laying there most of the day. She is getting carefully monitored walks, the vet said we can tone her heart. Is that possible?, she does seem better. I will check out The links, thank you so much.

Something about this whole thing is not making sense to me though, if she has no tumor, what makes them think Anipryl will help her at all?

I understand Cushing's, (Moon's syndrome) and it's opposite, Addison's disease, in humans, but I am confused about what is really happening here. I am shy but I guess I am just going to have to confront the Vet's and demand some clear answers.

Again, I am open to any advice, feedback or help anyone can give me. Thank you again Glynda and Squirt's Mom, I appreciate it more than I can say!!! I am sooo glad I found you.

Sablesmom

[lulusmom]

Hi again.

Is Sable still on steroids and if not, how long has it been? Aside from the skin infections what symptoms are you seeing that leads you and your vet to believe she has cushing's? Can you please get copies of all tests that were done by your vet to diagnose Sable and post the results here? The all day test would be either the high or low dose dexamethasone suppression test. This test involves a baseline blood draw, then an injection or dexamethasone, a four hour draw post injection and an eight hour draw. The acth stimulation test involves a baseline blood draw, than an injection of synthetic acth (usually cortrosyn) and than a blood draw one hour post injection. Please get copies of bloodwork and urine tests. Post only the abnormalities on the bloodwork, including the normal reference ranges. Did your vet do an abdominal ultrasound and if so, can you post the findings. Dogs with pituitary based cushing's usually have two equally enlarged adrenal glands and enlarged liver. If an adrenal tumor is involved, only one gland will be enlarged and the other gland will be much smaller or atrophied.

FYI, the female vet who thinks Anipryl is the first drug of choice for cushing's knows little about the disease or the drug. I cringe when I hear any vet say that Anipryl is their treatment of choice. Here's an interesting fact you might want to share with the Auburn graduate. The developer of Anipryl, Dr. David Bruyette, does not recommend prescribing Anipryl unless the dog has mild symptoms or the pet owner cannot afford the testing that is necessary with trilostane and lysodren. His first choice of drug is Trilostane.

I can't really give you an answer as to why your vet thinks Anipryl will help Sable. The goal of treatment is to resolve the symptoms associated with cushing's but I haven't seen you post any of the symptoms that are common with cushing's. Does Sable have a voracious appetite, excessive drinking and peeing, is her urine dilute, does she pant, does she have a pot belly, is she sensitive to heat and seek out cold surfaces, aside from skin infections has she had a loss of coat or thinning of coat, change in skin pigmentation.

Given the information you have provided us about your vet, I sincerely believe that their experience with cushing's is very limited. I am glad that you have decided to assert yourself and ask questions. If your vet has done a conscientious job of testing to confirm a diagnosis, there should be no reason why he should not be able to tell you whether Sable has a pituitary tumor or an adrenal tumor. If she is like the majority of dogs, she has pituitary based disease. Don't be shy about advocating for Sable. You are her only voice so make it heard.

We have a wealth of information in our Helpful Resources section so please access it and read, read, read. To get you started, I am including a link to some good information for pet owners new to the disease. Once you get past that, keep reading because knowledge is power with this disease and you need to take a proactive part in Sable's medical care. We're here to help you become the best advocate you can be for Sable and it will help us a great deal if you would get those test results and get them posted here as soon as you can. Your vet should be happy to provide copies for you.

http://www.k9cushings.com/forum/showthread.php?t=180

[Squirt's Mom]

Blindness in dogs is much harder on the parents than it is on the pups. ;) When it happens suddenly with no apparent cause, it is just that much more difficult to accept. It can cause the pup some depression at first but the vast majority rally and do just fine.

I have 2 blind babies, each blind from different causes, both under 5 lbs and full of life! They are both different in how they handle their blindness, too, but part of that is because Brick has hydrocephalus, which apparently caused his blindness, and as a result he doesn't have sonar to the degree that Trink does. They are both adventurous outside and love to roam around doing doggy things. Inside, Trink could care less if things stay in the same place but for Brick it is very important that they do stay in the same place. He is very tactile in his approach to movement. He knows where he is by what his feet feel. I have different types of rugs in different areas of the camper and he always knows where things are by the feel of the rug he is on. He will also rub his body along the walls and cabinets feeling for certain things that indicate it is time to turn toward his box, plate, bowl, etc.

Trink is simply amazing to watch. She literally has the ability to know where something is and to go around it 95% of the time. She seldom bumps into anything. I have watched her for nearly a year now and can only assume that she can feel the difference in the way the air moves when there is an object around and she can hear the difference in the sound of the air moving around the object. The first time her vet met her she was roaming around the waiting room when he came in. He watched her for a minute then said, "Well, Leslie, I think she can see some." To which I replied, "But, Dr. B, she ain't got no eyeballs!" LOL Trinket had glaucoma and her eyes have been removed. Brick still has his but they are useless.

Blind pups rely on their other senses to get around in their world - smell and hearing and touch. Some things you can do to help Sable adjust is make sure everything stays where it is so she can develop some confidence in moving around; use different scents for each room via oils on a rug in the doorways or other mild scent providers, being sure to always use the same scent in the same room, ie always vanilla in the bedroom; use different nap rugs in the entryways to different rooms; use those carpet protector runners to give her a trail to the back door, the kitchen, and other places she will frequent, a different runner for each trail; use bubble wrap or other padded covers for corners, walls, cabinets, etc that she is prone to bump into; take her on short walks at first only in those areas she has always walked in to let her develop some confidence that things are still the same around her. Talk to her a lot, often.

Watch her and let her teach you tricks to help her adjust. She will adjust and pick up things you aren't aware she is. I had a deaf and blind Dane many years ago who taught me the signal for going outside. Dinah was always in the house in the evenings and after supper, I would load the dishwasher, start it, and take her out for the nite. After a while of this routine, one nite I started the dishwasher and looked up when I saw movement out of the corner of my eye. There was Dinah at the back door! She had learned that when she felt the vibration of the machine it was time to go out. I didn't intend to teach her this but our routine did it anyway. From then on, anytime I wanted her to go out all I had to do was start the dishwasher and she would go to the back door.

These blind babies are so very amazing - not only in what they can accomplish but also in what they can teach us about their condition if we will just pay attention. I know a blind baby who still plays fetch with a ball! Just a plain ole ball - no noise, no nothing - Myron just knows where that ball is! So don't get too discouraged over Sable's vision loss. Patience and attention will do wonders for you both.

Hugs,
Leslie and the gang

[kapohotricia]

Hi Sable's Mom, and Sable,

I don't have any answers for you because I am so very new to Cushings and my Kirby has a different kind but I just wanted to say how very sorry I am that this has happened to Sable, and to you and hubby. Our daughter is adult, too, and I understand when you say she is your baby. Just wanted to send a big hug. Hang in there and stay happy for Sable. She doesn't know anything is wrong but will worry if you seem sad. I pray she will soon get the help she needs. Aloha,
Tricia and Kirby

[sablesmom]

Hi All,

Thank you so much for the supportive posts. I am still reading, reading, reading, reading. I only get paid once a month, so I am waiting until I get paid to take Sable back to the Vet's, and get some of the answer's I need so I can post them. Until then, let me list the symptoms she had.

Excesssive drinking, major, to the point where we thought she had developed diabetes, and overeating, drooling, thinning hair on her torso, swelling all over, including her face and feet and legs, excessive peeing, oddness about her eyes, developing a pot belly (hard to see, she is long haired), trouble standing and walking, weakness. Seeking out air conditioners, fans, and cold floors to lay on, very heat intolerant. And of course, finally, walking into things, showing us clearly she could not see, but that is not the Cushings, but Sards.

She is not on steriods now and has not been on them for 8 months, although she still has some of the skin condition that she used to be treated for with steriods under her chin. I have just been keeping that area very dry and her drooling has greatly improved. She is drinking less and no longer eats everything in sight, she now leaves food in her bowl. So those were the symptoms that lead me to tell the vet I thought she had cushings.

They did the 4 hour ACTH test, I didn't see any paper work with it but they said it confirmed she has Cushing's.

I am not from this area. I usually live in large urban areas, and am not used to not having the resources I would usually have. It does not suprise me that the female vet is wrong. I might as well tell you I am in Alabama and finding it hard here. I don't know of a better provider and I don't really trust the one's I am using. Taking her to the closest large city is a several hour drive and in the heat wave we are having she (and I) are just not up to it until she is better.

So those were her symptoms, like I said some have improved. It has been a hard day for me because she passed a little boy in the door of an apt. we passed going outside for a walk. She heard him and wagged her tail and wanted to go find him. She loves kids and it is one of the few times I have seen her wag her tail. This is a building for the elderly or disabled and you almost never see kids. It made me so sad for her, to think she is bored and needs more stimulation. I have to borrow a car and can't go out in the heat, but I am trying to think of a way to get her around children. It seems to be the only thing that perked her up for a second. But I think it is more my problem than her's. Thank you ALL for the support and help.
Sincerely,
Sablesmom

[Squirt's Mom]

Hi,

I'm glad you saw a positive reaction in Sable today when she saw that child. That always gives reason for even more hope. ;)


They did the 4 hour ACTH test, I didn't see any paper work with it but they said it confirmed she has Cushing's.

When Squirt was first diagnosed as having the pituitary form, PDH, she had five cushing's tests - LDDS, HDDS, ultrasound(2), ACTH and the UTK panel. All five of these tests "confirmed" Cushing's based on her cortisol level. However, when the second ultrasound was performed, I was told she had a tumor on her spleen. A short while later the tumor and part of her spleen were removed. After that surgery, her cortisol level returned to normal and has remained within the norms since.

Elevation in cortisol is a normal response to stress - external or internal. That tumor was stressing Squirt's body so it was releasing excess cortisol and once the stressor was removed, the cortisol returned to normal - as it should. SARDS is definitely a stressor and for some unknown reason seems to quickly and strongly induce the same signs as full-blown Cushing's does. So, IMHO, that ACTH may not be of much value in determining if Sable really does have Cushing's or not at this time.

I would enjoy her as much as possible, keep giving the Anipryl if it seems to be helping, and not worry about further testing for a while. Let Sable's body adjust to the loss of vision and recoup a bit, then if she is still showing signs, start the testing over.

Again, just MHO. ;)

Hugs,
Leslie and the gang

[Squirt's Mom]

I saw this on Facebook today and thought of you and Sable so I wanted to share with you.

http://www.patrickmahaney.com/guest-blog/special-needs-training-for-owners-of-blind-dogs/

There is also a good book called "Living with Blind Dogs" by Caroline D. Levin, RN that has some good info in it.

Hugs,
Leslie and the gang