Jake has atypical cushing's (wire-haired fox terrier- about 8 y/o)

[gcc12]

Hello,

We have a wire-haired fox terrier named Jake, who is about 7 or 8 years old. We adopted him in January 2008 and he's the sweetest little guy in the world. His cushing's diagnois came by serendipity I guess, although unfortunately that serendipitous event was our witnessing relatively fast onset partial paralysis in his rear legs. He has two slipped discs, the one at L1/T13 is quite severe. An abdomnial ultrasound revealed bilateral adrenal tumors, one much larger than the other. His major symptoms are the pot-belly and he drinks like a fish. He'll finish any amount of water you put in front of him (within reason). But he's drank as much as three cups in one sitting. We have to measure his daily intake so he doesn't urinate while we're at work; and I don't want him to get a bladder infection from holding it all day.

Since Jake has atypical cushing's, he was started on a maintenance dose of lysodren. He has had two treatments so far so we have not seen any changes, although we don't expect to for a little longer since there is no loading dose.

He can walk, but drags his knuckles a little and slips and falls on hardwood floors. He also "forgets" where his back legs are and they get crossed up.

He's such a happy little guy. At this point we're hoping he loses a little of that pot belly (and some weight) which may relieve some of the stress on his vertebra.

I guess only time will tell. He'll have his stim test again on Nov. 4 after 3.5 weeks of the lysodren. With the atypical cushing's though, that test is really just to see if his cortisol is too low, not to determine if he's improving. At least from what I understand.

He is going to do water therapy for his back as we were told he is not currently a surgical candiate.

Any personal experiences people can pass on about the atypical cushing's would be welcome and appreciated. I've tried to read up, but you start seeing the same literature over and over.

Thanks,
Geoff

[Squirt's Mom]

Hi Geoff and welcome to you and Jake! :)

I would strongly suggest you get a reference to an IMS (Internal Medicine Specialist). They have more training and experience in complicated cases - and two adrenal tumors is not only complicated, it is very rare. I would also suggest you talk with a board certified surgeon about surgery for Jake to remove the tumors. They will be able to tell you is he is a candidate or not. If he is, surgery can affect a cure! ;)

Could you please post the actual results of the tests Jake has had so far, especially the UTK full adrenal panel, including the units of measurement (ug/dl, nmol/l, etc) and normal ranges for each value. Also please tell us exactly what the ultrasound report said for all organs seen.

Now for the good news - you are in the very best place to be. Not only have you found a group of folks with wide experience and first-hand knowledge, you have found the most loving, caring group there is. You and Jake will not walk another step alone; we will be here with you every step of the way. Please don't hesitate to ask questions. Read all you can, then ask more questions.

I am glad you found us and look forward to learning more as time passes.

Hugs,
Leslie and the gang

[addy]

Hi and Welcome from me as well,

Your Jake sounds like a sweetheart. I can empathize, my Zoe was diagnosed at the age of eight and she had come into our lives in 2007.

Having an experienced vet makes a huge difference in the treatment of your Jake. I could not even finish talking to the vet when she first told me Zoe needed additional testing and her UC:CR test was really high. I just said, I have to go and hung up the phone.:rolleyes: Then burst into tears.:o

Hang in there. We are here to help anyway we can. We ask a lot of questions and will sometimes give you unsolicited opinions:D:D but we all are pretty much walking in the same shoes.

Glad you found us,
Addy

[Squirt's Mom]

Mornin' Geoff,

I have edited my first post because it has been pointed out to me that I don't know much about bilateral adrenal tumors. :o:) Apparently they can cause elevations in the intermediate hormones associated with Atypical and yet not produce excess cortisol. So I am going to sit back and listen to the experts here explain this to us both. ;)

Hugs,
Leslie and the gang

[gcc12]

Thanks so much for the responses. I will be sure to post all of the results when I get a chance. Jake is under the care of an IMS, a neurosurgeon and his regular vet. Upon finding the tumors, the neurosurgeon called in a general surgeon from down the hall who sat down with us. Thankfully we are in a very large city with lots of resources in one place. He explained that the largest adrenal tumor is on the left adrenal gland and has pushed it up against the aorta. He said that surgery to remove this would be technically difficult and quite risky given the location and positioning, and that it would be a safer course to start with medical treatment.

My wife also took him for a consultation at an integrative care facility today that specializes in water therapy, laser therapy, etc., for his back problems.

It is difficult to follow some of the more technical aspects of this strange disease. He started the lysodren last Friday, and has had two doses. He did have some diarrhea last night and this morning, but no other mood changes, loss of appetite, etc.

I will post his test results this week and any updates. Thanks again for the responses and support.

Geoff

[lulusmom]

Here's something I posted on another member's thread in an effort to explain the difference between pituitary dependent and adrenal dependent cushing's.


If as dog has pituitary dependent cushing's, the adrenals can be normal size, if early on in the disease, but most often, both glands are equally enlarged. If an adrenal tumor is involved, unless there are bilateral tumors which is very rare, only one adrenal gland is enlarged and the other is either much smaller or completely atrophied. I'll try to explain how this whole mess works and how cushing's screws up a perfect communication system.

Picture this. The pituitary gland is just hanging around in a dog's head with a cortisol meter in it's hand waiting for it to beep. When that meter beeps, the pituitary gland says, "oh it's time for more cortisol and releases acth hormone. The adrenal glands get jolted awake by the acth and obeys the pituitary gland by releasing a good shot of cortisol. That's how it works in a perfect world in a normal dog.

If a dog has a pituitary tumor, the pituitary gland gets all screwed up in the head and can no longer operate the meter correctly. The tumor is evil, like that little devil that stands on your shoulder and tells you to do bad things. :D Well, the evil tumor tells the pituitary "hey we need more cortisol dummy" and the pituitary says duh, okay boss and keeps releasing a steady stream of acth. The adrenal glands have no idea what is going on up in the head so they just do what they are being told to do and release cortisol in response. So now we have the pituitary gland that is dumping acth like crazy and the adrenal glands are dumping cortisol like crazy. So after this mayhem goes on for a while, the dog is floating in a sea of acth and even worse, a sea of cortisol and then all heck breaks loose. The dog starts peeing everywhere, drinking like crazy, panting (like me going up one flight of stairs) losing hair (like me under stress), sucking up food like crazy (call me Hoover), develops a pot belly (like me, a big fat sea cow after chinese sodium overload) and thinning skin that bruises easily (yeah, yeah, yeah also like me). No, I don't have cushing's, I'm just old and infirm with a huge appetite. :D

If a dog has an adrenal tumor, the adrenal tumor could care less about the pituitary gland and lets loose a whole bunch of cortisol and/or one or more of whatever sex hormones it darn well feels like dumping. Remember that the pituitary gland is perfectly healthy and is operating that meter just fine. When the adrenal tumor releases cortisol, the meter never beeps so the pituitary gland is thinking "cool we got cortisol so I'll just hang around here and do nothing. Well that's just great but the adrenal gland that doesn't have a tumor is sitting around on it's butt doing nothing while its evil twin is over there going "bwaahaaaahaaa, I don't need no stinkin acth. It starts shooting out adrenal steroids like it's a gatling gun and with so much cortisol in the blood, it effectively turns off the pituitary gland. So the pituitary gland goes idle, there is no more acth to jolt the poor normal adrenal gland and it starts to shrivel up and atrophy from lack of use. Kinda like most of the muscles in my body. :(

So that's my story and I hope it helps you understand why most of us cushparents are screwed up in the head. It's the evil pituitary and adrenal glands' fault.

[addy]

I have to say sorry as well as this is new to me too. I sure did not want to make things more confusing for you.

We'll do better and let the experts have their say.:o:o:o

Hugs,
Addy

[frijole]

It is difficult to follow some of the more technical aspects of this strange disease. He started the lysodren last Friday, and has had two doses. He did have some diarrhea last night and this morning, but no other mood changes, loss of appetite, etc.

I will post his test results this week and any updates. Thanks again for the responses and support.

Geoff

Geoff - Did your vets tell you that diarrhea is a sign to STOP giving lysodren? It is a sign that cortisol has gone too low. It could be something else but I just wanted to suggest you phone and tell them about the diarrhea. What dose is Jake on and what is his weight? Thanks, Kim

[Cyn719]

Our love prayers and support are with you xo

[Squirt's Mom]

Hi Geoff,

How is Jake doing? The vomiting is a bit worrisome so we would love to hear from you!

Hugs,
Leslie and the gang