Does this sound like Cushing's? (Sweet Journey has passed)

[TracieT]

Hello! My name is Tracie. I made an appointment with a new vet for my 14 year old lab/Pekingese yearly checkup. I called and moved it up because she suddenly was limping and her belly looked swollen. When I took her in they said she had a tooth infection, put her on antibiotics and ran some bloodwork. They called with the results and said her cortisol was high and she was anemic. They said we need to check her for Cushing's with the low dex test.

Well, a few questions. Since then (week and a half ago) she has gotten progressively weaker. Is having a hard time getting up and going up and down the two steps out the door. She is eating fine and pottying fine. She just lays there and looks miserable. From everything I'm reading I can see why they suspect Cushing's....bloated belly and high cortisol. But would such a fast onset of weakness be consistent with that?

We are just trying to figure put what to do. The testing is really more than we can afford at $260....the appointment last week was $300 after all the bloodwork. And I'm just wondering if there is more going on with her....like cancer or something. This rapid decline just doesn't sound like what I'm reading with Cushing's. Two weeks ago she was fine!

Any thoughts?

[lulusmom]

Hi Tracie and welcome to the forum.

No, what you are describing does not sound like cushing's. Dogs with cushing's don't have anemia and they don't get a pot belly suddenly. Cushdogs' bellies get big from 1) enlarged liver due to accumulation of glycogen 2) muscle wasting caused by the catabolic effects of cortisol and 3) redeposition of fat due to cortisol's effect on fat metabolism. All of this stuff doesn't happen over night and I think you would be seeing a whole lot of other symptoms prior to noticing a big belly. Excessive drinking and peeing and voracious appetites are the most common symptoms that usually lead a pet owner to take their dog to the vet.

Can you please get a copy of the bloodwork and any other testing that was done and post the abnormal values here and please include the normal reference ranges. I noted that this was an annual check up. Did your dog receive any vaccinations on that visit? If so, which ones did she get?

Looking forward to hearing more about your precious girl.

Glynda

[StarDeb55]

Glynda has given you excellent advice. Cushing's does not have such a rapid onset of symptoms. The great majority of our babies have had symptoms, literally in some cases for years. Since most pups develop Cushing's in their middle or senior years, parents will frequently attribute the symptoms to aging. Now, when it comes to an elevated cortisol, I wouldn't put much stock in that result pointing to Cushing's. Your little one had an active dental infection when that cortisol was measured, & in the presence of any acute illness, cortisol will most definitely be elevated. As Glynda has said, if you could get copies of the bloodwork that was done, & post only the abnormal results, we can probably offer you better feedback.

Welcome to both of you! We are here to help in any way we can.

Debbie

[TracieT]

Thank you for the quick response!

I didn't get a copy of the results, but I will call about them.

She has always scarfed her food down and then tried to steal our other dog's food her entire life and nothing really seems different about how she is eating.

She does seem to be drinking a little more, but not excessively and she is holding her bladder fine. No hair loss.

She did not get any vaccinations. The dr didn't want to do any until they figured out what was wrong, which I'm glad of. They just put her on an antibiotic for the dental infection.

When they called back with the results I told them her limping was worse and they had me come get some pain med....Tramadol....and I gave it to her for a few days, but it didn't seem to change anything at all.

[lulusmom]

Hi again,

Just to expand a bit on what Debbie mentioned regarding the dental infection and nonadrenal illness elevating cortisol, the low dose dexamethasone suppression test (LDDS) is very likely to yield a false positive result in these situations. Did your vet wait until the antibiotics had a chance to work?

To my knowledge I've never heard of a dental infection causing anemia either so I suspect there may another underlying condition causing your girls problems.

Glynda

[TracieT]

No, the bloodwork was done right when the infection was diagnosed. We haven't been back yet.

Yeah, I was looking online at reasons for anemia they aren't good reasons.

[Sage]

I found this link which explaines canine anemia. And with that swollen belly I was looking at the gastrointestinal bleeding which could explain the bloated belly. Easy to read and understand.
http://pets.webmd.com/dogs/symptoms-and-treatments-of-anemia-in-dogs

The symptoms of anemia they mention include lack of appetite, lethargy, and weakness.

[TracieT]

I wonder how difficult it would be to diagnose the cause. She definitely does not have lack of appetite. I feel like something is hurting her in her joints or back. With her limp and having a hard time walking. She also seems like she can't lift her head very high.

I think I might take her back to our old vet....I trust him more. Wishing I hadn't gone to a new one.

[lulusmom]

Hi Tracie,

If you are willing to go to another vet and I recommend that you do, I would suggest that you find an internal medicine specialist (IMS) in your area. Anemia is serious and an IMS has the training and experience to readily identify problems. You can use the link below to search for one in your area. If you tell us what city and state you are in, we may have a member who can recommend someone. A good number of us have chosen to have our dogs treated by an IMS and some have both an IMS and gp working together. It is likely that you will need a referral from your gp vet.

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

[TracieT]

I am near Dayton, Ohio.

[lulusmom]

Hi Tracie,

I was able to find one IMS in Dayton and have included the url below. You will need a referral from your gp vet.

http://www.suburbanvetclinic.com/dayton-vet-internal-medicine.html

[Squirt's Mom]

Hi Tracie and welcome to you and your baby girl! :)

I have only one thing to add - I strongly suggest you have an abdominal ultrasound done asap. Forget about other testing for Cushing's right now but get the ultrasound done.

Keep in touch and know you are no longer alone. Regardless, we will be here with you every step of the way.

Hugs,
Leslie and the gang

[TracieT]

Thank you, everyone! You are all so kind!

I got Journey's blood results. I'll list the things that were out of range. If there is something else you want me to list, let me know. I don't know what any of this is!

(some of this is hard to make out, so hopefully I get it right)

ALK Phosphatase 247 Should be 10-150
Amylase 1259 Should be 450-1240
CTALP 184 Should be 0-35
HCT 31 Should be 37-55
MCV 56 Should be 60-77
MCHC 39.9 Should be 32-36

[TracieT]

Ok...I'm looking things up now. The last page says this:

Hemolysts PResent. RBC, HCT, MCV, MCH and MCHC affected by the presence of hemolysts.
Ratio of blood to EDTA is low. Excess EDTA may affect RBC, HGB, HCT, MCV, MCH. MCHC and cell morphology.
Scanning of the blood smear revealed adequate platelet numbers. Due to clumping, the automated platelet number cannot be accurately determined.


So......I'm wondering if her anemia could be autoimmune, which is what I am finding when I look up Hemolysts.

[TracieT]

I'm taking her to my old vet in an hour. I will let you know what happens. My stomach is just a mess worrying about all this. :(

[lulusmom]

Hi Tracie,

Thanks for posting the bloodwork. I am assuming that what you have listed as CTALP is actually ALT as the reference range you posted is appropriate for that liver enzyme. ALKP has an isoenzyme that is triggered by steroids and it is this liver enzyme that is moderately or severely elevated. ALT is a liver specific enzyme and cushdogs normally have mild to no elevations. Your dog has the complete opposite which is suggestive of an underlying condition that is causing injury to liver cells. Still don't see cushing's here.

Glynda

[TracieT]

Wow. I just got back. The dr. looked at all her results and said she's fine. He went over every number with me. He said she is absolutely not anemic (that other numbers would have to be off as well as the one that was a little off), absolutely does not have Cushing's. He said everything actually looked very good for a dog her age.

He did x-rays on her neck and shoulders because after looking at her he was convinced she was just in pain. She has no arthritis and her discs look fine. He said her neck muscles are just VERY tight and that is probably causing her a lot of pain. He upped her pain med the other dr. gave me, added another pain med and a muscle relaxer and said that should get her back to normal.

I'm so upset with this other doctor. I do know veterinary medicine is a lot of guess work because the animal can't talk. But the way he explained her blood results, I just don't understand how the other vet came to the conclusions she did. And why she wasn't concerned with Journey's pain. Uggg.

Anyway, I am very thankful that I don't need this forum now, but you have all been absolutely amazing and I appreciate it more than you know. Thank you so much!

Oh goodness....she is out there barking! I just gave her all her meds about 15 minutes ago. She hasn't barked like that for almost 2 weeks!

[winterhorses]

It sounds like things are looking up. Yay!

Were you given any reasons for the stiff neck muscles (other then age)? Have you considered acupuncture? And perhaps you could look into some easy DIY massage techniques. Good luck; I hope Journey feels better quickly!

[TracieT]

He asked if she'd been particularly active before she started hurting, but I can't think of anything out of the ordinary. So I guess he thinks it is an injury. She is always hyper and running around crazy, but she has slowed down in her old age, so I don't think she'd been jumping around or anything. Now that I think about it, there are two steps down from the kitchen to the back door. They are wood, but we have the rubber treads on them, but every once in a while she and the other dog will slip. I wonder if she did that. That's all I can even come up with.

I will look up some massage techniques. I'm afraid of hunting her, but she might like it. I warmed up some rice tonight and put it in a sock and held it on her neck for a while. She seemed to like that.

[frijole]

Hi. I don't know if it is an option in your area but I would HIGHLY recommend acupuncture. My baby Annie had an inoperable tumor and she fought it for 2 yrs. I tried so many things and I was skeptical about acupuncture until I saw my tired, lethargic gal come bouncing out at the end of the day. It was like I got my old dog back. She loved it and I loved taking her there for that reason. Night and day. Sure hope you have that same option. Kim

[TracieT]

I will look for an acupuncturist. Journey is 14 and I have another dog, Rhett, who is 13, so even when we make it through this we will inevitably be facing more problems in the near future.

[Squirt's Mom]

Hi Tracie,

Some herbal ideas that may help Journey....

Arnica Montana - first choice, either compress, oil or salve
or
Comfrey compress

You can give supplements of Vit C and glucosamine sulfate or chondroitin sulfate to help with the connective tissues. To help minimize inflammation you can give yucca, devil's claw, willow bark or boswellia. Boswellia is endangered so try the others first. ;) Yarrow and ginkgo can help with blood circulation which should speed up healing.

Hope she is better soon!
Hugs,
Leslie and the gang

[TracieT]

Oh, thank you! I have someone those things already! I need to get some comfrey. It's something that always crosses my mind for injuries and I never have it on hand. I may stop at the health food store while I'm out today.

[TracieT]

The NSAIDs and muscle relaxers helped a little, but I took her back yesterday and the dr. was concerned it wasn't helping more. He kept her on the muscle relaxers and switched from the NSAIDs to a steroid, dexamethasone. Gave her her first dose yesterday afternoon, second in the middle of the night and this morning her hind end....which has always been fine....is so weak she can't get up. I called the dr. and he said to cut her dex dose in half. Does anyone have experience with this? I have read that steroids can cause muscle weakness...this seems pretty severe. But since I'd read so much about Cushing's and since it is too much cortisol, it makes sense to me that a steroid (which is basically synthetic cortisol) in too high a dose could cause the same symptoms as Cushing's. I'm just wondering how quickly her strength will come back cutting back the dose. or if something else is going on. Her neck pain was actually a lot better to deal with than this. :(

[TracieT]

I talked to another dr today...my dr isn't in...and he doesn't think it is the medication. He said just take her off of it, though, just in case. Now I'm freaking out because my regular dr said don't just stop the meds when he told me to cut it in half. This guy said just stop. She can not walk at all. She has diarrhea, too. And this morning when I picked her up to take her outside she couldn't hold it and went all over the place. :( I don't know what to do....I'm a mess.

[lulusmom]

Hi Tracie,

I know how you feel. I was a mess too when I went through a similar situation not long ago. My dog ended up in the ER on IV fluids for two days with pancreatitis.

I highly recommend that you get Journey to a vet asap. Inability to walk, weakness, diarrhea and loss of bladder control are all serious symptoms by themselves but put them all together and it spells emergency. What is going on with Journey may have absolutely nothing to do with the medication but something is not right and she needs to be checked out asap.

We'll be waiting for your update and in the meantime, my thoughts and prayers are with both of you.

Glynda

[TracieT]

We had Journey put to sleep Friday. She was back on the medications, they think she ruptured a disc in her lower back and the dr said to give her two weeks to see if there was any improvement. We made it to ten days and I was sitting in the yard with her when she started whining. I picked her up and her head was cocked to the side, her mouth drooped on one side and her eye was going the wrong way. I guess she had a stroke. My husband came home from work and we left our kids with my parents and took her to the vet. It was horribly painful and my heart is broken, but I'm so glad she is no longer in pain. We are doing ok. I just worry about my other dog, Rhett. The first night i let him out and then couldn't find him. He is 13 and blind and usually doesn't go to the back of the yard. I finally found him, all the way by the back fence sitting by Journey's grave. :( We let him see her before we buried her so he would know she was dead, but he is still looking for her. I can just tell he is sad...not eating well or anything. I am just going to be sure to keep him busy and spend extra time with him. He was one when we got him, so for 12 years he has never spent a night without her. I hope his heart can heal along with ours.

Thank you all again for your help and support. I truly appreciate it. Give your doggies extra hugs.

[frijole]

Tracie, I feel your pain and send you strength and love. You know you did what you had to do and your baby is now free from pain. It'll take some time for dear Rhett to heal too. It's hard to watch I know but the love you have for each other will help you through this. Thanks for coming back to update us. We will forever honor Journey's memory and hope you will stop by when you are up to it. RIP dear angel Journey. Kim

[Harley PoMMom]

Dear Tracie,

I am so sorry for your loss of sweet Journey and my heart goes out to you and your family.

Will be keeping you all in my thoughts and prayers.

With Heartfelt Sympathy,
Lori

[mytil]

Oh Tracie,

I am so terribly sorry - my heart is with you and your family.

((((hugs))))
Terry

[labblab]

Dear Tracie,

Although it is such sad news, thank you so much for returning to tell us what has happened. This way, we can join you in honoring sweet Journey and all that she has meant to you and your family. Journey's name has been added to our special thread of remembrance:

http://www.k9cushings.com/forum/showthread.php?t=3918

And we will be in touch with you to see whether you might like to add a photograph to be linked with her memorial line.

In the meantime, though, please know how sorry I am. It hurts so much to lose such a precious companion. And it brought tears to my eyes to read about Rhett standing vigil at Journey's grave. He is another precious spirit, too. We will always welcome you back at any time to share thoughts and memories, or just to talk about how you're doing. I send you my warnest wishes, and many hugs during these sad first days without your sweetie alongside you.

Marianne

[Squirt's Mom]

Dear Tracie,

I am so sorry to hear about Journey but I do think you made the right decision, as incredibly painful as that is. Journey and you fought the good fight and I know she is full of gratitude for all you did for her, including this final gift - often the greatest gift we can give.

Today, Journey has no chemical coursing through her body, she feels no pain, nothing but pure joy and love. She is strong and vital once again thanks to you.

If Rhett and Journey had the type of relationship my Syra and Dinah, who was deaf and blind, did he is going to need some extra TLC from you. After Syra passed, who was Dinah's seeing-hearing-dog, Dinah became very clingy and scared for a while but with some extra time and the use of a leash to help her feel secure moving around, she came out of it. The image of him sitting at her grave is so moving. There is no doubt Journey was much loved by all her family.

As Marianne said, please know we are here anytime you want to talk.

Our deepest sympathies,
Leslie, Squirt, Trinket, Brick, Tasha, and our Angels, Ruby and Crystal

[jmac]

I am so sorry for your loss, but I am glad Journey is no longer in any pain. I hope your family will find some peace and comfort in your happy memories with Journey.

Julie & Hannah

[Cyn719]

Tracie

My thoughts are with you at this very sad time. Losing part of the family is so hard. Journey had a wonderful life with you will have the memories in your heart always.

Sending lots of strength, support, hugs and prayers to you and your family. Hope Rhett does better with time. The bond between two dogs is so strong and amazing. But with your TLC he will do fine.

Angel Journey will always be remembered

Hugs xoxo

[Bo's Mom]

Tracie,
I am so sorry to hear of Journey's passing. Hugs are sent to you and your family. Bo and Latte send furry hugs to Rhett at this sad time too.

Belinda

[k9diabetes]

I am so sorry to learn of Journey's passing. Your devotion to and love for her is obvious and I know how hard that decision is to make even when there isn't any other choice really. Releasing her from pain was a very loving and unselfish thing for you to do.

Godspeed to your girl,

Natalie

[Casey's Mom]

Tracie I am so sorry to hear of Journey and the adjustment for Rhett. I am sending prayers and love your way.