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Bethany
05-16-2012, 10:18 PM
Hi,
Our dog Indy was just diagnosed with Cushings yesterday, and it’s been a long, grueling haul up to this point. Things are so bad to begin with that I’m not sure at all how he is responding to his first day of Lysodren treatment. Here is some background:
Indy is an 8 year-old weimaraner, up until this point very active and always hungry. Last year, his weight started to balloon. He’d always been a big eater, and he was less regularly active due to our work schedules at the time, so I wasn’t terribly concerned about the weight gain at first. Last fall, I started noticing several lipomas on his back and small circular patches of hair loss, dandruff, and irregular shedding along with the weight gain. After researching lipomas and coat problems, we switched to a raw diet and started that January 1st of this year. I thought he might be hypothyroid based on his symptoms, so I started using a whole food supplement called BioPreparation to address that (we use the human version of this supplement ourselves, and it is truly amazing). Between the raw diet and the BioPreparation, the change was great! Indy looked like he was losing weight, all but one of his lipomas dissolved naturally, and his coat was much softer (although the hair wasn’t growing back in the spots where it went bald to begin with). His energy level was almost puppy-like and we were convinced we were getting our old dog back. At this point, I hadn’t even heard of Cushings.
In April, Indy seemed a little more lethargic than usual. I also noticed that his head felt bonier and looked different (his occipital bone had never been visible at all, but now it’s quite prominent). Within a day or so of the initial lethargy, Indy started having tremors and acting disoriented when he woke up from naps; he was bumping into things like his depth perception was off. He also had one very slight seizure the night the disorientation started (a couple of repetitive head shakes, no loss of consciousness). We took him to the vet, and they ran his blood work. Everything was normal except that his liver enzymes and BUN levels were way up and his WBC was extremely low. The vet x-rayed his abdomen also. Everything looked normal except for his enlarged and rounded-looking liver. He had an ultrasound 2 days later that revealed no tumors or abnormal growths in any of his organs including the liver; the liver was just lighter in color than it should have been and enlarged/rounded.
They put him on Doxycycline to treat a possible infection, but he vomited it up no matter how I tried to dose it, and they advised we stop after 2 days of bad results. He also had several more significant seizures after starting the Doxy. The Doxy killed his appetite too, and he became very suspicious of food for the first time in his life. They suggested Lyme disease and tick-borne illness testing, which came back negative. We also ran fungal testing, which came back negative. The vet’s best guess was lymphoma that had spread to his brain/spinal cord or Cushings, but Cushings was lower on her list than lymphoma--all of this based solely on the ultrasound and symptoms. I did not allow a biopsy of his liver during the ultrasound because he seemed like he was at death’s door to begin with, and the biopsy required anesthesia. I didn’t trust that vet enough to put him under successfully in a delicate state. After the ultrasound, they recommended I see a neurological specialist out-of-town or take him home and wait for nature to run its course.
I then got a second opinion from a holistic vet, who asked if Indy’s thyroid level had been tested. It hadn’t. The first vet told me that thyroid issues, if they existed, were secondary to whatever was going on in the liver and brain. From what I’ve read, the endocrine system is pretty central to what goes on elsewhere in the body, so I wanted the thyroid tested anyway. It was also extremely low. The holistic vet guessed that the low WBC was based on something autoimmune, rather than an actual infection. He started Indy on NatureThroid 2x daily on April 26. We also had him on 3 caps daily of Thorne Hepagen C for liver support and a B vitamin complex 2x daily for an extra initial boost. I also kept him on a lower dose of his BioPrep because it seemed to help with his disorientation and tremors. He snapped right out of his mental fog and was back to himself for about a week.
Then the disorientation came back with a vengeance (this was the week of the full moon, which can cause increased seizure activity). Every time he fell asleep, he’d suddenly twitch and wake himself up. He didn’t have any other full-blown seizures, but we took him back in to the holistic vet. I wondered if his thyroid dose was too high, but he said Indy’s original numbers were so low that nothing short of eating an entire bottle of thyroid meds at once would bring him up too high. I had also noticed that Indy was peeing for longer amounts of time than usual, and based on that and the frantic circling and whining, the vet decided to do an ACTH stim. The vet was out of the hormone needed, so we had to wait two days for it to arrive, and he prescribed Indy an anti-anxiety med (SedaPlus) in the meantime to help him get some rest and stop pacing so much until we got him tested. It worked great for the first two days, but then his appetite decreased again and he seemed to be even more disoriented than before. He started circling constantly and frantically, and also getting stuck in corners and head pressing any time he was awake. He wouldn’t eat full meals, so he wasn’t getting full doses of his other medicines. We had to stay outside with him for hours at a time this week because he just hurts himself constantly by bumping into things inside the house.
The ACTH stim came back positive this Monday. Based on the worsening neurological issues, the holistic vet also advised that we see a neurological specialist. He didn’t see any problem with starting treatment for Cushings, so he prescribed us Lysodren. I gave Indy one Tuesday morning (500mg), and it was quite a battle to get it down. I had to cut it up and put it into chopped hot dog pieces (his favorite treat), which has been the only way I can get some of his pills into his system. He didn’t even finish the entire tablet. I didn’t notice an immediate difference; he was still pacing and circling, but he was obviously weaker than yesterday because he hasn’t eaten a real meal for days now. He also hasn’t had a drop of water to drink on his own (but that started before the Lysodren). I have been squirting drops of water and BioPrep into his mouth every few hours because the BioPrep is the only thing that seems to reduce his tremors a bit. It’s also supposed to stimulate the appetite because it’s algae-based, but he still isn’t interested in food at all. Sometimes he smells it and seems interested, but he acts like he has forgotten how to eat.
Quite frankly, I’m at my wit’s end. Indy is exhausted and miserable. The vet told us to stop the Lysodren for at least two days to see if Indy perked back up, and if so, to give him a half dosage when he seemed like he could handle it. We’ve been getting about 2 hours of sleep a night and the days are exhausting as well—he really can’t be left unattended for any amount of time at all now. It is beyond heartbreaking to deal with this, and there is a good possibility I am pregnant as well, so I need my sleep, and this stress has been overwhelming for me and my husband too. Not to mention, the Lysodren is a major pregnancy hazard, and I didn’t realize it could be absorbed through the skin when I touched it the other morning.
I guess my next step is to decide whether or not to go to the specialist (2 hour drive), but both vets we’ve seen now have mentioned the possibility of a brain tumor or cancer, which we can’t afford to treat. I don’t want to put Indy through chemo if it is cancer anyway. I also don’t want to stress him out even more just to get bad news that I can do nothing about. I’m really feeling like the only thing I can do is love him until it’s his time to go, but I’d love to know if any of this sounds familiar to others or if anyone has any insights about what other options we have.

frijole
05-16-2012, 11:44 PM
Wow. I can tell you are just exhausted from everything that has been going on. First off - let me say that I'm not sure based on what you have described that your dog has cushings. I'm going to ask alot of questions and it is simply to get the whole story... obviously the issues started a while ago.

It looks like cushings was diagnosed based on the acth test and an ultrasound. Do you have the results (there are two numbers on the test)? Also on the ultrasound report does it say anything at all about the adrenal glands? Normally in cush dogs one or both of the the adrenal glands are enlarged or shrunk. That would be very helpful. The vet should have known to look for this is they were looking at cushings.

What were the readings (abnormal high or low) on the blood panel you did? How high were the liver enzymes and how low was the WBC?

You said Indy hasn't been eating or drinking any water - that is the exact OPPOSITE of a cush dog. They have ravenous appetites (like they are absessed, head butt trash cans even though they have eaten a full meal, roam the house in search of food) and they drink BUCKETS of water. If Indy isn't eating or drinking like that no WAY Indy has cushings.

I seriously doubt the vet that came up with the diagnosis and the lysodren dosing regime has any experience treating cushings because that dosage is 1/3 of what it should be AND the vet would know to never EVER give lysodren to a dog that isn't eating or drinking.

ACTH tests measure cortisol in the system and there are false positives quite frequently - caused by non-adrenal illnesses. If your dog is fighting another illness the body probably is creating extra cortisol in order to fight it and that would cause the false positive.

Please cease lysodren!

How long have the tremors and the disorientation been happening? Does Indy appear to be in pain or just disoriented?

Whatever is causing this in all likelihood is serious enough that a holistic vet can't cure it. I would be going to a very experienced internal med specialist and taking my file of all tests done so far in order to save yourself time and money.

I'm hoping some of our members have some ideas as well. I am glad you found us and totally understand your frustration. It is obvious you love your dog and are desparately seeking answers. I have been there and know the feeling. The people here have alot of experience so please tell us all you can and hopefully we can be of some help as you sort things out.

Hang in there - you aren't alone. Sending hugs, Kim

Bethany
05-17-2012, 01:04 AM
Thanks so much for your reply! Right now, the only numbers that I have are his ACTH ones because they were emailed to me. I can get the other blood work numbers from the vet when they open tomorrow. As far as the ultrasound, I never got any paper results; the vet just showed me the footage and talked through what she saw. My impression was that the liver was the only abnormality, she pointed out that the other organs (kidneys/pancreas/heart) looked normal and healthy. No word on adrenals. The vet that did the ultrasound said she didn't think all of his symptoms were consistent with Cushings.

ACTH numbers are 2.8 (pre) and 21.3 (post).

I haven't given Indy any more Lysodren (just that one partial pill on Tuesday), and he still isn't eating or drinking. His urine was orange today, and he has some kind of strange discharge coming from his nose that dries up and blocks the nostrils. He's very sensitive when I try to wipe away the crusting. He's been crying less for the last day or two, but honestly he just seems completely wiped out. He did show signs of pain more often before; he would grind his teeth when he got tremors, it was so pitiful to see. Now he only cries when he first wakes up (like "oh great, now I have to get up again and expend all the energy I don't have") but seems totally distant and out of it otherwise. I've also noticed his movement becoming stiffer since the one Lysodren pill.

As far as the drinking goes, Indy has always been a camel. He doesn't drink often, but when he does, it's surprising how much he takes in. I first noticed more peeing when we went to the raw diet (which by the way he started to refuse when he got sick, so we switched to home cooked). It wasn't a lot more urine, but he didn't need to drink as much water on the raw diet because there was more water content in his food. I really noticed that once he started all these medications, the amount of urine was WAY higher than the amount of water he drank.

I had my suspicions that Indy might need more testing to confirm the Cushings diagnosis, and now I feel like I definitely need to get him to someone with more expertise. Kinda sad that I live in a state with one of the best vet schools there is and can't find a helpful vet to save my life!

Bethany
05-17-2012, 01:09 AM
Oh, and the disorientation just started in April. No other history of seizures or anything neurological. Given the way the disorientation started just a month ago, I wonder if it could be hepatic encephalopathy?

Sage
05-17-2012, 01:13 AM
"The vet told us to stop the Lysodren for at least two days to see if Indy perked back up, and if so, to give him a half dosage when he seemed like he could handle it."
....
This is just not the way Lysodren therapy is performed and your dog is in need of a Vet and/or specialist who has experience with Cushing's and it's treatments.
I think your dog needs an ACTH test immediately, a new blood and urine panel, and all performed and interpreted by a professional in the field.
If you spend a few hours reading some stories here you will educate yourself quickly on the protocols of these drug therapies as well as educate yourself on the symptomology of not only Cushing's but many other complications which share many of these same symptoms. In most cases I've read about, until these concurrent conditions are remedied and brought under control, it is very difficult to isolate and confirm an accurate Cushing's diagnosis in the first place.
My advice is to STOP the Lysodren, spend hours reading some experiences here at k9Cushing's, and seek out a more experienced professional that can help you define the situation your dog is in.

labblab
05-17-2012, 07:33 AM
Hello from me, too!

I am so sorry that Indy is in such a sorry state right now, and I am in total agreement with you and the others that absolutely no more Lyosdren should be given at this time. It sounds as though there is something seriously wrong, and not necessarily Cushing's at all. Depending on the "normal" reference range that accompanied the diagnostic ACTH test, a result of 21.3 may be only borderline elevated. And as ill as Indy sounds, that elevation could easily have been caused by a disease or condition other than Cushing's.

Indy has many symptoms that are so worrisome. All the neurological issues are hugely concerning, and so is the orange urine and your observation that he is urinating out more fluid than he is taking in. Different drugs can cause color the urine, but so can extreme dehydration and liver disease. Indy may have multiple issues going on, including kidney disease, too.

I absolutely concur that you need to seek specialized consultation. The supplements that you are giving Indy may have been good for him in the past, but they may be dangerous for him now, depending upon what is going on with him. I'm baffled by the holistic vet's comment that he can't possibly be overdosed on thyroid medication. If NatureThroid is a bona fide thyroid replacement, then I can't imagine why there would be no risk of overdosing with supplementation that is too high. Every dog taking thyroid supplementation needs to have the level monitored. And adding Lyosdren into the mix right now seems extremely dangerous.

Do you live too far away from the vet school for Indy to be seen in consultation? Indy sounds like a very sick and a very complicated litte boy. It would be wonderful to call upon the joint expertise of an entire faculty of specialists. Barring that, here's a link that will list any internal medicine specialists in your area. These are vets who have had additional training in complicated disorders.

http://www.k9cushings.com/forum/showthread.php?t=182

I'll keep my fingers crossed that you can get Indy in to be seen by an expert sooner rather than later!

Marianne

frijole
05-17-2012, 08:13 AM
Me again - thanks for the info on the acth test... as Marianne said - it is at the absolute border and based on everything you have said I highly doubt it's cushings. I wouldn't spend another red cent on acth testing. I would take the lysodren back to the vet that prescribed them and demand a refund on the balance as they clearly were in the wrong for prescribing lysodren and the stuff isn't cheap at all.

I would also get a copy of the write up from that ultrasound. Read it and tell us what it says.

But most important - find a specialist asap. I would consider the symptoms you have described serious enough to warrant getting you in right away.

Kim

Squirt's Mom
05-17-2012, 11:10 AM
Hi Bethany and welcome to you and Indy! :)

Goodness, honey. What an ordeal you have been facing. I agree - stop the Lyso and forget about Cushing's for now...there is something else going on with your sweet boy.

When you mentioned the head-pressing, my first thought was a brain tumor. Scary, I know, but head-pressing is one of the common signs of this as is circling, getting stuck in corners and such, and confusion. I think a neurological exam might answer your questions...tho the answers may not be what any of us want to hear. Someone here once told me when I was so terribly afraid for my Sweet Bebe, Squirt, that "knowing is always better." At the time, I wasn't sure I agreed with him, but with knowledge we can make sound decisions.

I also wondered about Indy's vision - has that been checked?

Thyroid issues can mess up the whole system whether the levels are too high or too low. I absolutely do not agree with the vets assessment that an overdose is impossible - that is simply ridiculous to my ears. If the substance they are using to treat low levels actually works, then common sense says it can also cause an overdose. As one who lives with an autoimmune thyroid disease, I can tell you that monitoring and frequent regulation of medication is vital to managing a dysfunctional thyroid. And a properly functioning thyroid is vital to the well-being of the whole body. ;)

I also agree with stopping all of the other meds/herbs/supplements he has been on that he can possibly do without and get him into a specialist asap. ;)

You haven't been here long but I want you to know that you and Indy are now family and we will walk beside the both of you for the duration of this whole journey. You are not alone. Not for one minute. We will help in any way we can, even if that is simply to listen and offer a shoulder to lean on.

Hang in there!
Hugs,
Leslie and the gang

Bethany
05-17-2012, 09:06 PM
Hi everyone, and thank you so much for your support! I'm really grateful to have found you and appreciate all of your compassion and insights.
The past 24 hours have been an absolute nightmare. Someone broke into our house last night (yes, while we were home.....one of the scariest things I've ever experienced), and to make a very long story short, we've had to deal with the police and our landlord all day today. When it rains, it really freaking pours I guess. I did get in touch with a specialty clinic about 2 hours away, and we made sure there will be a neurologist there to see Indy tomorrow. I will keep you all posted, but I'm trying to catch some little naps whenever Indy is resting. What a week...

frijole
05-17-2012, 09:19 PM
OMG. You have your hands full. I'm saying major prayers for you and dear Indy. Keep us posted - we are here for you! Kim

Squirt's Mom
05-18-2012, 08:09 AM
Oh, my! :eek: I am so glad you are all ok! What a horrifying ordeal! Bless you heart...

Do keep in touch as you can and know we are all right there with you.

Hugs,
Leslie and the gang