Overwhelmed!

[jjgator99]

Just found out from labwork that Max has Cushing's Syndrome. Just to give you a little history: Max is an 11 year old Lakeland Terrier. We adopted him from Lakeland Rescue when he was about one years old. About two years ago we found out he was hypothyroid and was put on Soloxine (2mg) 2xday. About 2 or 3 months ago I took him to the vet because he was very lethargic ( thinking his thyroid med needed to be adjusted). After labwork, found out his thyroid level was fine but that he had an autoimmune disease. His PCV was 17 & was told he was killing his own red blood cells. He also had an infection. Was put on an antibiotic for the infection & prednisone which was gradually decreased. On the prednisone he was drinking & urinating constantly. Also, he walked around the house all evening long. Would not settle down. Once he was off the prednisone, he quit walking all evening but continued to drink & wet constantly. Then he would just 'crash' at night. Took him back to the vet & asked him about Cushing's. Just got the labwork back. His preACTH was 3.7, his postACTh was 35.3. The vet put him on trilostane 30mg and told me to bring him back in ten days to be retested. I am devastated. Was wondering if the autoimmune disease had anything to do with the Cushing's. Also would like to know about a good natural supplement to give him. Max shakes, but he always has (very common in Lakies). He has a harder time jumping up on the couch & I think he has arthritis. When he lies down, he lies down very slowly, like it hurts him. His coat is very dull & lost its color & he is losing his hair.
We just went through a crisis with our miniature schnauzer who twisted her spleen. Her PCV was down to 7. We almost lost her! Our vet did emergency surgery & saved her life. Just getting frustrated & overwhelmed. I'm not ready to lose our precious kids! Shotzie is doing fine now, but I still worry.
I just want to make sure I am doing everything I can to provide them the best care.

[lulusmom]

Hi and welcome to the forum.

Can you please check your email inbox and spam folders for an email from us asking you to validate your membership. Once you respond to that email, membership will be finalized. Until then all post will have to be moderated and manually approved by staff members. I have manually approved this one and all members will now be able to see it.

Can you please tell us if your vet did an abdominal ultrasound to determine which form of cushing's Max has? If an ultrasound was done, can you please post the findings for us?

A post stim of 35 ug/dl is pretty darn high but I am still concerned that a diagnosis was confirmed based on the results of one diagnostic test. This is especially concerning if a dog has a pre-existing or chronic condition, like Max, which can transiently elevate cortisol.

Will be looking forward to hearing more about your precious Max. I'm sure sorry for the reasons that brought you here but I'm glad you found us.

Glynda

[jjgator99]

Just checked my spam mail and found the email. (Sorry about that!)
Our vet did not do an ultrasound but had previously done other labwork prior to the ACTH test. Max has shown the majority of all the symptoms for quite some time, but after the first diagnosis & putting him on the prednisone, the drinking & urinating became a lot worse. I thought it would subside after taking him off the prednisone but it didn't. Our vet is on the conservative side as far as running tests. I think he also didn't want to run up our bill since we recently have spent so much money on Shotzie and her surgery. We've spent well over $3K on Shotzie alone, not to mention the cost for Max. (Which i would do again in a heartbeat.)

[jjgator99]

I was so excited to find this website & to be able to correspondend with other dog lovers. I am so disappointed that Glynda has been the only one to respond. The more I read about Cushing's, the more certain I am about Max's diagnosis. Drinking water constantly, peeing all the time, his voracious appetite, reluctance to jump on the couch, his dull coat, shedding (which Lakies don't ordinarily do). Doesn't want to go on walks anymore. I am really worried about Max. I'm also worried about our schnauzer Shotzie who recently had her spleen removed and her stomach cut open. She only had 20% chance of making it through surgery because she was eo critica.
Sincerely, Jan

[Squirt's Mom]

Hi Jan,

I, too, am a bit concerned about the diagnosis considering there are other known issues. You mentioned an autoimmune disease - what disease are you talking about? Does PCV = packed cell volume?

While it is nice of your vet to take your expenses into consideration, it is rather risky to start treating with either cush med without a firm diagnosis. These are very powerful drugs. ;)

My Squirt was diagnosed with PDH (pituitary based Cushing's) based on five cushing's tests - LDDS, HDDS, ACTH, UTK panel, and two ultrasounds. But after the second ultrasound I was told about a tumor on her spleen. Once it was removed, in Sept of '08, her cortisol returned to normal and remained within range until this past summer, at which point we started her on Lysodren.

The autoimmune condition, the infection, and certainly the use of the steroids just prior to diagnosis is concerning to me. Also, I am never comfortable with diagnosing based solely on an ACTH - that test is primarily for monitoring once treatment has begun tho many vets use it to diagnose.

Can you tell us how much Max weighs?

What other meds, herbs, supplements is he on, if any? How much does he take and how often and what for?

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

Hugs,
Leslie and the gang

PS. Be patient - this is summer, folks out of town and so forth, and some, like me, may be sick in bed. Someone will always get back to you and your posts are always read even when a reply isn't made - we don't always have something to say. Tho that is really, really, rare for some of us! :D

[Boober]

Hi Jan
Sorry I don't have any advice to offer you as my dog Boober was finally diagnosed with Cushings yesterday after 1.5 years of tests and wrong diagnosis. Today she is getting her LDDS test to confirm what type of Cushings. She has has many ACTH tests, 3 ultrasounds, HDDS and a UTK adrenal panel.

I haven't been on the forum long but very greatful as they were the ones that mentioned getting the adrenal panel test which pretty much clinched the diagnosis after the Vets wrote Boober off with chronic active hepatitis this past spring.

I'm not thrilled about Boober having Cushings but so glad to finally have a diagnoisis as the last year and a half have been very frustrating.

Sue and Boober

[addy]

Oh, I'm sorry, we have not been here for you. This time of year is hard. I hope Shotzie is okay.

As for Max, my Zoe was first diagnosed in June 2010. I was overwhelmed and crying every day. She did not fit the normal profile of a Cush pup and at that time her colitis was more worrisome than her Cushings so we waited to start treatment.

My point is, Cushings is usually not an emergency so you have some time to make sure of the diagnosis and read up on things.

Im glad you found us.

Sorry to hear about your pups

[jjgator99]

Leslie, PCV does stand for packed cell volume. Max was diagnosed with hemolytic anemia several months ago. That is when he was put on prednisone for 2 weeks with the 2nd week tapering off it. I was wondering if Cushing's could cause the anemia or if the anemia could cause Cushing's .. Also wondered if it could be atypical Cushing's caused by taking the prednisone. Max is fed Royal Canine for Urinary as prevention for kidney & bladder problems. He takes 2mg Soloxine 2xD. Also takes a Pet Tab. Since the anemia he also takes 2cc of Lixotonic once a day. Would like to get him on some good natural supplement but there are so many different choices I don't know what to do. Also think he needs to be on a different dog food now with all his health issues. Shotzie is on ID dog food. I need to talk to our vet about running more tests but I'm afraid he will think I know more than he does. He saved Shotzie's life & I feel so indebted to him! I was the one who told him I suspected it was Cushing's in the first place. Thank you so much for responding!! Sincerely, Jan

[StarDeb55]

Jan, here's a late welcome from me! I noticed your questions about Max's hemolytic anemia. I want to let you know that I am a lab tech with 30+ years experience, & my speciality area is hematology, so I'm kind of familiar with hemolytic anemia. It's very doubtful that the cushing's caused the anemia or vice versa. Cushing's does cause an overall suppression of the pup's immune system, making them more susceptible to infections, & making infections harder to treat & heal. Hemolytic anemia is, indeed, an autoimmune problem that can be caused by a number of different things. Just to give you the short lesson on what happens, for whatever reason Max's body does not recognize his RBC (red blood cell) as his own. The immune system thinks they're foreign, so it goes into overdrive, thinking, "Yikes, this is a foreigner in our boy's body, we have to get rid of it." The immune system then will usually attach an antibody to the RBC it sees as "foreign", once the antibody is present, then, when the RBC passes through the spleen, it is hemolyzed (destroyed). Part of this syndrome is that the bone marrow is, also, suppressed, so it's unable to start working extra hard to replace the RBC that are being removed by the spleen, so an anemia develops. I do have one question about the anemia. By any chance, was Max eating any type of people food that might have had onion in it, even onion powder? Onion can cause a life-threatening anemia in our pups. I wasn't aware of the problem with onion until a couple of years ago when one of our members was giving her pup canned broth when he was not feeling well due to vomiting/diarrhea. This little did develop the anemia, & was critically ill for quite awhile.

Would you mind clarifying one point for me? Was the ACTH done while Max was on prednisone? If he was off prednisone, how long was he off before the ACTH?

Hope you find the explanation of hemolytic anemia helpful.

Debbie

[jjgator99]

Hi Debbie! Thanks for the reply and the explanation about hemolytic anemia. As far as your questions about eating onions, I don't recall Max eating anything with onions but he did get on the counter & get into soup my husband was making. It may have had onion powder in it. We do not feed our dogs people food except apple (no seeds), cantaloupe, & once & awhile pineapple or spinach. Max is a very curious dog, & is always getting into things. He is also extremely bright! He used to push the kitchen chair (which is on rollers) over to the counter top & jump up & get on the kitchen counter. We now bungee cord our kitchen chairs together so he can't do that. Actually, since he has had many health issues in the past two months, he has not attempted to get on the counter. We found out about the anemia April 16, At that time he was very lethargic & quit jumping on the couch. I thought it was his thyroid & his soloxine may need to be adjusted but his thyroid was fine. He takes 2mg of soloxine 2xD. He also had an infection for which hewas put on prednisone 5mg 2Xd for 2 weeks, then 2.5mg 2XD for week, then 2.5mg every other day for week. At first I thought the excessive drinking & peeling was from the prednisone because it seemed even worse, but it didn't subside after going off prednisone. Max had been off the prednisone at least three weeks before the labwork for Cushing's.
He had lost weight, went from 16.5 pounds to 15 pounds. He has since put the weight back on, but it seems to be distributed differently. I wouldn't say he has a pot belly, but he appears thicker in the middle.He is constantly hungry. He shakes a lot more, especially in his hind legs. Max has always shaked (common in Lakeland Terriers), but it is a lot more prevalent now. OH! Just asked my husband about the soup Max got into, he said it did have onions in it. We can't remember exactly when the soup episode happened but we think it was after the anemia diagnosis. Can't be certain though, because my husband made another big patch of soup prior to that. Last time Max had bloodwork his HCT was 39.7. It was 17 on April 16th. So far, i haven't seen any change with Max since he has been on the Vetoryl, but it has only been a few days. Could the anemia be reversible? Also, could the Cushing's be medically induced from the prednisone?
He goes back next week for labwork. Thanks for reading this! Any tips or advice is appreciated! Max & Shotzie are our precious children! Sincerely, Jan

[lulusmom]

Hi Jan,

I want to take a minute to make a few comments and ask a few questions. Please see text in blue below:


Leslie, PCV does stand for packed cell volume. Max was diagnosed with hemolytic anemia several months ago.

Does your vet have any idea what may have caused the AIHA? Did Max have any vaccines a short time before the diagnosis?
That is when he was put on prednisone for 2 weeks with the 2nd week tapering off it. I was wondering if Cushing's could cause the anemia or if the anemia could cause Cushing's ..

No. Cushing's has the adverse effect on the immune system. The excess cortisol suppresses the immune stystem whereas autoimmune disease kicks the immune system into overdrive. Nobody really knows what causes cushing's and it's highly unlikely that anemia would have anything to do with it.

Also wondered if it could be atypical Cushing's caused by taking the prednisone.

The actual diagnosis for dogs who develope cushing's symptoms due to oral or topical prednisone is called iatrogenic cushing's. Atypical cushing's is a completely different diagnosis.
Max is fed Royal Canine for Urinary as prevention for kidney & bladder problems.

Did Max have struvite bladder or kidney stones in the past?
He takes 2mg Soloxine 2xD. Also takes a Pet Tab. Since the anemia he also takes 2cc of Lixotonic once a day.

Was Max diagnosed with hypothyroidism? If so, when was he diagnosed and when was the last time your vet checked the T4 hormone? FYI, hypothyroidism can cause anemia but I don't believe to the degree Max experienced. Did your vet prescribe the Lixotonic and did he also prescribe the Pet Tab? I ask because most dogs don't really need vitamin supplementation if they are on a balanced diet and too much an cause problems for them.

Would like to get him on some good natural supplement but there are so many different choices I don't know what to do. Also think he needs to be on a different dog food now with all his health issues.

What would the natural supplement be helping? Cushings? How long has Max been on the prescription diet? If a dog is predisposed to struvite stones, they are usually on a special diet for life.

Shotzie is on ID dog food. I need to talk to our vet about running more tests but I'm afraid he will think I know more than he does.

Never be afraid to advocate for your dog. We are their only voice so make it heard. I'm here to tell you that I do know more than my old gp vet when it comes to cushing's. He is about clueless as you can get without being in a coma. :D I have an old country vet who takes care of my rescues and I've had to teach him how to assess acth stimulation results for purposes of monitoring. Vets can be the best thing since sliced bread at treating resolving routine canine issues but there is a world of difference between cushing's and routine anything. :)

Glynda

[jjgator99]

Hi Glynda!
Our vet said he didn't know what caused the AIHA (I assume that stands for autoiimmune hemolytic anemia). He was diagnosed with that in April. He did not have his vaccines this year. They were due in June but we discussed it & thought it better not to do any vaccinations this year. Our vet said he has built up enough immunity over the years and would waive them even though in Florida rabies vaccinations are required every year. Do you agree with that?
Max has not had stones in the past, but has had many bladder infections over the years, so our vet put him on it for preventative. He said he would have to be on it all his life.
Max was diagnosed with hypothyroidism about 3 years ago. When I took him into the vets in April I thought he needed his soloxine adjusted because he was so lethargic. After labwork, the vet said his thyrold was fine (he checked his T4 at that time), but then told us about the AIHA. He was also drinking a lot of water & peeing & I also wondered about diabetes. Once he was put on the prednisone, he started drinking & peeing excessively & started having accidents in the house. My husband & I just recently retired from teaching, so luckily we are home now during the day & can take him out often! The vet did prescribe the lixotonic in April but I just picked up the Pet Tab. I asked our vet if he could stay on the lixotonic.
Max has been on Royal Canine for at least 3 years. Not sure exactly when he started.
Please advise about the supplement/vitamin issue. I thought it would be helpful. Last week I asked our vet if he knew of a good natural supplement to give, & he said let's work on these other issues right now & then we will discuss that. He did say it was OK to keep Max on the lixotonic. Shotzie is taking the lixotonic too. I didn't ask him about the Pet Tabs, I just thought I could continue with that until he suggested something else.
Thank you so much for advice and concern. It means so much to be able to discuss this with people who are informed & understand.
Sincerely, Jan