Muscle Loss 12 YO Golden

[Murphys Mom]

Hi All,
Looks like there are many friendly, helpful and understanding dog lovers here! Thank you in advance for being so supportive.

My name is Kathy and I have the most wonderful Golden Retriever she loves everyone, people and other animals, sweet, kind and loving. Up until 2 months ago she was happy, healthy and very young for her age. She is 12 Years old named Murphy has just been diagnosed with Cushings today. It was her panting and that got me to call the vet and after tests and a couple other issues (including gallstones) we have come to the final diagnosis of Cushings.

I have felt happy, sad and just plain scared since the Vet called. As all dog lovers I think my girl is the best dog on the planet and feel terrible for her and scared about everything I read.

We start the meds tomorrow (trilostane 60 mg once per day, though I questioned my Vet based on things I have read here, but she insists once a day is better than twice and the cost of the medicine is almost double if I do split the dose) and in some of the other postings I noticed mention of muscle loss and skull issues of which my Murph has experienced both (skull and hind legs)within the last two months. It seems to have gotten worse as time goes on, is there hope for her regaining muscle after we get all her levels in check?

Thanks so much for all you kind words in other postings, I am feel more hopeful.
Kat

[lulusmom]

Hi Kat and welcome to you and Murphy.

I'm sorry for the reasons that brought you to us but I'm sure glad you found us.

Can you please round up copies of all of the testing that your vet did to diagnose Murphy? Those would include blood chemistry, cbc, urinalysis, acth stimulation test, low dexamethasone suppression test (LDDS) and any ultrasound findings. Did your vet diagnose pituitary or adrenal dependent cushing's? Does Murphy have a voracious appetite and drink and pee buckets? These are the most common symptoms of cushing's and I didn't see where you mentioned either of them. That is a concern since your vet has already prescribed treatment.

If you've read any threads, you will have seen that we like to look over our vet's shoulders to make sure all the i's are dotted and the t's are crossed. Cushing's is one of the most difficult canine diseases to diagnose and unfortunately, it is also one of the most misdiagnosed. There isn't just one test that is conclusive so to do it right, a vet has to rely on more than one diagnostic and validation test (acth stimulation test, low dose dex test and UC:CR), all of which can yield false negative and positive results. Since the goal of treatment is to remedy the problematic symptoms, overt clinical signs are key in confirming a diagnosis.

Sudden onset of symptoms is not the norm with cushing's and panting is not at the top of the list of cushing's symptoms that prompts a pet owner to take their dog to the vet. Can you tell me how soon after the gall stone episode that diagnostics for cushing's were done?

Sorry for all the questions and requests but the more we know about Murphy's medical history, the better prepared we are to give you meaningful feedback. I've subjected you to enough for the time being but don't be surprised if I come back to torture you some more. :D

Looking forward to hearing more about your precious Murphy.

Glynda

[Murphys Mom]

Glynda,
Thank you so much for your reply. I am sorry I didn't mention her excessive thirst, need for tons of potty breaks and the panting. Her coat has just become a bit different but she does not have the other symtoms. She is actually not hungry but until a month ago was always eating every bit and loved a treat. (She still loves treats). In hindsight I think he hunger did increase, I just didn't see it. The vet did an Ultrasound 1st in early June which is how she found the gall stones (she said that was extremely rare) and was treating Murphy with 3 different meds trying to eliminate the infection and hopefully the gall stones. Nothing changed for Murph so we took her in last Monday for the cushings test which came back positive.

I will ask for the test results and be back as soon as possible. The muscle loss has me really concerned as her skull has become concave and her hind legs so weak. It pains me to watch her try to get up.

Thanks again so much!
Murph's Mom
Kathy

[lulusmom]

Hi Kat,

Does Murphy's head look like she has lost muscle or does her skull appear to be concave and if so, what areas? Perhaps you could post a picture?

[Murphys Mom]

Here are the test results as I can best read:
Cortisol sample 1 3.5 (1.0-5.0)
Cortisol sample 2 31.4 (8-17)

The rest shows and says everything pointing to hypoadrenocorticism. Basically stating she has it.

I am sorry, this is very hard to read and not as documented s other postings I have read.

Her head is concave left side and I will provide a picture asap. (Camera is the lake and my phone takes terrible pics)

Thanks again for everything.
Blessings,
Murph's Mom
Kathy

[Murphys Mom]

Glynda,
I posted pictures in the following folder:

Murphy 12 YO Golden by Murphy's Mom Kat

Hopefully you can see what is going on. I also included her sister, Molly!!

Thanks again.
Kathy

[Murphys Mom]

Glynda, I also got more info from the vet...waiting for someone with better eyes to read it for me. Will be back with her blood work taken b4 the cushings test.

Thank you from the bottom of my heart!
Kathy

[lulusmom]

Hi Kathy,

I love the pictures of Murphy and Molly! They are beautiful girls and I am sure they are attention getters when you are out and about with them.

After seeing the unilateral muscle atrophy on the left side of Murphy's skull, I can tell you that this is not the progression of muscle wasting we see caused by the catabolic effects of cushing's. I am concerned about the accuracy of a cushing's diagnosis based on an acth stim test, which can yield false positive results, and one or two symptoms that appear to have come on suddenly and which overlap with non adrenal illnesses. I am very interested to see if the abdominal ultrasound revealed more than gall bladder stones...like abnormal liver and adrenal glands. I'm also interested in seeing the abnormal blood chemistry and urine values to see if they fit the normal cushdog pattern.

I don't want to alarm you but the most common reason for unilateral (one side) muscle atrophy in the head is something called a trigeminal nerve sheath tumor. I've included some url's below, one of which is a story of a patient as told by Dr. Michelle Gerhard Jasny, DVM and a paper on Brain Tumors in Dogs and Cats from NC State University College of Veterinary Medicine. If you scroll down several pages on the SCSU site, you will see a picture of a golden with a concave dent on the left side of the skull.

I'm an insurance professional and have no experience in the veterinary or medical arena, aside from my personal research, so any feedback you get from me is straight out of a layperson's mouth. In my layperson's opinion, you may be dealing with cushing's but I have a gut feeling cushing's is not Murphy's problem. If it were me, I would talk to the vet about this right away and probably ask for a referral to an internal medicine specialist.

http://www.mvtimes.com/happy-lopsided-pooch-394/

http://cvm.ncsu.edu/vhc/tc/clinical_services/neuro/brain_tumor.html

Glynda

[Murphys Mom]

Hi Glynda,
Thanks again, I checked the links and she does indeed look like the golden in the picture but does not have any of those symptoms at this time, other then the panting and thirst along with lots of potty breaks. She has no trouble eating, she does not have any trouble closing her eyes or mouth, eating nor appeaars to be in any pain. The vet said that she sees that loss of muscle in older pets quite often and since Murphy appears normal she let it go. Her 1st diagnosis was as follows after the Ultrasound:

Found Gall Stones, suspect hypothyrodism. Weakness in hips may be due to gall stones or bladder infection - Cushings less likely.
Prescribed 3 antibiotics, 2 amoxicillin, metronidazol,e and 2 pain meds tramedol, rimadyl & levothyroxine.

Cushings results:
cortisol serial 2 acth
time 1 1230
time 2 230
cortisol sample 1 3.5
cortisol sample 2 31.4
hyperadrenocorticism (hac) Post ACTH results greater than 20 ug/dl are consistent with HAC.

Here is the urinalysis:
total proten - 5.7
calt - 254
calt phoephatase -n 155
cggtp - 14
bilirbin - 00,2
urea nitrogen - 0,4
phosphorous - 4.5
glucose - 91
calcium - 9.2
sodium - 140
potassium - 5.1
triglycerides - 348
amylase - 367
lipase - 296
cpk - 97
hemolysis - 4 no significant interference
wbc - 5.7
rbc - 5.54
hemoglobin - 14.3
hematocrit - 40.0
mcv - 72
mch - 25.8
mchc - 35.8
blood parasites - None seen
rbc morphology - normal
platelet count - 314
platelet est - adequate
neutrophila - 5073
lymphocytes - 399
monocytes - 171
eosinophils - 57
basophils - 0
t4 - 0.5


Hope this makes sense to you as it impossible for me to understand.

Let me know if you need more, the vet call today and we start her on 30 mg of Vetoryl tomorrow, she changed the dose due to Murphy being under 50 pounds. I pick it up 1st thing in the morning and she states I should see signs of improvement in 7 weeks.

Again and I can't say it iften enough, thank you from the bottom of mine and Murphy's hearts.

Kathy

[lulusmom]

Kathy, I'm sorry that I didn't mention that we only need to see the abnormal values (high and low) and also the normal reference ranges. Can you repost or edit your last post and insert the reference ranges for the abnormal values only? I don't see the urine results. Did your vet do a urinalysis to 1) check urine specific gravity and 2) to rule out urinary tract infection?

Glynda

P.S. I still have concerns about the diagnosis given there is no mention of abnormalities in the liver and adrenal gland(s) and even without the normal references ranges on the bloodwork, I am not seeing anything that is screaming cushing's. I'm now concerned about your vet's experience with cushing's and Trilsotane. Old dogs , with or without cushing's, don't suddenly develop a concave dent in one side of their skull from muscle wasting. Additionally, if dosing is close to adequate, you should see improvement in symptoms within seven days, not seven weeks. By seven weeks we'd hope that you would have Murphy close to stabilized with symptoms well behind you. Did your vet tell you that you need to have Murphy in for an acth stimulation test 10 to 14 days after starting treatment and that you need to have her to the office within 4 to 5 hours of giving her the morning dose with food?

[molly muffin]

Hi kathy and welcome. The really good thing is that you are dealing with people here who have a lot of experience with cushings, years worth in some cases.
Murphy and Molly are just lovely. Thanks for the pictures! Post more any time you want. hahaha :)

hugs,
Sharlene

[Murphys Mom]

Yes, they determined gall stones and bladder infection including urinary tract infection which is why they gave her so many meds including 3 antibiotics.

Here are the notes of high/lows:
This is what is listed under the ctalory urinalysis:
total proten - 5.7
calt - 254 HIGH
calt phoephatase -n 155 HIGH
Creatinine - 0.4 LOW
triglycerides - 348 HIGH


Nothing else...she did indeed tell me she had to be back in 2 weeks and then again in 3 months, 6 months and every 6 months after that. I like the sound that there will be many 6 months to come!!

My Vet just treated another dog 3 weeks earlier than Murphy with Cushings and from the sound of it she did research all the latest news and available data on the subject, that is why she isisted Murphy needed the meds once a day, not twice.

I am headed to pick up the meds now. I will asked a few of the questions if I can get in with her.

Thanks again! Hugs to you for helping me and my Murph!
Kathy

[lulusmom]

Hi Kathy,

If you can tell me which lab did the bloodwork, I can try to find the normal reference ranges. I have a slew of blood chemistry tests for my own dogs so I may have tests done by the lab who did Murphy's.

When you go to the vet, please share the blog written by Dr. Michelle Gerhard Jasny, DVM with her. The dog this vet examined had no symptoms and was eventually diagnosed with trigeminal nerve sheath tumor by an oncologist. Also can you please ask her which form of cushing's Murphy has (adrenal or pituitary). The abdominal ultrasound is used to make this determination so she should have seen the adrenal glands on imaging. If pituitary, both glands are enlarged or normal and if adrenal, one is enlarged and the other is smaller or completely atrophied.

Is Murphy's urine dilute (clear like water) and do you know if your vet did a urinalysis? Also, the T4 of .5 is usually considered pretty low based on the labs I've seen here but noticed you didn't include that in the abnormal values. Can you double check that please?

Am I getting on your last nerve yet? :o

Glynda