new cushings diagnosis

[redsla]

Hi, I'm Redsla. My toy poodle who is almost 12 has been diagnosed with cushings. He has had seizures since he was 3 1/2 yrs old and has been on pheno 2x a day all these yrs. Has done really well. Seizures got bad abot 41/2 yrs ago and we added levothyroxene and he has been great. No one believed he was as old as he is. His name is Merlot and he has weighed 8.8lbs since he was 2 never fluctuating more than .2. He went in to have teeth cleaned in late June and has not been the same since. He ended up having to have 2 teeth pulled that no one knew were infected. He never cried or fussed but they were really bad. We have also planned to take out his tonsils for the past couple yrs whenever we decided to put him under to clean his teeth due to all the swollen gland problems. 2 wks after he came home he started peeing in the house. Merlot is litter box trained and has never ever peed in the house outside his box. He didn't go all over just on the path to the box. He got very disoriented and seemed lost much of the time. Very unusual. It appeared he was loosing his eyesight and they suspected Sards because of how frightened he also became. That sort of got better as far as sight we know he sees shadows and we accommodate. But Then, he started getting ravenous and drinking gallons of water. This dog never drank water. We have had to force give him water over the years so this was very noticeable. Finally did the low dose dexamethezone test and it came back positive for cushings. Vet decided to puthimon Lysodrine but we are on hold since he has decided not to eat. I have bought every food in the world and he wants nothing to do with it. It is like his sense of smell went away. Until I can get him eating again, I can't start him on his new meds. Any thoughts?

[labblab]

Hello to you and little Merlot, and I am so sorry that you have been having all these new problems! However, one line in your post really stood out for me:

He went in to have teeth cleaned in late June and has not been the same since.

Cushing's is typically a chronic disease that develops very slowly, and it is very unusual for an entire array of symptoms to appear suddenly. Given the apparent loss of eyesight in conjunction with his other problems, I do understand why SARDS has been a consideration. However, if it were me, I would be wondering whether there has been a systemic infectious process at work, or whether the anesthetic itself may have compromised Merlot's liver or kidneys, and is causing at least some of these problems. [Edited to add: Please see my subsequent reply in which I have been reminded that SARDS itself can be accompanied by rapid increases in thirst, urination, and appetite]

One problem with the LDDS is that it can be skewed by other nonadrenal illnesses and return a "false positive" even when Cushing's is not actually present. So given Merlot's loss of appetite (uncommon for a Cushpup), I would also be very hesitant to start Lysodren treatment at this time. I would first want further diagnostics to be performed, including perhaps an abdominal ultrasound.

Given Merlot's problems, I am assuming that your vet has performed a full blood panel and urinalysis subsequent to the surgery? If so, can you please post any abnormal results, along with the lab's "normal" reference range? And if your vet has not done a full blood panel and urinanalysis, that is the first place I'd start so as to check on major organ function as well as indicators of active infection. Also, given the fact that he has been receiving thyroid supplementation, has his thyroid function been recently monitored via a complete thyroid panel? I know that phenobarb affects thyroid results, so a simple T4 reading probably is not a sufficient assessment of his true thyroid function.

I am so sorry for the reasons you are needing us, but I am so glad you've found us. And I will be looking forward to any additional information you can supply.

Marianne

[Steph n' Ella]

Redsla, Hope you can gather all your tests and post! Poor little Merlot! There are lots here who have good ideas for getting pups to eat. Maybe check out this site...

http://www.holvet.net/slippery_soup.html

[molly muffin]

Hello and welcome. Marianne stated things very well. Usually cushings develops slowly and over time you start to notice all the symptoms that you said came on suddenly.

Since I have a dog that was originally misdiagnosed I'm rather leery when things that don't seem right are considering a given. I would not say it is a "given" that Merlot has cushings at this point. Infection, maybe, thyroid, kidney, liver all need to be looked at independently of cushings. For this I would suggest a referral to an IMS, these are not symptoms to guess about but can be very serious.

I'm so glad you found us.

Sharlene and Molly Muffin

[labblab]

Hi again,

After reading your first post, I went back to refresh my memory about SARDS and am reminded that not only can complete visual loss occur very quickly, but so can associated disruptions in smell, thirst, and appetite. We also do know that some dogs with SARDS may also exhibit Cushing's.


Typically the onset of visual loss is sudden. In some cases it is noticed virtually overnight. In other cases observant owners may notice a degree of visual aberration for 5 to 10 days before complete loss of vision becomes apparent. Very typically the owners will report an often dramatic increase in drinking and appetite in the weeks before onset of visual loss. In many cases the weight will have increased in that time. Some owners report a concurrent decrease in hearing and smell...

A routine blood and urine work up in these patient may reveal changes which are suggestive of hyperadrenocorticism (Cushing's Syndrome). If these tests are followed up with specific testing for Cushing's (low dose dexamethasone suppression test, ACTH stimulation test) some cases will be confirmed as Cushingoid. These patients should be treated for their Cushing's syndrome, but this will not restore vision. The relationship between Cushing's syndrome and SARDS is not known.

http://www.eyevet.ca/sards.html

Have your vets now discarded the notion that SARDS is the cause for Merlot's visual problems? If so, is this because the visual loss does not seem to be total?

Also, I apologize that I missed your earlier comment that Merlot was originally ravenous. Can you tell us some more about this recent loss of appetite?

Marianne

[redsla]

My vet called today and said he wants to do ultrasound tomorrow. He thinks the cushings reading is wrong and thought about it all weekend. Have I said I love my vet and his daughter who is also a vet? I personally believe that Merlot would have died yrs ago if not for them. This is breaking my heart with his panting, weight gain, peeing etc. He is allergic to the cat so Jazz is banned from the house these days. We can't give him allergy meds because of his frail liver. Our previous poodle ( a rescue) succumed to Cushings so I am pretty sure Merlot doesn't have it. Money is so very tight right now for us and I just spent $50 on the Lysidrone which I'm glad I'm not giving him right now. I will post more after I have the ultrasound done tomorrow afternoon. We are on pst time and apt is 2pm. Thank you all for being here.

[labblab]

I am relieved to hear that your vet has recommended the ultrasound, because a lot of useful information can be gained that way. Was the Cushing's in your other dog formally diagnosed? What are the differences between that dog's behavior and Merlot's that are making you doubt that Cushing's is at play for Merlot?

By the way, here's another article about SARDS. I am still wondering whether or not it is involved in Merlot's sensory losses. For instance, if he has lost the sense of smell or taste, then that might account for the new inappetance.

http://cal.vet.upenn.edu/projects/ophthalmology/ophthalmo_files/Tools/SARDS.pdf

Marianne

[molly muffin]

Thinking of you and Merlot today.

Sharlene

[redsla]

Well yesterday Merlot had the ultra sound. Vet sai that 1/3 of his liver is "funky" looking but he and 4 other vets could not decipher exactly what was wrong. They said his gall bladder looked fabulous and that was a good sign. They told me to give him Denamarin for the next 30 days and we would check him again and see where we were. He seemed in a good mood last night and ate well last night and this morning. However when I got home after work he could barely walk on his right back leg. At first I thought he may have jumped off his chair wrong. But for the past month I have watched that same leg start to go out from under him but never completely so I sort of know its been coming. I fed him and he ate well and went out with me to potty and I went to Bible Study for 1 1/2 hrs since I was a fill in leader tonight and had to. My husband came home right after I left and said he just sort of layed around. When I got home, I noticed he wasn't putting his leg down at all. When he did he couldn't stand on it. He let me take him out to pee and he pooped but then made me pick him back up to come in. To me he is now bloated and he wasn't before. He is heavier and I know it is fluid. I have emailed my vet and will talk to him first thing in a.m. Little Merlot just looks at me and tips his head when I tell him we will fix it. My heart is breaking. I am so glad you are all here. Thank you.

[redsla]

Right now my heart is breaking. Merlot is just trying to sleep in his bed next to me here at the computer and can't make his leg work. He just looks at me to help him and I don't know what to do. Is it Cushings or isn't it? And will the Lysedrine, if they say to start giving it to him, hurt whatever the "thing" is on his liver? When I went to work this morning, he was still playing and running around and tonight he can't walk on his leg and he is bloated and looks so sad. My heart is heavy and I am glad that I have this forum.

[molly muffin]

Cushing is more of a muscle wasting problem with the hind quarters. This sounds like something else.
How are his white blood cells levels? I'm thinking a full senior wellness panel is needed. What is his liver values at, the ALT?
Hopefully someone will be along soon that has some ideas to jump in.
I know it is so hard to see them in any kind of distress.

Hugs,
Sharlene

[labblab]

In order to perform an abdominal ultrasound, I believe they have to manually hold a dog on its back. I wonder whether they may have strained Merlot's leg in the process, especially if he had some pre-existing weakness there? Was the leg fine when he came home from the testing, or was he favoring it at all?

Also, did the ultrasound show the condition of Merlot's adrenal glands? That is probably the primary image of interest when making a Cushing's diagnosis. The adrenal glands can be very hard to see, and it usually takes specialized equipment and personnel to interpret images of the adrenal glands expertly. Unfortunately, many vets in general practice do not have equipment sophisticated enough to view the adrenals, and that's one reason why specialty referrals are made. If your vet remains unsure about what is going on with Merlot, perhaps a consultation with an internal medicine specialist ("IMS") would be helpful at this time. What with Merlot's sensory losses and multiple worrying issues, it could really help to have an expert sort through all the tests and medical history...

Marianne

[3bostons]

Hi, Im sorry to hear of your heavy heart and I feel for both of you, I hate it when our fur friends are hurting and we dont know why. Maybe what Marianne said could be the cause, they do put them on their backs for the ultrasound. I hope it turns out to be something simple like that and not anything worse.

hugs, kona and deb