12 yo Weim on Prednisone diagnosed with Cushings

[jambeedog]

My 12 year old female weim has a history (last six years) of regurgitating and then aspirating it into her lungs. She has been hospitalized for aspiration pneumonia 7 times in the last 6 years. A few months ago I had Upenn take another look at her and finally they realized that she has slight partial laryngeal paralysis which may be constributing the aspiration. Most importantly they need to stop the regurge so that she is not aspirating it. She was diagnosed with IBD thru an endoscopy and recently put on prednisone in order to stop the regurg. She also has a low thyroid level and has been on Soloxine since she was 6 yo. Other than that, very healthy and happy.

She has had alot of muscle loss and weakness in the rear end and after blood work Upenn says they are pretty sure she has Cushings.

Here's my problem and I wonder if anyone has this issue or knows anything that would be helpful:

Because she is on prednisone we can't test for cushings nor can she be treated with medication for the cushings because the prednisone totally screws all that up. Now once the IBD is under control we would like to take her off it for a few days and test her for Cushings just so we can be sure but she really has all the symptoms and from the bloodwork results of a dog with cushings.

Since we can not test for cushings yet nor can we treat with pharmaceuticals my regular vet (who is holistic) has put her on White Crane's Uro-G-Plus a chinese herbal remedy for Cushings. Does anyone has experience with this remedy and is there anything I can do about the muscle loss, she is very weak in her hindquarters and falls and trips often her feet even flip over and she walks on them for a few steps every now and then. Just bought her some Neopaws boots for traction and stability which she does well with. She is receiving acupuncture and seeing a rehab vet who would like to do hydrotherapy to build up some muscle but she can't because there is always a chance she could get water in her mouth and aspirate and we need to prevent her from aspirating at all costs given her history and the fact that her immune system is probably already compromised.

Any thoughts or suggestions(or questions to help you better understand her situation).

I just want to keep her going and comfortable for as long as I can but it may be that she will never be able to go on medication for the cushings (assuming we are able to test her in the future and it is determined that she does in fact have cushings). Her current symptoms are frequent UTIs, hindend weakness, sleeping more, excessive drinking and peeing, can't explain the bloodwork values to you, all I know is they showed me which things were high and which were low that were consistent with cushings.

[Harley PoMMom]

Hi and welcome to you and your girl,

So sorry for the reasons that brought you here but glad you found us.

There are three different forms of Cushing's; Pituitary-Dependent Hyperadrenocorticism (PDH), Adrenal-Dependent Hyperadrenocorticism (ADH), and Iatrogenic Cushing's disease.

Iatrogenic Cushing's is caused by prolonged periods of steriod use, which your girl has. Never have I read that the use of the Cushing's meds, Trilostane/Vetoryl or Mitotane/Lysodren, should be the treatment for Iatrogenic Cushing's, they are only used when PDH/ADH is confirmed. When a dog is taking any steriod for a while, whether it be orally or topically, this can cause Iatrogenic Cushing's. Only gradual tapering of the steriod is the solution for Iatrogenic Cushing's.

Iatrogenic Cushing's in a dog has the same symptoms as PDH and ADH. With PDH, there is a tumor of the pituitary gland which causes the pituitary gland to overproduce a hormone (ACTH) that stimulates the adrenal glands to produce cortisol.

With ADH, there is tumor on the adrenal gland, surgical removal of this adrenal tumor is the only "cure" for this type of Cushing's.

Are you taking your girl to the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania?

Besides the Soloxine and Prednisone, is there any other medicines she is taking? How much does your girl weigh? What is the dose of prednisone she is on?

Please know we will help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

[jambeedog]

Yes she is seeing a vet in the Internal Medicine Dept at Matthew J. Ryan in Philly. Besides the Soloxine and Prednisone she is also on Reglen, pepcid, a B-12 shot once a month, and Adequan injection for her hips once a month, and for the next week an antibiotics for the UTI. She is also getting the following supplements, Seacure, Krill Oil, Ubiquinol (coq10), enzyme/probiotic mixture and I just ordered DGL (licorce) as its supposed to get rid of acid reflux and then possible she can be taken off the pepcid and maybe even the prednisone.

Blue weighs 65# (she was 70# up until recently) and she is currently on 20 mg twice a day of the prednisone with the intention of lowering it once she stops regurgitating. It has diminished over the past three months but not completely stopped, I still notice regurge about twice a day which is 75% better than before the prednisone.

Blue is on a raw diet that I buy pre-packaged and frozen from a local company. (it consists of tripe, chicken, turkey, vegetables, various oils, and acv.

[Squirt's Mom]

Just an FYI - in my reading on herbs for dogs, I have found that Licorice should never be given to a dog with Cushing's as it is an adrenal stimulant. So you might want to make sure your vet approves this for your baby.

[Harley PoMMom]

When I initially read your post I thought that Blue might have Megaesophagus. From my bit of research it seems that, many times, Laryngeal paralysis and Megaesophagus occur together.

I also have read that Dogs with Megaesophagus find that the Bailey chair has helped.

Here's a link with info about the Bailey chair:http://petprojectblog.com/archives/dogs/megaesophagus-and-the-bailey-chair/

Love and hugs,
Lori

[lulusmom]

Hi and a belated welcome to you and Blue

I'm sorry that Blue is having so many issues but if there is any good news in all of this, it is that any cushing-like symptoms you are seeing, including muscle wasting, can be attributed 100% to the prednisone she has been on for months and months. Quite frankly, I don't understand why the internal medicine specialist would even consider pursuing actual testing for naturally occurring cushing's without first addressing the most likely suspect which is Iatrogenic cushing's. As Lori already mentioned, the treatment for this is withdrawing the drug. Did the specialist happen to tell you why he thinks Blue has naturally occurring cushing's as opposed to Iatrogenic cushing's?

The Bailey chairs are extremely effective so one may make a huge difference for Blue. Handy people have made their own so hopefully you have handier family members than I. :D If you Google Bailey chair for dogs, you'll get lots of youtube videos.

Glynda

[jambeedog]

Yes I spoke with my vet about it and this is DGL in its deglycyrrhizinated form so it doesn't contain the glycyrrhizinate that affects the adrenal glands, its only purpose in this form is to help with gastrointestinal problems.
http://www.integrativepsychiatry.net/dgl-plus-pure-encapsulations180.html

Thank you so much for mentioning it, I always do some research on a product first and then check with my vet.

[jambeedog]

They tested her for megaesophogus and her esophagus is fine and functioning normal.

[jambeedog]

she has just been on the prednisone for just three months, the suggestion of cushings by the vet at UPenn was before she started the prednisone. She had never been on it previously.

[lulusmom]

They tested her for megaesophogus and her esophagus is fine and functioning normal.

I'm not sure Lori was inferring that your dog had megaesophagus but rather that your dog's regurgitation could be helped by a Bailey Chair. If I remember correctly, this chair was invented by a pet owner who made it specifically to help his dog's regurgitation and aspiration. Both are a complications of megaesophagus which can lead to aspiration pneumonia.

Besides the muscle wasting and blood abnormalities, what symptoms did your dog have prior to prednisone that are associated with cushing's?

[Spiceysmum]

Hi,
My dog, Brin (who doesn't have cushings) regurgitated most of his meals after he was seriously ill early this year from internal bleeding. As soon as he'd finished the last mouthful it all came straight back up. He eventually had an endoscopy which found he didn't have megaesophagus but there was a slight problem with it. I started feeding him from a height and it stopped straight away. I know you have probably heard of this and possibly already do it but I thought I'd mention it. We didn't buy a special dish holder, we actually use a wooden block and a plant pot to higher his dish, lol
Brin also has weakness in his back legs and topples over sometimes.

Linda

[jambeedog]

Hi,
My dog, Brin (who doesn't have cushings) regurgitated most of his meals after he was seriously ill early this year from internal bleeding. As soon as he'd finished the last mouthful it all came straight back up. He eventually had an endoscopy which found he didn't have megaesophagus but there was a slight problem with it. I started feeding him from a height and it stopped straight away. I know you have probably heard of this and possibly already do it but I thought I'd mention it. We didn't buy a special dish holder, we actually use a wooden block and a plant pot to higher his dish, lol
Brin also has weakness in his back legs and topples over sometimes.

Linda
Thanks for your reply. Did Brin ever aspirate his regurgitation? The food/water doesn't usually come out but I can tell a bitter taste is in her mouth by the way she is swallowing. The vet said its the acids from her stomach and they irritate her throat causing her to gag as well. I have heard of this and my dog's bowls are elevated but only about 6 inches. How high are your bowls...high enough for him not to have to bend down at all?

[jambeedog]

I'm not sure Lori was inferring that your dog had megaesophagus but rather that your dog's regurgitation could be helped by a Bailey Chair. If I remember correctly, this chair was invented by a pet owner who made it specifically to help his dog's regurgitation and aspiration. Both are a complications of megaesophagus which can lead to aspiration pneumonia.

Besides the muscle wasting and blood abnormalities, what symptoms did your dog have prior to prednisone that are associated with cushing's?
constant drinking and peeing, peeing in her sleep, hungry all the time, temors in her lower jaw and her hind quarters, loss of hair on her tail...but the rest of her coat looks fine. She actually doesn't have any new symptoms since she started the prednisone although I assume its probably not helping with the existing symptoms. The peeing is better and she did wear a diaper for a few weeks while sleeping but she very quickly learned to wake up and come get me when she had to go so she wouldn't go in the diaper. She does pee on the floor ocassionally but its much better and so is the water drinking. I'm assuming this might be due to the chinese herbs.

[Spiceysmum]

Hi,
The bowl is about 12" high. He is a Springer Spaniel and this is just the right height for him not to have to bend down too much. He never did aspirate his regurgitation. Every day he brought one of his meals back up as soon as he'd finished eating it but I'd give him more half an hour later, as he was losing so much weight, and he'd be fine.
I think they said after his endoscopy, that his esophagus wasn't inflating (deflating?) properly. He also used to make a really loud hacking or gagging sound when he was laying down but this has stopped too which I assume has been helped by feeding from a height.
Has the prednisone stopped the regurgitation now? Can they not try some different medication to help control the acid? My husband had to try quite a few before he found one that helped him with his stomach acid and reflux.

Linda

[jambeedog]

Hi,
The bowl is about 12" high. He is a Springer Spaniel and this is just the right height for him not to have to bend down too much. He never did aspirate his regurgitation. Every day he brought one of his meals back up as soon as he'd finished eating it but I'd give him more half an hour later, as he was losing so much weight, and he'd be fine.
I think they said after his endoscopy, that his esophagus wasn't inflating (deflating?) properly. He also used to make a really loud hacking or gagging sound when he was laying down but this has stopped too which I assume has been helped by feeding from a height.
Has the prednisone stopped the regurgitation now? Can they not try some different medication to help control the acid? My husband had to try quite a few before he found one that helped him with his stomach acid and reflux.

Linda
She definitely regurges less on the prednisone but not completely gone. We have tried a few other things before resorting to the prednisone. She gets pepcid and reglen now but we also tried prilosec and sucralfates as well as prescription dog food.

[molly muffin]

Hope your girl is doing well.

Sharlene