Overwhelmed and Scared (Sheridan is now at peace)

[Scotty12869]

Good Morning my name is Scott and I have 3 Minature Schnauzers. The one I am going to be talking about it my little boy, Sheridan... I have had him since he was 8 weeks old. He is now 11 yrs old. A little medical history to start. He has Atopy and has been on prednisone for a number of years. He has generally been a very healthy dog up until this past weekend. He started vomitting, became lethargic, and not himself. We have been through this in the past where he would get this way, but thought it was something he might have eaten that he wasn't supposed too because of what he vomitted, and a reaction to his medication. He would bounce back after 2 days and be his regular self. On Monday this week we went to the vet and he noticed his potbelly and commented on it, but nothing else. He had an eye infection that we were given an ointment for. But nothing was really addressed as far as the vomitting. He was on the upswing at this point. Tues was pretty good day, then by late Tues night/Wed morning he was vomitting and drinking huge amounts of water and urinating in the house which was a new thing. Called right away and were able to get an appointment for the late morning. While waiting I did some research on-line. Googled Min Schnauzer vomitting and drinking lots of water... Came up with Cushings... He had most of the signs of cushings, no hair loss though... So we went to the vet for the appointment. He did his usual check over, then I started asking questions... Are we dealing with Cushings? They did a blood test (lasercyte) and (catalyst Dx) with about half normal and then half very high readings. I am not a vet!!! Please explain these numbers to me! He went over some, to say that they maybe pointing to pancreatitis... Finally I asked in his professional opinion are we dealing with Cushings? He said yes finally! With all that I have read and am quite honestly overwhelmed at this point, what I understand there is no true test for cushings, just evidentiary testing. OK... So what I need to know, before I put my baby through more of this process is what kind of life will he have? Is this a maintaining program with a choice of medication? is the way he is for the rest of his life or will he get back muscle mass lost, will he be back to his normal playful self again? I know there are no guarantees in life or medicine for sure... What I am looking for are people who have A, dealt with and B what their expireinces have been? I want him to have a quality of life for himself and his dignity, not my own selfish wants... He has been feeling pretty good for the last couple of days, drinking less, but the panting is present in the evening, he has a little more energy everyday, we even chased a squirrel today and got friendly with another dog walking. The vet put him on a low fat diet for right now of ID which by the way he doesn't eat... So I cooked chicken breasts and rice to get something in him... He is eating this quite well...

I know this is a nutshell version and am probably forgetting things, but at this point I need answers and questions for our visit on Tues this coming week...
Thank you all in advance for you help and advice.
Scott

[Harley PoMMom]

Hi Scott,

Welcome to you and Sheridan, so sorry for the circumstances that brought you here but glad you found us.

When a dog is given a steroid over a period of time, whether it is by injection, orally, or topically, Cushing symptoms can appear, this form of Cushing's is called iatrogenic (veterinary-induced) hyperadrenocorticism. The only treatment for iatrogenic cushing's is to slowly taper the use of the steroid but sometimes when dogs have severe allergies this can be very difficult to do.

Prednisone is a synthetic corticosteroid and will interfere with cortisol assays, so no tests for Cushing should be done.

Since Sheridan is vomiting, which is unusual when a dog has Cushing's of any form, I believe finding out the reason for the vomiting is the number one priority. Pancreatitis can make a dog very ill, and vomiting, among others, is a symptom. A spec cPL test can confirm pancreatitis when it is suspected.

It would help us a great deal if you could round up copies of all tests that were done on Sheridan and post any abnormalities that are listed. The more information we know about your sweet boy the better our feedback will be.

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

Love and hugs,
Lori

[goldengirl88]

Hello Scott and welcome to you and your babies. I am fairly new here too. What caught my eye about your story was it sounded almost exactly like mine. I was scared to death, had never heard of this disease before, and didn't want my dog to suffer. My Tipper was diagnosed in August of this year. From allergies as a puppy, she was given prednisone, that is how she got Cushings. She had terrible symptoms. She has been doing well with the Vetoryl. She receives a split dose, as the symptoms were returning in the evening. She is herself again, running, playing, walks about a mile every day. The dogs can have a good quality of life. My neighbors think nothing is wrong with her. So far so good for us. Tipper is 11 also. I try to be vigilant in her care. I think that is very important. If you are aware and keep a good check on them you can manage this disease. I have had break downs and cried countless times since her diagnosis. I know it is very scarey. Find a good Vet who has experience treating Cushings, get the appropriate testing done, and post the results. These people are wonderful on here, and will guide you on the right path. You must first make absolutely sure you are dealing with Cushings. If you can keep it together, afford the testing and meds, and watch your dog like a hawk, you and your baby should do well. I wish you all the luck, as I too felt like I had a punch in the gut when I heard my precious Tipper has this horrible disease. God bless you and the babies, and let us know what is going on.

[Scotty12869]

Good Morning Lori,
Thank you for your response. I did discuss the possiblity of iatragenic cushings and he said highly unlikely since he has not had any dosing since Friday of last week. The vet we see has been seeing Sheridan since we returned to WI from NC 3 yrs ago. I did trust him up until this point. From what I have read, he should not have any tests for cushings since he has been on steriods. What I have at this point are the blood tests that were done on Tues.
First is the
LaserCyte
RBC 5.45M/uL Normal is 5.50-8.50
HCT 39.4%
HGB 18.9g/dl Normal is 12.0-18.0
MCV 72.3 fL
MCH 34.6 pg Normal is 18.5-30
MCHC -.-g/dL
RDW 18.2 % Normal is 14.7-17.9
%RETIC 0.7%
RETIC 40.4 K/uL
WBC 31.72 k/uL Normal is 5.50-16.90
%NEU 88.7%
%LYM 2.4 %
%MONO 7.2%
%EOS 1.6%
%BASO 0.1%
NEU 28.14 k/uL Normal is 2.00-12.00
LYM 0.77K/uL
MONO 2.27 k/uL Normal is 0.30-2.00
EOS 0.49k/uL
BASO 0.05 K/uL
PLT 793 K/uL Normal is 175-500
MPV 15.1 fL
PDW 26.7%
PCT 1.20%

The Catalsyt DX
GLU 375 mg/dl Normal is 70-143
BUN 14 mg/dL
CREA 0.4 mg/dl Normal is 0.5-1.8
BUN/CREA 35
PHOS 7.6 mg/dl Normal is 2.5-6.8
CA 10.1 mg/dL
TP 7.5 g/dL
ALB 2.8 g/dL
GLOB 4.7 g/dl Normal is 2.5-4.5
ALB/GLOB 0.6
ALT 105 U/L Normal is 10-100
ALKP 621 U/L Normal is 23-212
GGT 1 U/L
TBIL 1.0 mg/dL Normal is 0.0-0.9
CHOL 322 mg/dL Normal is 110-320
AMYL 1206 U/L
LIPA 2677 U/L Nomal is 200-1800
Na 150 mmol/L
K 3.9 mmol/L
Na/K 38
Cl 113 mmol/L
Osm Calc 312 mmol/kg
I understand what some of these are, such as RBC and CHOL... But most I do not and quite frankly don't understand.

I am going to schedule a spec cPL test right away.

Should I be thinking about looking into a new vet, since this is one who has had his own personal dog with cushings? I just feel I need one who will guide more...

Thanks,
Scott :D

[Squirt's Mom]

Hi Scotty and welcome to you and Sheridan! :)

If I had to bet, I would bet that Sheridan does not have true, naturally occurring Cushing's. Rather I would put my money on him having the Iatrogenic form - caused by the long-term use of prednisone - NOT the actual disease. He has not been off the med long enough, I don't think, to say with any confidence the drug is not causing the signs you are seeing. Sheridan's case and Tipper's case are different - Tipper did not take pred long-term. If memory serves, she only had it a few times off and on when younger. Prednisone does not cause true, naturally occurring Cushing's - the cause(s) are as of yet unknown. Pred only causes the veterinary-induced form, Iatrogenic, which is cured by weaning off the prednisone. Once the pred is out of the system, the signs disappear. It is possible for a pup to actually have a pituitary or adrenal tumor (naturally occurring Cushing's) AND be on pred for another condition; in that case, once the pred was stopped, the signs would continue unabated.

As Lori said, any tests for Cushing's now would be a huge waste of money and time plus unnecessary stress for Sheridan. The pred will cause false-positives on all of the tests, making them completely invalid. There are alternatives to pred and if I were you, that is the first thing I would discuss with his vet - how to get him off the pred and on to something that will help yet not cause the side effects pred does. I would also be pushing for pancreas testing asap - today if possible. Pancreatitis is a very serious condition and requires prompt attention. ;)

Thanks for posting those results. Could you do one more thing for us and edit the post to include the normal ranges for each of those values? Different labs use different norms so it helps us to see what they call "normal".

I'm glad you found us and look forward to learning more very soon.
Hugs,
Leslie and the gang

[labblab]

Hello from me, too!

You have already gotten some very helpful info from Lori and Leslie about testing, and I just want to add this piece. I totally agree that Sheridan has not been "off" the prednisone for a long enough time to determine whether or not his symptoms have been caused by the supplemental steroid. However, if he remains symptomatic, the ACTH would be the best diagnostic test for the iatrogenic form of Cushing's. Here's a quote from an article by Dr. Mark Peterson, who is a veterinary endocrinologist who is extremely well-versed re: Cushing's:


[The ACTH is the] Best test to diagnose iatrogenic hyperadrenocorticism in dogs. If the dog has clinical and laboratory features consistent with Cushing’s syndrome (e.g., polyuria, polydipsia, polyphagia, pot-belly, truncal hair loss, high serum alkaline phosphatase) but has a recent history of glucocorticoid use, this is the test of choice. If the cortisol response to ACTH stimulation is low-normal or blunted in this dog, the diagnosis would be iatrogenic Cushing’s, rather than the naturally occurring disease. None of the other pituitary-adrenal function tests can make this differentiation.

Here's the article that's the source of the quote:

http://endocrinevet.blogspot.com/2011/02/diagnosing-canine-cushings-disease.html

Off the top of my head, I'm not sure how long a prednisone-free window is desired prior to performing an ACTH in this situation. I'll try to check that out and return with that info. In the meantime, I agree that the issue of possible pancreatitis is the most pressing right now.

Marianne

[Scotty12869]

Hi Leslie and Gang! Thank you for your response and greatly appreciate it. I did go back and add what they are referring to as normal readings.

When I asked the vet about the Iatrogenic he said that it should have been enough time for this to run its course and out of his system... I did think this odd since you have to build it up in the system to begin with... He has not had any pred since last Friday...

Scott

[labblab]

Per this additional article by Dr. Peterson, I'm surprised to see that in the absence of other issues, 48 hours "off" prednisone may actually be sufficient to proceed with testing for iatrogenic vs. naturally-occuring Cushing's:

http://endocrinevet.blogspot.com/2011/04/q-prednisone-and-cushings-syndrome.html

However, I don't think you'd want to test at the same time that a dog is exhibiting symptoms of other acute illness, such as pancreatitis, which might also have the potential to skew results.

Marianne

[Scotty12869]

Hello everyone who has been responding! Thank you so much and it really means the world to me to have such an outpouring of help with this. I thank you and Sheridan Thanks you so very much!

I currently have a call in to the vets office for a cPL... Just waiting to see when we can do it. On this note, I am currently unemployed and working for myself so income is very limited at this point. I have just dropped $400 in the last couple of days with them... Anyone know what this test should usually run?

Thanks,
Scott

[labblab]

Scott, I had a Spec cPL performed through IDEXX laboratory a little over a year ago at a cost of approx. $75 (my non-Cushpup was suffering from an acute pancreatitis attack at the time).

Marianne

[Scotty12869]

Marianne, Thank you... Still waiting to hear from Vet...

[Harley PoMMom]

Hi Scott,

Before performing the spec cPL test a 12 hour fast is required. Here's a link with info about the spec cPL test: http://www.idexx.dk/animalhealth/laboratory/speccpl/index.jsp

[Scotty12869]

Hi Lori,
Thank you for letting me know! I greatly appreciate it...

[lulusmom]

Hi Scott and welcome to you and Sheridan.

Thank you so much for posting the blood chemistry and cbc results and I hate to do this to you but can you please edit your post and insert the normal reference ranges? You only need to include these ranges if the result is high or low.

Glynda

[Scotty12869]

Hi Glynda, I think I have it edited properly. Please let me know what you think. If you need more information, please let me know.
Thanks,
Scott

[lulusmom]

Hi again.

Thanks for posting the reference ranges. I think pancreatitis and even diabetes would be a more likely suspects than cushing's. Sheridan's glucose is pretty darn high. Cushing's can cause a mild elevation but pancreatitis is more likely to cause moderate to severe elevations. Mini Schnauzers are prone to pancreatitis so I think doing a cPL test would be a really good idea. I personally would have the blood glucose rechecked again. This is a quick and inexpensive test. Did your vet say anything about the high glucose?

I have no idea why your vet would be so certain that Sheridan has cushing's based on the blood abnormalities and symptoms. Pancreatitis and Diabetes Mellitus share a lot of the same blood abnormalities and symptoms associated with cushing's. At this point, if I were you, I'd start ruling out the likely causes before I went to the expense of testing for cushing's. You wouldn't want to start testing anyway until Sheridan is back to normal and eating well. By the way, was Sheridan eating like a pig before she got sick and is she overweight?

Glynda

[goldengirl88]

Leslie:
Just wanted to refresh you on Tipper. She was on Prednisone for a long time, because of life threatening problems form her allergies, so that is where she developed her Cushings from. I didn't know if you remembered that . She seems to be going along ok right now thank God!

[molly muffin]

Hi Scott and Sheridan and welcome to the forum. I've been reading the thread, but didn't want to get off track from what the way more knowledgeable people than I were discussing with you. I do want to extend a warm welcome. I hope that you are able to get the cPL test and glucose test soon as that is rather dire in a situation with vomiting, diarrhea being exhibited. If you get nothing satisfactory from your vet for getting the test done, you can always go with an ER doctor, although that would be more expensive usually. Worst case scenario though that is an option.

Also, taking a dog off prednisone who has been on it for a long time cold turkey is not recommended. Usually they suggest that you wean them off the pred. I don't know what kind of reaction could be expected with a fast withdrawal. Maybe something for the more experienced to weigh in on.

Very light meals, small, 4 times a day, boiled chicken, rice, nothing fatty at this point, would help if he does have Pancreatitis. We have another member who has just been going through a bout of this of another thread, which you can reference here.
http://www.k9cushings.com/forum/showthread.php?t=3491&highlight=Pancreatitis&page=10

I do want to welcome you and hope that you can get this figured out quickly. Vomiting and diarrhea are not the first signs of cushings and cushings usually develops slowly, over time. Pot belly, panting, excessive drinking, frequent urination are all signs that build up and start to happen more frequently.

We'll be waiting anxiously for updates. (I see WBC are up, any signs of an UTI?)

Sharlene and Molly muffin

[Scotty12869]

Good Morning Everyone!

I finally had to call the vets office again in the afternoon since no one called. I did talk to one other vet there that has seen Sheridan in the past. She took a look at his blood work that was done and said without a doubt we are dealing with pancreatitis and most likely Iatrogenic Cushing. That there was not going to be a need to do a cPL as it would be another $180. He will be getting an anitbiotic this morning to help with his loose stools. Sheridan is doing much better everyday. We went for a walk last night and made it around the entire block even had a spring in his step for most of it. You will never know what a relieve it is to know what we are dealing with and he is on the mend! We have been having a bland diet of chicken breast and rice since Thurs, He loves it... There is a smile and a sparkle back in his eye, this is one of those things that really hurts to see your baby suffering, but those things are missing from their character and personality it just tears your heart out.

I want to THANK each and everyone of you personally... Lori, Tipper and Tippers Mom, Leslie and The Gang, Marriane, Glynda, Sharlene and Molly Muffin! You are all Angels! It really is a blessing to have people like you with knowledge and that you care enough to help others who are going through diagnosis of Cushings, but not only that, you were able to tell that we most likely were dealing with pancreatitis. What a wonderful gift you all bring to the world. I Thank you, Sheridan Thanks you, Hyacinth (his daughter) Thanks you, and Angel Thanks you all! Good Luck to you all and to those you will help in the future. You are all blessings to everyone that you help and may you all be blessed in return.

If there is ever anything I can ever do for any of you, please let me know!

I know Thank you is just not enough!

Scott, Sheridan, Hyacinth and Angel

[Squirt's Mom]

Hi Scott,

Yes, there is one thing you can do for us - please stay in touch and let us know how you and your babies are doing from time to time. Cushing's or not, ya'll are now family and we want to hear from you.

I am so glad you have a direction for Sheridan and that you are already seeing improvement. You're right - there is nothing in the world like seeing that light come back into their eyes. ;)

Hugs,
Leslie and the gang

[lulusmom]

Ditto to everything Leslie said. :D

[molly muffin]

Ditto Leslie also. :)

Big Hugs and belly rubs for Sheridan,

Sharlene and the molly muffin

[Scotty12869]

Hello Everyone... It is with heavy heart, but relief that Sheridan is out of pain. We were very hopeful that he would recover completely, but that was just not to be the case. He did very well during the end of last week and throughout the weekend, playing with his ball, carrying his babies around and taking them for a walk, getting back to a normal life, but not quite. Late Monday afternoon he was not himself again, sleeping mostly and not really wanting to do what he loves to do. Took him for a walk, he needed coaxing to go and really didn't want to be out there. Talked to the vet and said that he might have ups and downs while getting better. So, he rested through the night on Monday. He did not eat, drank some. He was up just before 5 AM, peeing in the bathroom and had a bowel movement. I took him out and he did his business and came in the house, which took a lot of him to do that. 15 mins later he wanted out again, he had another bowel movement of just mucus. Came back in then wanted back out again to vomit. He threw up his antibiotic and antacid. He came back to rest for a little bit. He was very lethargic and weak. Called to vet to get him in and see what we could do. Kept him comfortable through out the day between vomiting and going out to have a bowel movement. Needless to say he went down hill very quickly. With the pancreatitis and diabetes and they also think early stages of cushings his little body could take no more. Laying on his blanket on the sofa he had mucus coming out from him in the rear. He was getting sicker and sicker. He put up a good fight to try and overcome. (My prayers were answered to see him play and be himself one last time) But we did not really have anymore choices for him, but the best for him and not be selfish that I wanted him here with me.

He crossed the Rainbow Bridge at 6:15 PM last evening in our arms. He is at peace playing with all of his friends that went before him. It is very lonely here this morning without him here, but I am so thankful that he was here. Having his daughter Hyacinth and our rescue Angel make it easier to face the day. I know he will always be with us, but just not physically.

Thank all of you for your thoughts, prayers and concerns. I hope that all of you know what an impact you have made on me in a short time. Take care all of you and may all of your furry babies be strong, healthy and find love everyday.

God Bless you all!

[labblab]

Oh Scott, I cannot tell you how sorry I am to read your news. But just as you say, Sheridan is now at peace, and for that we must all be grateful. What a dear, brave boy!

Sheridan's name has now been added to our special memorial thread of honor:

http://www.k9cushings.com/forum/showthread.php?t=3918

There he joins all our beloved babies who have welcomed him to The Bridge. He will never be forgotten by his family here. Nor will you -- please do return at any time, just to talk or share memories of Sheridan and the rest of your family.

Sending many hugs, always in loving memory of your sweet Sheridan ~
Marianne

[Scotty12869]

Thank you so much Marrianne

[Roxee's Dad]

Dear Scott,
I am so very sorry for your loss....

Rest in Peace Sheridan, you are very loved.

You are our newest and brightest star in the sky.

[Squirt's Mom]

Dear Scott,

I am just so sorry to hear this. It was my hope he would rebound and be at your side for a long time to come. Sometimes no matter how hard we try, the answer is not the one we wanted. :(

Please know we are here for you any time you wish to talk. We would be honored to share in your memories of life with Sheridan.

Our deepest sympathies,
Leslie, Squirt, Trinket, Brick, Tasha, and our Angels, Ruby and Crystal


Do not stand at my grave and weep;
I am not there. I do not sleep.
I am a thousand winds that blow.
I am the diamond glints on snow.
I am the sunlight on ripened grain.
I am the gently autumn rain.
When you waken in the morning’s hush,
I am the swift uplifting rush
Of quiet birds in circles flight.
I am the soft stars that shine at night.
Do not stand at my grave and cry;
I am not there. I did not die.

[molly muffin]

Oh Scott. I'm just crying as I read this. Poor little Sheridan put up such a good fight. I'm so glad he got to have another play day before he went downhill.

Hugs, I know this is very, very hard for you and for your other babies, who miss him so much.

Hugs,
Sharlene and Molly Muffin

[lulusmom]

Scott, I am so terribly sorry for your loss and my thoughts and prayers are with you.

Godspeed sweet Sheridan.

((((Huge Consoling Hugs))))
Glynda

[Boriss McCall]

Scott, I am so sorry to here about your baby Sheridan.
hugs

[labblab]

Scott, I just want to make sure you know you have a couple of PMs (private messages) from me about possibly linking one of Sheridan's photos to his memorial line. No rush at all for a response, but I just want you to know the messages are there. :o

Marianne

[mytil]

Oh Scott, I am so very sorry to read this - my heart is with you.

sending healing ((((hugs)))) and we are all here for you.
Terry

[scoora]

Scott, I am so very sorry to hear of your loss of Sheridan. My thoughts and prayers are with you.
Vicki-Scoop and Raleigh's mom

[jmac]

I am so sorry to hear about Sheridan. I'm glad he was with you and that he is now at peace. You're in my thoughts...

Julie & Hannah

[Tina]

Scott, I am so very sorry to read about Sheridan. My thoughts and prayers go out to you.

Tina and Jasper

[Bo's Mom]

Scott,
Please accept our condolences on the passing of your greatest friend, Sheridan. I know it had to be the hardest thing to say goodbye but he knows you cared and would have done anything for him.