Meet Jesse (7 y/o Australian Shepherd)

[Jesse]

Jesse is a 7yr old, NM, black tri, Australian Shepherd. Diagnosed with degenerative joint disease at 1yr. Aided by Glucosamine, Celadrin and vit C, he has lived a very active life, always by my side.
Four days after his 7th birthday (January 20th) he was diagnosed with Masticatory Myositis. A week of 50mg of prednisone had him losing weight, hair falling out, eating, drinking and peeing excessively. But jaw pain stopped, never got lock jawed.

Then it went from bad to worse.

Our journey of reducing Prednisone and adding Azathioprin has left him very sick and looking horribly CUSHINGOID.

Although the initial side effects mentioned subsided, he now has:

*muscle loss
*weakness, esp rear end, hips are pure bone, head pure skull
*increased panting
*exercise intolerance
*pigment changes on the belly

Theses things INCREASE as I attempt to wean him off the meds.

My question to you good people; Is this normal? I mean does he have to go through this as part of withdrawal? Will things improve if we "wait it out"?

Linda

[goldengirl88]

Hello:
I just wanted to welcome you to the group. Jesse is certainly beautiful, and I am sorry he is having problems. Please post any test results you have, his weight etc. so you can get help. I hope things get better for your baby. Blessings
Patti

[addy]

Feldman: Iatrogenic and naturally occurring Cushing's are clinically indistinguishable. While the ACTH stimulation test is an inferior screening test for naturally occurring Cushing's, it is the gold standard for the diagnosis of iatrogenic cases. If a dog looks, smells and feels like it has Cushing's and if an iatrogenic source is suspected, an ACTH stimulation test should be performed. Treatment could not be easier: Stop the steroids

Hi and Welcome,

The above quote is from a world known endocrinologist. Unfortunately it does not say how long it may take to resolve. Usually waiting it out is exactly what one would do.

How long has Jesse been on the steroids? How long has it been since you started weaning him off?

Hang in there, members will stop by with their experiences.

[Budsters Mom]

Hello and welcome from me too. :)
I am sorry for the reason that brought you here, but so glad you found us. You have come to the right place! There are many K9Cushing's angels standing by to help and stay with you every step of the way. They love details, test results, any information you can get your hands on. The more the better. We will do all we can to help. So again welcome to you and Jesse.

Hugs,
Kathy

[Jesse]

Thank you everyone and esp. Addy. The quote you provided is exactly what I needed. I was not going to have him tested but now I think I might.

Linda

[Jesse]

Oh ya, and we've been weaning since February. Last week we were down to 2.5mg daily but when he seemed to be getting so weak I panicked and agreed with the vet's previous suggestion of increasing it again. I did so to 1 and 1/2 pills (7.5mg) for three days and then back to one 5mg pill which is where we're at now.

[lulusmom]

Do you happen to know if your vet ruled out Myastenia Gravis before s/he confirmed the MM diagnosis? I ask because dogs with MG can have symptoms much the same as MM and/or can have both conditions. FYI, MG causes really severe muscle weakness, muscle loss and intolerance to exercise. It's a bit strange that Jesse doesn't have pu/pd (excessive drinking and peeing) as a result of the steroids. Dogs with MG can become incontinent but they don't have pu/pd. You would think that a dog on steroids with such profound muscle weakness issues would have more of the usual symptoms of iatrogenic cushing's like pu/pd and eating like a horse. If you wean a dog with MG off of steroids, it's possible that MG would worsen at lower doses so I'm wondering if there is more going on than steroids. Is your vet a general practitioner or specialist (neurologist or internal medicine specialist)? If a general practitioner, you may want to consider getting a referral to a specialist.

Do you know what tests were done to diagnose MM?

Glynda

[Jesse]

Wow Glynda, your scaring me. MG was never mentioned, this is the first I heard of it. Now I have something else to look up.
He was diagnosed by his jaw pain, swelling eye and high white blood cell count.
My vet is a GP who's recommended we see an internist. I can't as they are too far from me.

[lulusmom]

Hi Linda,

I didn't mean to scare you at all. I'm really nosy and am not afraid to ask questions about other possibilities, especially if the usual cushing's indicators aren't there. It's been a long time since my beloved cushdogs were diagnosed so I tend to forget how scared I was back then. I can see how what I posted would scare you even more and for that I am very sorry. I should have started my post with a disclaimer about how anal I am and that the reason I brought up myastenia gravis is because a friend of a friend contacted me about their dog who had similar symptoms. I'm a special needs rescuer with lots of experience with cushing's and because I bore them to tears about it, they think I am the next best thing to a vet. I am not! I'm simply suffering from OCD. :D Anyway, I had no idea what could possibly wrong with the dog and suggested that he see a specialist, who ultimately diagnosed myastyenia gravis. I'd never heard of it before then.

After he told me the diagnosis, my curious self had to know what it was. During that time, I know I ran across a few papers about dogs who had both conditions. I had never heard of MMy either until I started researching MG. I managed to find one of those papers and have included a link below. I'll keep looking to see if I can find any others.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC340171/

Again, I'm sorry I scared you.

Glynda

[Jesse]

You don't scare me as much as my dog does. He's wasting away before my eyes.
Don't think it's MG, never had the esophagus thing or vomiting.

Thank you for helping me:o

[Jesse]

As dr. Feldman says that ACTH is the gold standard for diagnosing iatrogenic cushings, I'm going to ask my vet for this test tomorrow.
Any advice about what I should say or do? My vet is a GP and hasn't dealt too much wish cushings.
What does it cost?

Linda

[molly muffin]

Hi and welcome,

I don't know what it will be in your location, but in Mississauga, Ontario, my vet charged 165.55 for the ACTH test.

Sharlene and Molly Muffin

[lulusmom]

Hi Linda,

The cost for acth stimulation tests vary and they are rarely under $200. Smaller dogs treating with cushing's savvy vets use less of the really expensive stimulating agent so that may be why Sharlene's vet only charged her $165. Your vet would have to use the entire vial for Jesse so be prepared to spend between $200 to $300. If it's less, count your blessings.

Now having said that, I'm not sure your money wouldn't be better spent by having Jesse seen by an internal medicine specialist and let the specialist determine which tests should be done. Jessie is not doing well and has been diagnosed with a very serious autoimmune condition. Given her current symptoms and history, I wouldn't automatically assume that you are dealing with iatrogenic cushing's. She was diagnosed very early in life with degenerative joint disease so this could be contributing to the symptoms you are seeing. Specialists aren't inexpensive but a lot of us have found out that you get what you pay for and a good deal of the time, it can actually be a lot more cost effective. When gp vets get in over their heads, no matter how many tests they do, sometimes they can never figure out what is going on and that can break the bank. Would you be amenible to a specialist. If so, let us know what city and state you are in and perhaps we have some members who can give you a name of two. You can also search for one at www.acvim.org. Most specialists require a referral but some don't. Your vet should be happy to give you a referral.

Glynda

[Jesse]

Thank you Sharlene and Glynda,

My vet did suggest an internist but told me I would have to go down to Guelph or down in Michigan. I am an hour east of Sault Ste Marie in Thessalon. I don't have enough money to travel like that. :(

[molly muffin]

I agree Guelph is way to far to travel to, something like a days drive minimum, staying over, etc. I did think of Sault Ste Marie as a possibility as that is the closest to you that I could find a specialist. I wonder though, if your vet would be willing to maybe do some phone consults with a specialist in Guelph at the hospital there? She could fax the test results to them, set up a timed conference call to review, or even perform other tests they might recommend prior to a conference call?
This could work if your vet is open to that possibility.
One other question. Has your vet the capability to preform an ultrasound? If so that could be helpful perhaps in looking at the adrenal glands, liver, gall bladder, spleen, etc.
I'm just throwing ideas out that you can speak with your vet about.
Maybe something will stick.

Sharlene and Molly Muffin

[Jesse]

Sharlene, Are you saying you know of a specialist in the Sault?
Would tests be covered by pet insurance (if I had any)?

Linda

[molly muffin]

I was just browsing usuing google and as that is the largest population to you, I thought it might be a possiblity.

I don't know if pet insurance would cover out of country or not. It could be worth it to give them (your insurance company) a call and see if they would or not.

What about possibilities in Salt Ste Marie on the Ontario side? I see they have several clinics there. I don't see any specialist but this one at least does do ultrasound if your clinic doesn't.

http://ssmanimalclinic.com/team/

And the owner has an interest in ultrasound and internal medicine, in particular complicated cases.
It would be about 29 km from you. Doable.

I'm not really sure what the next step would be for you, what tests needed, so, as I said, I'm throwing ideas out there. :)

Sharlene and Molly Muffin

[Jesse]

Thank you again Sharlene,

I was wondering if pet insurance covers lab tests in general in Ontario?

Linda

[lulusmom]

Hi Linda,

If you have pet insurance already, I would suggest that you read your policy to see what is covered. If you can't figure it out, you can call your insurance company and ask. Not all policies extend the same coverage, limits or deductibles; however, I would expect that labwork would be covered in most instances as that is considered preventative as well as diagnostic. The insurance company should be forthcoming in explaining things to you but if not, you can scan your policy and email it to k9cushings@gmail.com. I'm an insurance professional by trade and interpreting coverage, drafting policy forms, as well as writing and negotiating contracts, is what I've been doing for more years than I'd like to admit. :o

Glynda

[Jesse]

You are so dedicated, thank you again.

No, I don't have insurance. Just wondering if it would have helped. I had stashed away a small fund for Jesse and have used it up as well as some of my own money. I haven't totalled it up yet but I've payed the vet around $2000 since January:(

Linda

[molly muffin]

Insurance always helps if you already have it. However, most will not cover preexisting conditions. I know how it is, we don't have insurance either. Wish we'd been more vigilant about getting it before all this started.

Sharlene and Molly Muffin