meet Bernie- 5 yr old welsh- possible cushings?

[Bernie831]

Hello everyone, meet Bernie- a 5 yr old welsh terrier who has seen better days :( As his mom I am just desperately trying to figure out what is wrong and in my gut I feel its Cushing's or something similar. I will try my very best to give a good overview of what I feel has lead me to this conclusion because I am trying to figure out if pursuing testing/diagnosis is worth it. Bernie has had chronic ear infections and colitis his whole life, in and out of the vet with multiple uses of steroids/antibiotics. He was no stranger to the vet but otherwise healthy until this past Oct 2012. He had a seizure which took us to the emergency vet where he was diagnosed at 4 with vestibular disease. A nuero consult was done and we had a video scope procedure done where his ears were cleaned and scoped. The nuero dr recommended but didn't find it necessary to get an MRI- saw tons of debris and scar tissue (his left ear being the worse ) which left him with a remaining head tilt to the left. We were somewhat relieved and went home with antibiotics on a road to recovery. It was shortly after he started acting not like himself, I was very intuitive to him and knew something was off. He wasn't hearing the best, didn't react to loud noises (fireworks), had no desire to play, rubbed his head against the shower wall every morning, constant circling and even had episodes of barking at me cause he didn't realize who I was. I immediately took him to my vet. He presented very neurologic and her main concern was his pupil dilation and how they didn't react to light. She immediately sent us to get an MRI and spinal tap. Long story short, an MRI, spinal tap, 2 myringotomys later- all coming back clear- no tumor, no bacterial growth to prove an inner/middle ear infection- we were at a stand still. and my poor little boy had nothing to explain his constant ear swelling/ inflammation. I will take a step back and explain the MRI did show brain swelling on the left side, the nuero dr deemed it congenital and not "actively" growing so it wasn't a cause for concern. So he then proceeded to say it could simply be an allergy and wanted to throw more medication at him. I pursued an actually skin/allergy specialist cause I wanted actual answers before I did anything else. We did the skin test and revealed he was allergic to dust, dust mites, red cedar trees, a moth, and a couple of types of molds. We pursued and are currently doing allergy shots which have helped, we did atopic in the beginning but have since taken him off, and kept his food to a strict grain free diet with 2 x week baths. this was all going great until 6 weeks ago he suffered a bilateral cruciate tears. I didn't see it happen he was out back and all of a sudden couldn't walk. He was always a stocky dog, but definitely gained weight and became very top heavy- definitely has the pot belly appearance. He can't even fit into a large puppia harness being as little as he is. He has excessive thirst, very little accidents, constant panting, his belly turned black during his neuro visits- has since gone back to normal color. I am just at a lost for him and feel that mothers intuition that there is something we have missed. I am not an expert and just need some advice on what to do and how to pursue this. I heard there are very controversial thoughts around treatment for cushing's and how to proceed. I feel like the MRI would of shown a tumor on the pituitary gland? I am just so overwhelmed and always in state of worry for my little boy. He has a heart of gold, currently walking just fine and pushing through water/laser PT rehab. I will do everything I can to help him and just need your help on what to do next. thanks to everyone for any advice :) Nicole and Bernie

[frijole]

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[frijole]

Wow you have been through a lot. To be honest your case is not typical of what we see with cushings. What makes you suspect it. Did your vet mention it?

Is your dog still on meds that are classified as steroids? That can cause the frequent urination and other cushings symptoms.

Have you had a regular blood panel done? Anything suspicious show up? Cush dogs have elevated alk phos levels - that's usually how it is discovered.

If the MRI was of the brain they should be able to spot a pituitary tumor. It is located near the brain and typically they are very very very small. (so they'd have to be looking for it)

You said he drinks excessively but is not having accidents. Could even be the meds him to drink alot? The reason cush dogs drink is actually because the disease forces the kidneys to work overtime and they need the water. So they drink because they are peeing - sort of backwards. How much does he drink a day and how much does he weigh?

Cush dogs typically eat with passion as in they do not take time to breath, chew - they literally inhale their food. they think they are starving even after having eaten. they walk around the house like a vacuum cleaner looking for anything that might have fallen to the ground.

I'll provide a link to intro info on the disease. Kim

http://www.k9cushings.com/forum/showthread.php?t=180

what meds is Bernie on now?

[spdd]

Welcome to the forum. I am not experienced as most of the people on this forum, but if you are looking for answers, you've come to the right place. People here have educated me considerably about my dog.
We understand perfectly concerns about our furbabies, and I'm hoping you can get to the bottom of this soon.

[goldengirl88]

Welcome to the group. Sorry you and your baby have troubles. Because a tumor on the Pituitary did not show up could be because they were not looking for one there I agree, as they can be really tiny and could be overlooked easily. Maybe you could call and ask them to review it and look at that specifically. If it is Cushings it could be an adrenal tumor. They usually do an ultra sound to look there. What type of testing for Cushings did they do? If you have any results please post them. Keep a daily diary of your dog, and get copies of all tests to post on here. I hope you are able to get it sorted out so your dog is feeling better. Blessings
Patti

[Bernie831]

What brought me to the conclusion of Cushing's was my own internet research- I would always type in the multiple issues going on and things on Cushing's and Addison's Disease would come up. I brought it to my Vets attention. So is open to testing but said there is much debate on how to treat. And since Bernie has been through so much- all the stress he has been put through it could be a hard time to get a good blood panel because I know stress is directly related to cortisol production.
The meds he is on now is tramadol and gabapentin for pain- allergy shots too. Nothing that classifies as steroids. The most recent time he was on steroids was a low dose in march to help with the inflammation to his ears. He was on and off steroids for ear, eye, paw, stomach issues his whole life.
I know he isn't your typical case but I will say the excessive thirst has remained without any type of steroids, very much has his pot belly appearance and he DEFINITELY inhales his food- never even chews it. Its like he seems starved and is always willing to eat. And the weight gain seems impossible due to the fact that I have reduced his food intake. Since the cruciate tears, weight loss is a big issue cause of his rehab to his back legs- which it just breaks my heart cause I feel like he is starved and I have to feed him less.
His blood work is not too revealing- I had to get his whole history together for the allergy doctor so I had multiple blood panels to review. I will try my best to give the correct values :) I will say most recently his cholesterol was sky high and his BUN was elevated critically high but his ALKP was never out of range: I will give the values below, I will include the values that were high- sorry if they don't pertain to Cushings but I do feel they are important on some level:

blood panel on 3/25/2009 (Bernie was having persistent stomach issues - diarrhea and vomiting

ALKP: 128 U/L normal range 5-131 U/L
lymphocytes: 5379 HIGH normal range 690-4500

one month later his sickness persisted so another blood panel was repeated on 4/24/2009- Bernie was usually sick with diarrhea and vomiting:

ALKP 67 U/L normal range 5 -131
GGTP (liver enzyme) 13 U/L HIGH normal range 1-12
Monocytes: 1150 HIGH normal range 0-840

Blood work done on 11/28/2011
ALKP: 94 U/L normal range 23-212 U/L

Blood work done on 5/1/2012
ALKP: 87 U/L normal range 5-131 U/L

Emergency vet visit 10-2-12
ALKP: 32 U/L normal range 23-212 U/L

Nuero visit - blood work prior to MRI 4-11-13

ALKP: 61 U/L normal range : 10-150 U/L
AST : 79 U/L high normal range 5-55 U/L
Albumin: 4.5 g/dL Critically high normal range 2.5-4.0 g/dL
Cholesterol : 404 mg/dL High normal range 112-328 mg/dL

SO as you can see I feel the ALKP is not shocking high but always slightly elevated. I am sorry that is so much info but I just wanted to be as detailed as possible - let me know your thoughts.
thanks Nicole and Bernie

[frijole]

Thanks for all of the info. You are doing great having that info on hand - exactly what you need to do. It's so much easier to help when you can easily refer to what has happened over time.

I can see why you would suspect it is perhaps cushings. That said the alk phos levels in all those panels was within the range of normal and in fact it went down. It is not unusual to see alk phos in cush dogs with FOUR digits! So if it's cushings you caught it early. How long has the drinking been going on and please measure daily intake so we can see what you mean by 'alot'.

Cushings is very very difficult to diagnose and is frequently misdiagnosed as other illnesses have the same symptoms such as diabetes (insipidis and melletis) hypothyroidism to name a few. Have you ruled out diabetes and thyroid issues? I would start there as they are easy to diagnose.

Another test you could start with would be a urine test called UC:CR. It doesn't diagnose cushings but it can rule it out if it is something else. It's fast and not expensive.

Have you had an abdominal ultrasound done? It can quickly detect if anything else is going on with the organs. We have had several cases over the years (including myself) where dogs were misdiagnosed with cushings that had tumors on the spleen and other organs that resulted in cushings like symptoms when in fact they did not have cushings.

If you were to do any of the cushings tests I would do the acth test. I would not start out with the low dose dex suppression test as it often has false positives when other issues are going on. With the ear and pain issues your dog is probably creating excess cortisol to fight the pain so to be honest I'd start with the urine test and the ultrasound.

I know it is so frustrating when you are trying to find answers and not getting them as I've been on that path. I too was convinced it was cushings and it was not. So just be open and know that this disease is so often misdiagnosed you just want to be absolutely positive prior to any treatment.

Glad you found us. Kim

[Budsters Mom]

Hello and welcome from me too. :)
I love your avatar, as Bernie is smiling!:o 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. It looks like you are off to a great start with that! We will do all we can to help, but be ready for lots of questions! So again, welcome Nicole and Bernie. Hugs,