Iatrogenic Cushing's causing back leg weakness??

[Sheri and Nacho]

I found out last week that my 15 year old Border Collie, Nacho, has Iatrogenic Cushing's from being on prednisolone for 2-3 years for arthritis. She is 21 kgs and has 15mg of prednisolone per day. My vet specialist, a week ago, said "yes we have given it to her", (meaning Cushing's from the pred)- and mentioned nothing about treating her for it. She can hardly walk and is deteriorating rapidly. I am now wondering if her muscle wasting and severe weakness in her back legs is due to Cushing's, and not so much the Arthritis. She is now on Morphine as of the last week. The vet has suggested my only options left are x-rays to see what is wrong, as Nacho has tried all other arthritis meds without success.
So now I am left wondering should I increase or decrease the prednisolone???? So I have- in the last three days from, 15 mg per day to 10mg per day. This has made an improvement! Has anyone experienced their dog not being able to walk from too much steroids, cortisone??
Other symptoms of Cushing's she exhibits include, excessive drinking and eating(from the Pred), hairloss and flaky skin, slight pot belly, has just had a UTI, dilute urine with no evidence of kidney disease. She is also slightly anaemic which the vet specialist is not treating.
Please help, Nacho is the love of my life- my reason for living. She is a beautiful girl who deserves her mummy to keep fighting with her. Thank you. Sheri and Nacho

[spdd]

Hi Sheri. Sorry to hear about Nacho. You've come to the right place and others on here will direct you, ask lots of questions and help in any way possible.

Welcome to the forum.

[Squirt's Mom]

Hi Sheri and welcome to you and Nacho! :)

Yes, steroid use can cause Iatrogenic Cushing's and the only cure for this is to wean the pup off the steroids. Your vet says you have tried "everything else" for the arthritis...can you share with us what has been tried other than the steroids? Has he had Adequan, Dasuqin, acupuncture, cold laser treatment, water treatments, herbs/supplements/diet....there are many other options beside steroids. Here is a link that talks about canine arthritis and some of the things that can be done to help.

http://www.vetrica.com/care/dog/arthritis.shtml

In this article they state the following -


Steroids are commonly used to treat arthritis in the dog. They are potent inhibitors of inflammation, and very useful pain relievers as a result. While these drugs can be very effective in controlling the symptoms of arthritis, especially in the short term, they can seriously adversely affect the condition of the joint. That is, they make the disease worse rather than better.

Now, as the mom to a pup who is also 15, we have to choose our battles. ;) I find myself doing and allowing things that I would have never, ever have considered 3 years ago. Because the focus now, for me, isn't the length of her life but the quality of her days. My baby, Squirt, does have elevated cortisol but I have stood looking at the bottle of pred I have on hand and seriously thought of starting her on it for her pain. Both her back legs are pinned and screwed together because of luxating patellas and deformities in one leg. And she's 15, which in human years is something like what? 95?! :D At almost 60 myself I know the aches and pains of aging so I can barely imagine what our babies must feel like....and I don't know about you, but I whine a WHOLE lot more than Squirt about my aches and pains than she does hers! :p

So, all things considered, if I were in your shoes I would do my best to wean Nacho off the pred or at the very least get it down to the lowest dose possible then add other, less harsh, things to the mix. Look around your area and see what is available and affordable for alternative approaches like the acupuncture and hydro therapy. Look into supplements like fish oil, condroiton, glucosamine and herbs like Devils' Claw, Meadow Sweet, and a whole host of other anti-inflammatory herbs and supplements. I would be looking for a Holistic vet who might have some alternatives to offer. I would find a nutritionist and get him on a diet that is highly anti-inflammatory. You want to avoid foods like white potatoes, dairy products, corn, and others as they can make inflammation worse. You can google foods for arthritis and find lists of good foods and foods to avoid. These will probably be geared toward humans but they translate the same for dogs. ;)

I'm glad you are here and hope we can offer some ideas to help you and Nacho. Talk to us, ask questions, and know you are not alone.
Hugs,
Leslie and the gang

[labblab]

Welcome from me, too! Leslie has already given you great information. One thing I want to add or emphasize may be something you already know. But after having been on the prednisolone for 2-3 years, any steroid taper has to be implemented very gradually over a period of time. For Nacho's safety, the weaning protocol really ought to be overseen by a vet since her own system may not be able to step right back again and produce adequate amounts of cortisol on its own. Also, I am concerned to hear that Nacho is now receiving morphine. What is the gameplan with that? It is a narcotic much more powerful than tramadol and it can create dependence associated with physical withdrawal symptoms if it is abruptly discontinued. Do you think Nacho's mobility issues are really the result of pretty severe pain, or is it instead muscle wasting or muscle weakness? If it's the latter, the morphine isn't going to help and depending on the dose, could actually make Nacho more lethargic, depress her respiration, and carry other problematic side effects such as severe constipation.

You mention that this vet is a specialist, and yet it sounds as though Nacho has been treated all this time without even any diagnostic x-rays? She's been given the steroid and the painkillers yet your vet really doesn't even know for certain what is going on? Is the vet an orthpedic specialist or is his speciality in a different area?

Sorry for so many questions, but I do have some real concerns about the treatment that Nacho has been receiving. If you do not feel comfortable with the advice you are receiving from your current vet, are there any other vet options available to you?

Marianne

[Budsters Mom]

Hello and welcome from me too. :)
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, but be ready for lots of questions! So again, welcome Sheri and Nacho.

[molly muffin]

Hello and welcome from me too.

Leslie and Marianne have made some good points.

I will second that you need to taper prednisone very, very gradually, under the guidance of a vet. My golden was on prednisone for years, with pretty much the same sort of symptoms, she was taking it for allergies. It does end up affecting the skin and joints/muscles. So if you can find an alternative that would be great. Cushings symptoms usually decrease as you get rid of the steroid, however, if there is arthritic issues they could get worse. An xray would be worth while I think if it is a possibility.

Sharlene and Molly Muffin

[Sheri and Nacho]

Thank you Leslie, Marianne, Kathy and Sharlene!
The other medications I have tried are rimadyl, cartophen/carprophen, and tramal. She doesn’t seem to respond to NSAID’s. If I ween her off the pred she won’t be able to walk. I’ve had her on the lowest dose possible, but I keep needing to increase it. “Battle”is so true.
Other natural anti-inflammatories I have tried for the arthritis include Glucosamine, Chondroitin, and rose hip. I shall investigate the other options you have suggested, although I haven’t heard of most of them in Australia. Thank you.
After 5 days of a lower dose of prednisolone, her mobility has increased and can stand up on her own sometimes. It seems as though the prednisolone dose was too high and was shutting her body down. I am now worried about her anaemia- as pred decreases the activity of the immune system, and wonder if she has IAHA? I am confused because the treatment of IAHA is prednisolone!!!??
I am too worried about the Morphine. Nacho had a back operation 2 years ago, and she is now being treated by the medicine department instead of the surgery. They are the best I can find, as she can’t travel too far as it sets her body into a deeply stressed state- probably from the Cushings!!! I think the game plan with the Morphine is that the vet knows she is 15, and have given up trying to treat her. Mobility issues are with pain, and now muscle wasting. She hasn’t had X-rays for 2 years, since before the back op. I’m too scared to put her through more anaesthetic at her age, and the stress of it. The vet thinks something else is going on, she keeps saying cancer.
Thank you for your kind words of support. I do feel very alone right now, especially as Nacho is my only family- and I am hers.

[labblab]

Given Nacho's age, I had wondered whether perhaps that was the theory behind the morphine -- that there would never be a need to wean her off the drug. :o

My heart goes out to you, because it does sound as though you are in a very difficult situation. In the absence of any further diagnostics, I guess you may just be stuck in a pattern of trial-and-error as far as seeing what may or may not improve things for your girl. For what it may be worth, I don't believe my dogs have ever needed to be anesthetized when they have had x-rays performed. But perhaps it would be different for the series that the specialist is proposing for Nacho.

Even though we may not be able to offer out concrete suggestions, we still care very much as to how things proceed for you two girls. So please continue to keep us updated as to how Nacho does on this new lowered dose of prednisolone, OK?

Marianne

[knitbunnie]

Someone else mentioned it, and I'm going to add my support for trying acupuncture. It did wonders for my dog.