Undiagnosed GSD

[Hunter]

Hi everyone,
I signed up to the forum because I am in desperate need of help with my estimated 6 1/2 year old german shepherd, Hunter. I adopted him when he was probably around 8 months old but of course his age was unknown. I have no background information on him other than he was abandoned and left tied to a dumpster.
Roughly two years ago hunter was panting non stop. Since I am an animal health technician I was concerned and brought him to the vet. The vet told me it was nothing. I insisted that he was panting more than any other dog in the waiting room so they finally ran blood tests. Everything at the time was normal. I convinced myself that it was nothing and perhaps he was just more anxious than most. Finally after much time and consideration I brought him back because his panting was severe and continued. The vet looked at him and said immediately there was something clearly wrong with his heart. I was told to see a specialist if I wanted to know for sure. When I inquired about the costs they were very expensive and seeing as though he was still otherwise fine that I would wait and see. Seeing vets went on for a while because hunter would sometimes show a potbellied appearance for no apparent reason and had ear infections almost every other month. X-rays were taken and liver enlargement was noted but nothing too concerning seeing as his liver enzymes were not elevated based on his blood chemistry analysis. Again no action was taken. Finally about 5 months ago hunter was rushed to the ER vet clinic due to potential bloat. His stomach was enlarged and he was somewhat lethargic. Thankfully he did not need surgery but again his liver seemed to be slightly enlarged. The vet there told me she was more concerned about him peeing. He peed everywhere in the clinic. I went to my regular vet and had everything done- a blood test, urinalysis and evaluation with his x-rays. His specific gravity came back extremely low so they vet called me and said to bring him back as he may be going through kidney failure. I brought him in and they took one look and said he's too young, he seems fine. At that point I became frustrated. I knew there was something wrong with my dog and everyone was sending me on a wild goose chase. I gave up with the vet clinics and decided to treat whatever came up myself.
That leads me to now. Based on everything I have seen with hunter I did question cushings but not all the symptoms were there. Unfortunately now I am concerned that cushings is probably what hunter had all along.
In the past 2 months he has displayed almost all the symptoms. He has had accidents in the house, on our bed (not like him to ever do this), polyuria, polydipsia, an extreme appetite (always at his food bowl, steals food, begs, all things which he has never done before), his bones are very apparent on his ribs, lost muscle mass around his back legs and has trouble getting on the bed, has constant ear infections, his skin has red lesions (probably infected which I am currently treating with iodine), hard lumps on his skin, discoloured skin, thin skin (when shaving his fur off to treat the skin infection his skin was almost tearing open), he's intolerant to the heat, pants regardless of the temperature, lays only on the cold tiles for longer periods of time, seems anxious/irritated and is always moving around (can't seem to sit still sometimes) and lately he has just simply been acting weird. He doesn't want to be touched by others only myself and seems as though it hurts to be touched.
I would bring him back to the vet but I have spent thousands of dollars trying to figure out what it is and I am frustrated that no one pointed out cushings as a possible source. I also know that at the end of the day my choice would be not to treat seeing as I do not have the means to do so. Basically any help I can get in terms of information/support for him would go a long way.

Thank you so much in advance.

[molly muffin]

Hello and welcome to you and Hunter. :)

Do you have the latest blood test results? We would only need to see the abnormal tests, for instance ALKP 350ug with the normal range.

Has a heart murmur been ruled out? Did they see any enlargement of the heart when the ultrasound was done?

I just would want to rule that out.

So, other options would be, if the thyroid (T4) and glucose came back normal, then those two things could be ruled out. (thyoid problems and diabetes, both of which have the same sort of symptoms as cushings)
Urinalysis. What were the results of the latest one? Protein in urine, etc and what exactly what the specific gravity. If it was consistently below 1.008, then you might want to try the Diabetes Inspidius drops (they go in the eye) and see if that helps as that too has the same symptoms. I would test him for that as I feel like the water deprivation tests can be dangerous.

So, if all that is ruled out, then we really are at cushings. You want to rule out, just because cushings is so hard to diagnose. I'm sorry to say that you will need a couple tests, such as an ACTH test to see where the cortisol is at, possibly an LDDS test if you want to know if pituitary or adrenal based.

Then you need to decide on treatment if that comes back positive, and do you want to pursue vetoryl or lysodren. I'd go with the one your vet or specialist has the most knowledge of.

So those are just a few questions to get you started. We're very glad that you found us and will do all we can to help you on this journey and to be supportive.

Welcome!
Sharlene and Molly Muffin

[Harley PoMMom]

Hi and welcome to you and Hunter,

So glad you have joined our family and we will help in any way we can.

The daunting part can be in getting a diagnosis of Cushing's confirmed. Although it can be expensive to start with, the cost of treating for Cushing's usually goes down significantly after you've got the diagnosis confirmed and the treatment underway. And maybe your Vet would be willing to let you pay what you can afford (ie work out some kind of payment plan with you.)

Recurrent ear infections along with skin issues can be attributed to Hypothyroidism, has this been ruled out? What about diabetes, has this been ruled out also?

Please know that we are here for you and Hunter, and feel free to ask all the questions you want.

Hugs, Lori

[Hunter]

Thank you for the quick and friendly replies.

I have had him tested for Hypothyroidism last year and he was negative. It was a test I requested, not suggested. I asked about diabetes and they said based on his blood tests and urinalysis that he does not have it. They tested his glucose as well but we did not do a full curve so it would have been dependant on his state at the time. I have not recently (within the past 2 months) tested him for anything.

Also, I did not get the ultrasound done because it was far too expensive. He does have a relatively fast heart rate most of the time which goes hand in hand with his panting. I have recieved variable information regarding his potential "heart condition" because I have seen multiple vets in order to get a few opinions and other than that one vet they all said his heart seems to be fine, no murmer when listning to it but thats not to say it's not there.

For his most recent blood work I will have to request another copy of his results because I can not seem to find them. I will get back to you on that one but from what I remember there were elevated perameters but they were at the higher end, not over the limit per say.

I do have an additional question though. Lately hunter seems to be slightly limping. He loves to play ball but it seems as though his legs are so to speak "giving out". When I palpate them, move them to various degrees he doesnt seem to be in any pain but I have noticed he walks differently and runs as though he has somewhat of a limp. He doesnt seem to have as much muscle mass on his back legs specifically. I have noticed it much more since he has been shaved. I can post pictures if that would help :)

I will try and collect as much information as I can from the vet and post them but at the time being I want to gather as much information as possible so I can figure out how we will move forward. I do not want to put my dog on medication to treat cushings, if thats what it turns out to be. I work for a pharmaceutical company and I know what drugs can do to you, so based on my own personal beliefs (in respcet to those that choose to treat) I choose not to. That being said, I will however treat the surrounding issues (ear infections, skin infections, etc) as needed so that he is not in pain or discomfort. Sadly I watched my mother pass away from cancer and I have seen that the medication killed her and made her suffer much more than the cancer itself. I simply can not do this to my dog. I hope everyone can understand why I feel this way :( At the moment Hunter seems to be comfotable and I have been monitoring him every step of the way using as many resources as I can. I refuse to let him live in pain.

Thank you so much for all of your support.

[doxiesrock912]

From what you're describing , I also suspect that Hunter has Cushings. He has many of the symptoms that Daisy Mae had prior to treatment. Uncontrolled Cortisol affects their immune systems which leads to various infections.

Cortisol levels change throughout the day which further complicates the situation.

Daisy Mae is a completely different dog now that she's on meds. She also lost interest in me which broke my heart. The pot belly was the last symptom.

[Hunter]

I highly suspect that cushings is the culprit with him too.

But so far he still loves to play ball, sits on my lap like an overgrown cat and follows me everywhere so I don't think he is at a stage where it has progressed to a point where I have to put him down. Recently he wants to be closer to me and snuggle more than usual so I know there are physiological changes going on that I cant understand because I don't truely know whats going on with him. I'm not sure what I should look out for but for the time being I will keep him away from other dogs because I have noticed at the dog park he seems more edgy than usual. Not aggressive but defensive as though he doesnt want to be bothered. Other than that it is the usual for him and he still wants to play and run about, minus the slight limp I mentioned. As anyone with a German Shepherd knows, they are strong, loyal and wont give up. My boyfriend and I have discussed when Hunter will tell us it's his time. We agreed that when he doesnt want to play and has lost interest in his ball (ps he loves his ball- he would probably run to it even if the world were ending around him ;-p) is when Hunter will tell us it's time.

Does anyone else know what I should expect. Does it all seem reasonable with a sog suspected of having cushings?

[doxiesrock912]

Cushings is treatable and most dogs live out their full life spans.
We took Daisy to 3 vets before going to an internal medicine specialist. They confirmed Cushings and work in conjunction with Daisy's vet to treat her.

She's on Trilostane, 10mg twice a day. At first it was expensive, but once you have the right dosage of medication tests are needed less often. It is well worth the effort and expense. I'm unemployed and have no savings to use for backup and we made it through.

[Hunter]

I have posted pictures :)

[Hunter]

I am sorry to hear about Daisy's condition but glad she is doing well on the meds :) It's nice to know that there are pets out there being treated and being able to live a long and full life. She is lucky to have you :)

The last I spoke to the vet about cushings they said it was very costly and most people choose to put their pets down due to the cost involved. I'm not there yet and don't want to put him down since he is still very lively.

I live in Montreal. I am not sure if the cost differs from different regions?

[doxiesrock912]

With all due respect, that vet only partially correct.
I live in Cos Cob, CT, U.S.A.

While I am not familiar with the vet costs in Canada, I'm sure that there are others on the forum who can assist you with that. If you have a teaching vet hospital, I would advise you to go there. They're likely to have vets who are more familiar with Cushings, and they might work out a payment plan.

Also, google "Care Credit" and if it is available in your area, apply. Is it a credit card specifically designed for one purpose; ie: vet costs or dental. There usually is a promotional period of no interest for 12 or 18 months and it would help to spread the costs out. Also, some organizations are available to help with vet costs. Google that as well.

An ultrasound is advisable, but I would not have a general vet look at it. We have a small animal internal medicine specialist (IMS vet) for Daisy and I'll bet that you can find them in Canada. The ultrasound can in many cases help to determine the stage and type of Cushings based on what organs have been affected. We paid $344 for the ultrasound and the consult with the IMS vet. ACTH and LDDS test are used to assist in the diagnosis and to determine how far off the Cortisol is from the ideal range. These can range from $220 - $300.

In the beginning, it is costly. Once the vet has determined the correct dosage of meds and which med to use, and Cushings is "stable". Tests are needed less often. That is when the cost lowers.

Canada friends please chime in with your vet experiences and advice :)

[Hunter]

Thank you so much. I appreciate the information. I will definitely look into that and see what options I have. I think the vet meant on a general basis not nessasarily saying I would have to put mine down but I agree. I felt helpless when I was told that. This forum is really good at bringing some clarity to the situation and I feel much better knowing there is support.

Also, can anyone have a look at his pictures and tell me what you think?

Thanks again!

[Bandicoon]

Sorry about Hunter's trouble! My first GSD had degenerative myelopathy which is what started us on the road to a raw diet. Too late to save him, he was 9 and had already lost most control over his back end. But it really doesn't sound like what Hunter has. I'll take Cushing's over DM any day. If you are looking for general health support which _might_ help with Hunter's symptoms - or at least slow things down and stabilize him for more aggressive treatment, please see my intro post:http://www.k9cushings.com/forum/showthread.php?t=5695

[molly muffin]

Hello, yes I agree, ultrasounds can be very expensive and seem to like all things, vary from area to area.
Here in Ontario at an ER Hospital, because the regular vets do not usually have ultrasound machines, only x-ray machines, it cost 415.00 CAD for just the ultrasound. There is an extra charge of 150. CAD for the specialist who did and read the ultrasound and gave a consult on it. That is very expensive and cost prohibitive I think for many people.

We have one person in the UK who is treating with naturalist/chinese herbal approach and seems to be having good results currently symptom wise, although we don't know what the actual cortisol levels are since that hasn't been retested. I understand why they may not want to dump any cortisol via an ACTH test when things appear to be going to well for them. That person is Concerned Mom and her thread is here: http://www.k9cushings.com/forum/showthread.php?t=4702

I don't personally know of any particular medicine that lowers cortisol and if there was an easy natural approach, I'm sure most would do it.

As far as the limp, one thing that cushing dogs are also prone to is torn ACL's. Also, muscle weakness is common.

One option which won't help the cortisol but might help with other things hydrotherapy, laser therapy, etc.

So that is a couple more options to think about.

Dogs can live out their natural lifespan with appropriate treatment, if you ever do decide to go that route. It can hard to find that initial correct dose, but we have had dogs on it for years without adverse effects, you just have to be very diligent and have a vet that knows what they are doing.

Sharlene and Molly Muffin

[molly muffin]

Well he is a beautiful guy. Poor thing. The skin issues could be calicnosis cutis, which cushings dogs can get, have you noticed hard white bumps, etc?
It might be worth it to have a skin biopsy done, so you can get an appropriate treatment going for that. It could have a yeast infection in it and a good shampoo might work, medical one. One that some have used is ketoconazole wipes and ketochlor shampoo, but I think you get those from vet, after diagnosis and if they are appropriate for his skin problem.

Sharlene and Molly Muffin

[lulusmom]

Hi and a belated welcome to you and Hunter.

It sounds like Hunter had a rough start in life and things got much better for him after he became your boy. Bless you for adopting him. I'm sorry that you have never been able to find a vet who could actually put a finger on Hunter's problems. While the symptoms he recently developed are those commonly associated with cushing's, there's really no way to know if excess cortisol is causing all of his problems without appropriate testing. I too would like to see the results of his most recent bloodwork but even then, all we can really do is let you know if this is what we are used to seeing in the many cushdogs we've followed on this site. If they are what we usually see, we normally would recommend that you pursue testing to confirm a diagnosis. Since you have opted against treating regardless of your ability to afford further testing, our feedback will be extremely limited as there really is no over the counter meds and supplements that are effective. Some members have reported some improvements in symptoms with some of the online remedies that are being peddled, such as Cushex Drops and Supragland but these remedies have never been tested for safety and efficacy, and any improvements are usually short lived.

I completely understand your feelings about pharmaceuticals as I am an insurance professional and have been involved in many lawsuits against the big pharma companies. I am leary of all drugs but know that not all are evil incarnate. Both Lysodren and Vetoryl have some pretty scarey side effects but if a pet owner does their job and a vet does his/hers, side effects can be mitigated and even eliminated. The problem is that unless a vet properly counsels a pet owner on how the drug works and what side effects to watch for, the dog can pay the price for everybody's ignorance. I've treated three cushdogs with both drugsa and followed protocol to the letter. As a result, none of the dogs suffered any sickness due to low cortisol. I research every drug I take and every drug my dogs take......I want to know absolutely every thing there is to know about them so I know if it is contraindicated if taken with other drugs, what to watch for in the way of side effects and whether a drug adversely impacts any internal organs which would require periodic blood tests to monitor. In my opinion, every pet owner should do their own homework as placing blind faith in a vet to do theirs is a big gamble.

My first cushdog was diagnosed at three years old and had I chosen not to treat her, she would not have lived another eight years with a good quality of life. My boy, who was abandoned at a shelter with every cushing's symptoms in the book, including horrible infections in his eyes and ears, was already pretty senior in age and I literally cried the first time he loped across the yard after being stabilized on treatment. He used to fall over when if he tried to lift his leg to pee. He lived another five years and had I not decided to adopt and treat him, I'm convinced that he wouldn't have survived much longer.

I believe there are a good number of pet owners who do choose to euthanize their dogs because they are constantly drinking, peeing all over the place and begging for food all the time. A good number of those dogs are euthanized because the owner chalk it up to old age and just thinks it's time to let them go. Unless a dog has had the disease for years and the immune and internal organs are shutting down, the usual symptoms that can go on for years without treatment, are neither painful nor troublesome for the dog. They are a lot more troublesome for the pet owner. Honestly, if you are waiting for a sign from Hunter to let you know that it's time for you to say goodbye, you may be waiting for a long, long time because cushing's progresses at a snail's pace.

The best advice I can give you is to educate yourself about the disease and the effective treatments so that if the day comes that you may feel differently about treatment and can afford comprehensive testing to confirm a diagnosis, you can not only be a proactive participant in Hunter's treatment, you can be that shadow over your vet's shoulder that keeps him/her on the straight and narrow. :D You'd be surprised how many of us have educated our vets to the benefit of our dogs and others being treated in the practice. An educated pet owner and an experienced vet is a winning combination for any cushdog. In this economy, keeping a roof over our heads and food on the table is a day to day struggle so finding extra funds to pay for ridiculously expensive testing and treatment seems futile but where there is a will, there is a way. One of the ways is to apply for Care Credit. It's a revolving credit line that allows you to pay large bills same as cash for a year. I've used it many times over the years for my dogs and my dental expenses that aren't covered by insurance.

http://www.carecredit.com/vetmed/

Glynda

[molly muffin]

I hate to be the bearer of bad news but the last information I found is that Care Credit offered services for a limited time in Canada in 2010, but then stopped it at least by 2011 and no longer has a Canada division. :( I believe it is offered by GE in the states right?

I did find however, a PetCard, that can be used for vet care. https://www.petcard.ca/

Sharlene and Molly Muffin

[Junior's Mom]

Hi, and welcome to you and Hunter. I am in Ontario, so costs here may be similar to your area. Unfortunately, vets can pretty much charge what they want, so there is no guarantee. An ultrasound and consult with a specialist cost me $700. The low dose test, which may confirm cushings, and may tell you whether it is pituitary or adrenal cost $132. A complete blood panel, with thyroid check, and urine culture (important to check for urine infections) was $321. The acth which is important to get a baseline before medicating, and is used to monitor drug therapy was $130.
My dog weighs 52lbs. He started on a low dose, that has been increased twice so far. The acth testing must be done 10-14 days after starting, then at 30 days, then every 3 months if the dog is stable. This is why costs can go down after time. This timeline of testing must be repeated any time a dose is changed. Vetoryl is available from your vet or some online places with a prescription. Generally the higher the dose, the higher the price. A box of 30mg from my vet costs $105. The boxes come with 30 pills.
As many others have said on here, it is best to rule out everything else, and whittle it down to a cushings diagnosis. There is no 100% test for cushings, and many other things can mimic it.
If you have recently had bloodwork, posting the results here will help the members to possibly rule out some things.
Start simple and work your way up as you can afford it. A urine culture and specific gravity test. A urine to cortisol ratio test. A thyroid test.
I didn't start medicating my dog till a year after he was diagnosed. Cushings is slow progressing. He is doing very well so far, and his quality of life has improved a great deal.
Keep coming back here, to ask questions, read over the huge amount of information available, and to let us know how your dog is doing.
Tracey

[Hunter]

I am so greatful for such fantasitc responses. I read them last night and I have to say I feel much better knowing there are others that have gone through this and are here to offer support. You all seem to care so much and want to help- I guess you can say its brought my faith back in humanty ;)

My first step will be to find a vet that I trust and I will go ahead and take another blood test, urinalysis, etc as suggested. Everyone has provided me with such great information that I feel much more comfortable taking the right steps to diagnose him and think about potential treatments. Thank you so much everyone.

Also, I am very greatful to those offering price ideas so that I can evaluate how much this will cost and what my options are. I have a mortgage to take care of alone which makes the budget pretty tight so these are really good suggestions for me. BIG THANKS!!:p

[Bandicoon]

A really cheap thing you can do that seems to be helping Magnus is to give Hunter bone broth. This is so easy to make and practically free and your dog will love it. You'll need a large crock pot if you don't have one. I collect the bones from our meals, even the one's people have gnawed on - usually chicken and pork ribs but any bones even fish will do. Save in a plastic bag in the freezer until I have a couple of pounds, then put in the crockpot with about 1/4-1/3 cup of plain vinegar, cover with water and set the crockpot to simmer. The next morning there will be broth you can add to your dog's food or serve by itself (obviously, cool it down first). I then replenish the water and vinegar (which helps break down the bones and dissolve the nutrients into the soup) as I use it, for about a week, then use up what is left and start again with fresh bones. After a couple of days the bones will start crumbling when pressed with a spoon, and you can add them to the food in modest amounts.

Here's a link about the health benefits of broth: http://www.westonaprice.org/food-features/broth-is-beautiful

[Squirt's Mom]

I make bone broths from left over bones, too. I add other things like Reishi, Miatake, and Shitake mushrooms, veggie pieces like carrot ends or potato scraps and often nourishing tonic herbs. I drink this by the cup or add to things like rice, soups, beans, etc. as well as give it to my babies from time to time. They LOVE it as do I!

[Bandicoon]

What kind of crock pot are you using? We have a 6 quart Crockpot brand unit which we bought at Costco. All the plastic handles are beginning to crack and today the lid handle fell off. I think the plastic is defective, maybe not made to stand up to 24/7 use. Costco will take it back but I hate to have to get a new one every few months.

[Squirt's Mom]

I'm old fashioned. If the city would let me, I'd hang a cauldron over flames! :p I just use a huge stew pot and my stove. I put it in the fridge over night and start again in the mornings.

[molly muffin]

Start a notebook to keep track of symptoms, what happens when, etc. Also, go to all the vets you've been too and ask for a copy of all test results. No need to go doing this test and that until you know what all the others showed for sure. Then go back through the thread, see what the recommendations have been and then lets narrow down what test to do and when.

Well, the gang does need a place to live after all, including you, so that mortgage is pretty important too. :)

It's not easy finding the right vet, gosh, some of our members are on the same journey. Start with phone calls, talk about cushings, have they treated, what do they treat with, what sort of testing protocols do they follow, what has been their success rate. Then talk about cost, what do they think the cost factor to treat or not treat will be.

You'll get there. This place is an Awesome support site and why many of the admins and mods have stayed, year after year after year. Just to help others. It's important and we all were so freaked out and scared when we came. Everyone is, no one knows what to do, what the future holds, how they will afford any of it, it's the greatest of unknowns with pets. This gang just be there, no matter what.

Sharlene and Molly Muffin