Cushings Diagnosis/Breathing Issues/Head Twitching

[TandKNaskedov]

Our little girl Mieke, an 8-year old Bichon, has been diagnosed with Cushings. She had elevated liver enzyme numbers for several months, and after an ultrasound the specialist settled on nodular hyperplasia.

Things were fine for a couple of months, but last month her breathing seemed shallow, and she was having tiny, almost imperceptible head twitches. A week or so after I noticed this, the head twitching became more pronounced, to the point you can hear her teeth clamping shut sometimes. She also got voraciously hungry, wanting to go to her bowl frequently.

Back to the specialist for a liver biopsy, but when we arrived at the office the morning of the procedure and described even more symptoms, he changed his mind and ran Cushings tests instead. I don't know exactly what they were, but he is sure it is Cushings (pituitary).

She's just finishing her 2nd week of 20mg a day of Trilostane, and in tomorrow for tests again.

So, here are my concerns/questions:

1) Has anyone else had issues with breathing "congestion"? When she lays down, mainly on her side, she basically sounds like she is snoring, but she's awake. This concerns me as it seems she's working pretty hard to breathe.

2) I've read some on here about the macro adenomas, and the head twitching worries me as a sign of neurological issues. I'm especially concerned with the Trilostane possibly accelerating the growth of a tumor, as some have indicated on here. Thoughts?

3) Finally, what kinds of improvements in symptoms should I see if they get the dosage correct and the medication works as it should?

I plan on asking the vet these tomorrow as well, but there seems to be a wealth of experience on here, so I appreciate any input.

Thanks,
Todd (and Kirsten)

[Trixie]

Hi Todd, I'm sorry you're having these issues with Mieke. If you can post any of your preliminary tests the experts here will be able to help you better.
How much does Mieke weigh? Besides what you already mentioned do/did you see some of the other tell tale symptoms of Cushing's...like major thirst and urination--way more than normal? Or lots of panting? Skin issues or back leg weakness? Of course not all dogs show all symptoms.
Am I right that you noticed the head twitching and breathing problem before starting the medication? After starting the med did these get more pronounced?
Some people notice similar side effects from the medication like the snoring though I have not experienced this with my dog.
I notice my dog breathing fast and shallow when her Cushing's symptoms are flaring a bit...almost like panting in her sleep..when she's controlled her breathing is normal.
You should notice improvement in symptoms but sometimes it can take awhile and doses may need tweaking. Once the medication starts working well you should see an abatement of symptoms...less drinking, less peeing, not so ravenous, no panting, more relaxed...it depends what symptoms are more prevalent in your dog.
You will know how it's going once you get the results of tomorrow's tests. You should post those once you get them.
Hope you get some good results for Mieke. :)

Barbara

[Harley PoMMom]

Hi Todd and Kirsten,

Welcome to our family, although I am sorry for the circumstances that brought you to us I am glad you found your way here.

When the ultrasound was done, were the adrenal glands visualized? And if so, what does the report say about them? If would be of great help if you could get your hands on copies of all tests that were done on Mieke and post those results here, we only need the abnormal values, and especially the results from any diagnostic or monitoring Cushing's tests.

What symptoms did Mieke display that led you or your vet to test for Cushing's in the first place?

Regarding the breathing issue, off the top of my head, I can think of one member and here's a link to that thread: Tipper - adrenal tumor/breathing issues (http://www.k9cushings.com/forum/showthread.php?t=4509)

Thread with macro info: Macroadenomas (http://www.k9cushings.com/forum/showthread.php?t=3567)

With treatment the increased drinking/urination usually abate within 2-3 weeks. Any hair/skin problems take much longer to see improvements.

Here's a handy link with info about Vetoryl/Trilostane: Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185)

We're here to help in any way we can so do not hesitate to ask all the questions you want. ;)

Hugs, Lori

[TandKNaskedov]

Okay, thanks for the quick responses. I will see what I can get tomorrow re: test results. She is a 19 lb. dog and has had no weight fluctuations.

As far as symptoms go, there has been no hair loss, no excess urination, no excess drinking. Not sure about back leg weakness. She's never been real eager to jump up on the couch, and she has stairs to the bed, so I have no indication of that.

The twitching and shallow breathing both started before the medication. And while she was panting a bit more, we are in North Texas, and temps have just recently cooled. Most of her panting has been in situations where I would expect (on the bed at night, close to us, gets too warm). The shallow breathing, even when resting, is almost twice as fast as her brother, Jaap.

She had high liver numbers last October, but nothing was said by primary vet. When they were high again in March, we started looking into it more, and they put her on denamarin. After 60 days of that, her numbers were double, so we went in for ultrasound. On the ultrasound (early July), the only thing noted to us were a couple of (somethings) on the spleen that we didn't need to worry about. The Cushings check was a last-second switch off of the liver biopsy because we informed doc of a very noticeable increase in hunger and the shallow breathing. This, with the 3-months earlier liver concerns, led him to suspect Cushings.

After two weeks, I would say there has been no noticeable change in her symptoms, other than the breathing has gotten more hoarse when she beds down at night.

[goldengirl88]

I am sorry for what you and your baby are going thru. My Tipper has breathing issues, and I have read of others on here who have too. I know Tipper did not twitch or have tremors until she started treatment, and some say it is a side effect of the Vetoryl. I hope you get to the bottom of the breathing issues. Tipper always had bad breathing issues mainly at nite too. I know it is scary when you see it, it still scare me to death, and cannot be good. I pray you get a solution, and you baby gets help. Blessings
Patti

[Meg_Elizabeth]

I am in the same boat with Abby. She has similar side effects that scare the crap out of me. I'm not sure if they are caused by the disease or the Vetoryl. I just know that it has been her saving grace, the medicine they had her on before was killing her. I think the twitching and head shaking is normal for our pups. She doesn't seem to be in pain when it's happening, so maybe it doesn't even bother them? Best wishes

[addy]

Funny you posted about head shaking, my Zoe has been on Vetoryl for 2.5 years, recently she has had head tremors, she has never had them before. Is your pup on any other medications? Sorry if you already said that and I missed it.

[TandKNaskedov]

Sorry we haven't been on in quite awhile, we have been trying to keep up with Mieke's fluctuating symptoms and getting the Trilostane dosage correct.

Before, we had been asked to provide test numbers. I have those now, from all tests, I believe, but I have no idea what numbers to post.

Quick recap, diagnosed 2+ months ago, currently on Trilostane at 60mg a day, after working up from 20mg, then to 30mg.

Symptoms: huge appetite, some lethargy, head twitching, breathing congestion.

Since the bump up to 60mg, her energy is better, the head twitching has reduced (although slightly increased the past couple of days), the appetite is still there and the congestion is similar, or even a bit worse today (almost as if she's having a harder time swallowing, and she woke up coughing this morning for a few minutes, like she had to clear congestion...).

Anybody have any insight? And any specific numbers I can relay to make things clearer here?

Thanks

[goldengirl88]

Hello I wanted to welcome you to the forum. My Tipper has the very symptoms you are posting about from your dog. She does get a lot of muscle tremors while sleeping. I have not seen any while she is awake. The main thing that caught my attention was the congestive sound you say your dog has and the labored breathing. My Tipper has the exact symptoms. It seems at times she swallows a lot sounds like fluid. She does this a lot at nite I see her wake up and do this. She sticks her tongue out many times and seems to being having trouble swallowing. I have gone to I don't know how many vets etc. none of them can tell me that it is. If you do find out any information on this I am anting to know please. This has been one of my biggest worries with Tipper. At nite she would seem to be struggling to breath. Her chest would be heaving up and down like she was really having a hard time getting air. I am so sorry to hear you are experiencing the same thing. I even had them put a scope down Tipper's throat and her nose and they could not find anything. There is some connection to the Cushings with these symptoms as I have heard others talk about breathing problems too. It is one of the mysteries I have not been able to solve. I hope things get better for your baby. Blessings
Patti

[TandKNaskedov]

Hi Patti,

Mieke goes in for her Trilostane dosage check Wednesday, and I will definitely be asking about the fluid/coughing/tongue out, as this is exactly what I've seen the past couple of days. He has told us some fluid in the lungs is not abnormal for Cushings, but I never know what normal is. I will let you know what he says.

Thanks,
Todd

[goldengirl88]

Tipper has had chest xray and Ultra sounds, Scans etc. and no one ever said anything about fluid in her lungs so go figure. I have been so exasperated by the lack of knowledge on the part of these vets that I am amazed they were able to get certified to practice. None of the ones I have dealt with even remotely understand this disease, and I am sorry but that is so wrong. I will be anxious to see what they tell you. Blessings
Patti

[frijole]

Todd,

Fluid on the lung is NOT a cushings thing. Not healing quickly and immune system is compromised but if there is fluid on the lungs it can't be blamed on cushings disease.

Kim

[molly muffin]

Hi. I don't think I've posted to you before. You have been on quite the journey with Mieke and I hope that your vet can provide some answers on this trip.

As far as the lab numbers go, you only need to post those that are abnormal (high or low).
The best way is to post the date and then the test, result and range, for example:

9/10/2013
ALP 585 (50 - 150)
ALT 200 (30 - 100)

We'd like to see any cushing specific testing for instance:
9/10/2013
ACTH (this will have two numbers unless you are in Canada, then you'll have three)
pre - 5 ug
post 35.0 ug
(ug or nmol is the unit of measurement)

LDDS (this will have 3 numbers. A base, 4 hr, 8 hr)

Any urinalysis results with specific gravity included

and type out any ultrasound results.

That's a general gist and now you have homework :)

This gives us a better idea of what is going on and helps us to help you.

Sharlene and Molly Muffin

[TandKNaskedov]

Todd,

Fluid on the lung is NOT a cushings thing. Not healing quickly and immune system is compromised but if there is fluid on the lungs it can't be blamed on cushings disease.

Kim

I'm sorry, my wife just clarified for me as we haven't both been present for all discussions. He said some fluid (mucous, I guess) was normal in throat/nose, but he did not mention lungs.

He is a small-dog internal medicine specialist at one of the most used-places in the Dallas area, and he seems to be on top of things. I haven't had any reason to doubt him yet.

[molly muffin]

That might make more sense. :)

Sharlene and Molly Muffin

[TandKNaskedov]

Okay, I only have test results for right before her initial Cushings diagnosis and then her initial LDDS test, so here goes. Listing what vet report notes as "high" for first test:

10/17 (before suspicion of Cushings)
Bile Acid: 7.0 (0-6.9)
ALP: 2262 (10-150)
Total Bilirubin: 0.7 (0.0-0.4)
TCO2: 25 (17-24)
Indirect Bilirubin: 0.5 (0-0.3)

MCHC: 36.5 (32-36)
Neutrophil Seg: 85 (60-77)
Lymphocytes (LOW): 8 (12-30)
Absolute Lymphocyte (LOW): 992 (1000-4800)

Urine
Blood: Trace


After symptoms of increased appetite made doc rethink liver biopsy, he tested for Cushings instead:

Initial Test
Pre Dex: 5.7
Post 4 Hr: 0.5
Post 8 Hr: 1.9

[TandKNaskedov]

On the ultrasound, he cited a couple of nodules on spleen that were nothing to worry about.

[molly muffin]

hmmm, did it give a normal range for the LDDS test. Looking at that, maybe only a tad out of a possible normal range. I'd be hard pressed to go with cushings from that test result.

Others will be by to chime in with their thoughts though.

Sharlene and Molly Muffin

[goldengirl88]

I agree with Sharlene the test did not have high results to me. Although Cush dogs tend to have high ALP and yours does. I am hoping you get to the bottom of these breathing issues because as I said Tipper has them and I have never heard of fluid in the lungs. If they think it is fluid ask where they think it is coming from and get an explanation, although I don't think there is one as I think they are wrong. Blessings
Patti

[TandKNaskedov]

Hmmm, the numbers seem to fit the PDH guide I'm finding both in the test results and online:

I think the baseline is the first number on the test, labeled "Pre Dexamethasone," and that is 5.7

At 4 hours - "<1.5 or <50% of baseline, consistent with PDH..." it was 0.5
At 8 hours - ">1.5 and <50% of baseline,consistent with PDH..." it was 1.9

Maybe I'm reading something wrong? What kind of numbers did you folks get?

I think last time she got checked for dosage her baseline was at 9, not 5.7. Although I don't have that number in front of me.

[goldengirl88]

When you go to the vets please ask about this mucus and get it clarified for me where it is coming from and why. I have suspected post nasal drip or mucus with Tipper and I need to know if that is what is going on. I would appreciate it greatly. Blessings
Patti

[TandKNaskedov]

I should also note that Mieke had a bout with pyoderma, with irritating rashes on back legs, and hips. This was after (but not immediately) starting the trilostane.

[TandKNaskedov]

Patti, I'll definitely let you know what he says.

I am intensely curious though about all of your thoughts on the numbers not being high enough for Cushings :confused:. Please tell me what you're thinking when you look at her scores. Thanks!

[TandKNaskedov]

I'm looking through some older numbers now (July 27th), from our regular vet at Banfield. What do you make of these?

ACTH
Cortisol Sample 1: 1.6 (lab range 1.0-5.0)
Cortisol Sample 2: 6.9 BELOW NORMAL(lab range 8.0-17.0)

How am I supposed to read these numbers?

The ALP at this point was 946 (compared to over 2200 in October)

[molly muffin]

Looking at the ACTH test, that is negative for cushings. Cushings would be if the post number (cortisol sample 2) were actually above the normal range, greater than 17. With that low, you are at the other end of the spectrum, with a resting cortisol being right near the lower of the range, 1.6 (1.0 being the bottom). Too low and you might need to be checking for Addisons which is not producing enough cortisol.

My dogs LDDS was actually if below 1. then negative for cushings, which is why I say you would be right at the border. That along with the ACTH test results, make me very leery of the cushings possibility.

I really hope that some of our other members will check in and give their opinions on both test results.

Sharlene and Molly Muffin

[goldengirl88]

I thought it was low because most of the dogs on here are at 17 or a lot higher, my dog was in the 20's. I would also be watching this dog for Addisons with the resting cortisol being that low. Blessings
Patti

[labblab]

Hmmm, the numbers seem to fit the PDH guide I'm finding both in the test results and online:

I think the baseline is the first number on the test, labeled "Pre Dexamethasone," and that is 5.7

At 4 hours - "<1.5 or <50% of baseline, consistent with PDH..." it was 0.5
At 8 hours - ">1.5 and <50% of baseline,consistent with PDH..." it was 1.9

Maybe I'm reading something wrong? What kind of numbers did you folks get?

I think last time she got checked for dosage her baseline was at 9, not 5.7. Although I don't have that number in front of me.
Hello from me!

You are correct: given those lab norms, I agree that your dog does indeed test "positive" for pituitary Cushing's on the recent LDDS. I am puzzled by the July ACTH testing, though. From what you've said, Cushing's was not suspected back at that time. Why did the Banfield vet perform an ACTH?

Marianne

[TandKNaskedov]

I'm not sure why Banfield tested for that, other than she had had a couple of instances of high ALP numbers over the months preceding that.

[TandKNaskedov]

Looking at the ACTH test, that is negative for cushings. Cushings would be if the post number (cortisol sample 2) were actually above the normal range, greater than 17. With that low, you are at the other end of the spectrum, with a resting cortisol being right near the lower of the range, 1.6 (1.0 being the bottom). Too low and you might need to be checking for Addisons which is not producing enough cortisol.

My dogs LDDS was actually if below 1. then negative for cushings, which is why I say you would be right at the border. That along with the ACTH test results, make me very leery of the cushings possibility.

I really hope that some of our other members will check in and give their opinions on both test results.

Sharlene and Molly Muffin

I wonder if the Cushings simply hadn't kicked into full gear yet as it was last July?

[goldengirl88]

I too am puzzled by the ACTH. That is why I was not leaning towards Cushings. Hope you get some good concrete answers, I will be waiting anxiously to hear. Blessings
Patti

[TandKNaskedov]

Okay, got Mieke back from the doc yesterday. They ran x-rays to look at chest, and he thinks she has a mild bronchitis. Not enough to do a "flush" however that works, so gave some antibiotics.

Asked some Qs, got some info.

Patti, on the mucous/moisture/breathing/snoring, he didn't have a solid explanation, other than to say than he's seen it before in cushings dogs.

On the past two ACTH Stim tests, her numbers were in the normal range for pups NOT on medication, but still high for dogs that are taking medication, according to the reference ranges listed on the test results. I got nervous for a few minutes, as I was reading her numbers as "normal" and wondering why we were increasing her trilostane. Finally realized they listed different reference numbers for dogs undergoing Lysodren treatment, which I assume substitutes for trilostane treatment.

On the July low ACTH numbers, he said those numbers can come quickly when the cushings kicks in. I didn't ask, but I guess the over 100% increase in ALP numbers from July to October might support this.

Her skin irritation and twitching have diminished quite a bit in the past week, but I'm still concerned about her shallow/rapid breathing. Web sources list resting breaths per minute in the 15-30 range for dogs, and she is 30 when sleeping. Hoping it's caused by the bronchitis and will reduce a bit soon, but I'm worried about what it will do to her little heart to breath that fast so consistently.

One big question: we are leaving for Xmas for ten days, and since we're flying, can't take dogs. Anybody have grave warnings from their vet about boarding Cushings dogs? I'll ask my vet today when he calls with new ACTH numbers.

Thanks

[Squirt's Mom]

The ranges given as normal by labs are for pups who do not have Cushing's or who are not yet on treatment. The normal ranges for treated pups are different from those normal ranges depending on which drug the pup is taking. The normal range for a Lyso pup is 1-5ug/dl. The normal range for a Trilo pup is 1.45-5.1ug/dl but if all signs are controlled a Trilo pup can go as high as 9.1ug/dl instead of 5.1 - BUT ALL SIGNS MUST BE CONTROLLED if the post # is over 5.1 for a Trilo pup.

So there are three different normal ranges we look at - the ones from the labs for a non-cush/non-treated pup, the range for a Lyso pup, and the range for a Trilo pup. ;)

[TandKNaskedov]

Thanks Squirt's Mom!

I think our Doc is right on then.

[TandKNaskedov]

Anybody have any thoughts on leaving cushpup with boarding kennel? Normally I'd fly my mother in to watch dogs and house, but not possible this time.

[Renee]

Anybody have any thoughts on leaving cushpup with boarding kennel? Normally I'd fly my mother in to watch dogs and house, but not possible this time.

Do you have a boarding facility you normally use? Are you thinking of using a facility, or a vet's office?

I don't board my dogs often, but when I do, I am very picky about it. I don't like places that kennel the dogs for most of the day and all night. I feel like that is cruel to have a dog locked up in a kennel for hours and hours a day and all night too. The place I board my dogs has a minimum of 12 hours in a dog daycare setting (open area, with outside play yard access), and then overnight in dogs runs, not kennels. Dogs are never stacked on top of each other.

If you have the time, you should make appointments to interview some boarding facilities. A reputable facility will let you view the entire premises and be open to answering your questions. I would be upfront about the cushings. Ask how they monitor medication, ask how they monitor each dog, find out the protocol for when a dog is sick, see if they have a website or social media site where they upload updates on dogs. Ask how they give dogs down time if they need it. My own dogs get tired easily, especially my old man pug. When he boards, they give him a lot of time away from other dogs so he can rest.

Good luck. I am a wreck when I leave my dogs behind. I actually call the facility every day to check on them, lol!

[molly muffin]

I board my molly at the vets when I'm away. One because if something comes up, they can treat her, two they have a doggie day care also, so she gets plenty of play time and one on one play time (molly doesn't play well with others she doesn't know), three they don't do stackable kennels, they have runs, big enough for my molly to practically get lost in.

The other option and this is what my sister does is pay someone to stay at the house with her dog. Housesitter/petsitter in one.

Hope that helps
Sharlene and Molly Muffin

[goldengirl88]

I do not know anything about boarding so can't help you there. I am just really not understanding why none of these vets can given an answer on the fluid or mucus problem??? I hate that there is so little known about this disease and that it may be too late for our dogs to have this found out. It makes me feel very frustrated not knowing what is going on and how to stop it. Blessings
Patti

[TandKNaskedov]

Sorry Patti, I know how you feel. I've said the same about my father and Parkinsons for years.

Mieke's coughing and snoring have gotten a bit better the past couple of nights. Right now my bigger concern is how quick her breathing is when sleeping. Her little heart seems to be working overtime to keep up. Its about 30-35 breaths per minute when sleeping, or twice as fast as her brother.

Anyway, thanks for the tips on boarding. I'm reserved at a place we've used before, and they've been fine, but I didn't realize vets offered boarding. At this point, probably too late to get a spot over Xmas.

[goldengirl88]

Tipper had that kind of breathing also, and she does still at times. I know how it scares the daylights out of you. I wish this disease had a cure, and I wish the vets knew more about these problems it brings on. God Bless You and Your Baby, I hope things go well.
Patti

[TandKNaskedov]

Just out of curiosity, how long before most of you saw your pups get back to close to normal in behavior after dosage was figured out?

[molly muffin]

Once the cortisol is controlled usually you'll start to see an improvement right away. Within days of control, symptoms should get better. A couple weeks and you should see a real improvement after control is reached.

Sharlene and Molly Muffin

[goldengirl88]

My Tipper is an odd kind of case, but she showed improvement within hours of her dose, and I was so happy. Since she has had a bout with the diarrhea she has had no Vetoryl and she was really congested sounding last nite. This morning she has mucus in the corners of both eyes. Hope you baby is doing alright with the breathing as I know what a worry that is. It makes me so nervous to watch Tipper when she is doing that. Blessings
Patti

[TandKNaskedov]

Before I give my mini-update and ask a question, I wanted to say that there are so many concerned and kind folks on here, it's impressive. It's also difficult to keep up with every pup's progress. So, to all of those I am not keeping up with, my thoughts are still with you. To those who keep up with my pups, thanks so much.

Mini-update: The antibiotics are appearing to have an effect on Mieke's congestion and coughing. There is no moisture in her breathing, no more coughing fits every time she wakes up, and her snoring has greatly reduced. That's the good news.

The bad news is she is still lethargic/slow-moving, she doesn't seem like herself, the twitching is still there, and now we suspect she's having vision problems in one eye. These last two especially concern me, as it sounds like other owners' stories of macroadenoma symptoms.

She just hasn't had many of the standard cushings symptoms. No excessive drinking or urination, no hair loss, had a very mild pot-belly for a couple of weeks, but that is normal now. Really, the only cushings indicators have been the increased appetite and the test results.

The twitches/tics, along with several months of high ALP numbers, were what started our push to determine what was wrong with her. It wasn't an onset of other cushings symptoms. The first signs of possible neurological issues were also the first signs of cushings.

What do you guys think?

[TandKNaskedov]

Well, my wife and I and especially little Mieke are having a rough day/night. I am out of town and Kirsten stayed home with Mieke and her brother.

After the twitching, balance and vision issues a couple of weeks ago, we pushed for a definitive answer on a possible macroadenoma. CT scan revealed...no visible tumor, so less than 5mm. We felt relieved, but are still without an answer to the symptoms.

Mieke then had two real good days with minimal twitching or balance issues. The past three days, however, they've been increasing

Today...K called crying and said that Mieke had suffered a seizure earlier in the day. It's Sunday, so no easy call to a vet. Luckily, her friend is a vet and came over to help.

I don't know anything about seizures, but from reading it sounds like there is more than just the initial visible seizing. Since, she's acted confused with reduced vision. She was sleeping peacefully when K called me, but when K tried to wake her up, she wouldn't wake and began twitching. Panicking, she called friend again. Mieke eventually woke up, while friend rushed over and gave a small rectal injection of valium.

My wife is obviously shaken. I am as well. I am so far away and won't be there until Tuesday. She is calling doc first thing in morning, hoping to get quick neuro appointment. We are also feeling helpless because we have no idea what's causing this. Is this what Cushings does? She had high liver numbers for several months before Cushings diagnosis, so is it liver disease?

We are so lost, and nothing seems to answer our questions or give us a direction. I'll do anything to help this sweet puppy, but I don't even know where to start. Hopefully the Neurologist can get to the bottom of things.

:(

[Renee]

I wish I had some words of wisdom.

Seizures are downright scary. It's not a common side-effect, but vetoryl does list seizures as a possibility.

I think you are right to question whether it could be something other than cushings. But, also don't rule out that it could be cushings AND something else, both working against her. Maybe she has cushings, but also has liver disease which is not secondary to the cushings?

Have you seen any improvement in her cushings symptoms?

[TandKNaskedov]

Thanks Renee. Yes, we're considering a little of everything, such as not really Cushings, Cushings + something else, abnormal Cushings effects.

On the Cushings symptoms, they have been:
Huge Appetite: Still there, but somewhat reduced
Pyoderma: Cleared with antibiotics, hasn't returned
Reduced Energy: (further reduced)
Breathing issues/snoring: mostly gone

That's it for symptoms. The ACTH numbers have been consistent with Cushings and have gone down with Vetoryl (not far enough yet).

Meanwhile, the twitching has never been explained, continues to increase, and is why we took her to vet in first place.

I feel like we (K, me, vet) are missing something.

[Renee]

Have you / can you get a second opinion?

[TandKNaskedov]

Well, we're hoping to get a full blood work tomorrow, as focus has been on Cushings for so long. We have a scheduled appt with Neuro on 2nd, but will try to move that up if possible.

[Budsters Mom]

Please describe the head twitching in more detail, if possible. Are they tremors? The reason that I'm asking was that my Buddy had sporadic head tremors. His head (and only his head) would vibrate, like a cell phone. It scared Buddy. After exploring many possibilities and getting valuable feedback from this group, it was discovered that he had Reactive Hypoglycemia. That is a temporary drop in blood sugar. Giving him a small amount of Karo syrup stopped the tremors quickly and he'd be fine a few minutes later, although still clingy and scared.

[TandKNaskedov]

No, not tremors, and I've had a really hard time finding an accurate description online. It's an occasional jerking movement. Very quick, and not in a series. Maybe one every 20-30 minutes when it started, and now up to 4-5 times a minute when it acts up. Twitch is the same duration as if something startled her.

[Trish]

It is good the CT did not show any tumour and that would rule out any other kind of brain tumour, although I have heard MRI gives a better picture of that type of thing. It will be good to get that neuro opinion to get their take on it. So sorry you are having these troubles and it must be so scary for Kirsten wife looking after Meike. Hope things settle down overnight. How lucky you have a vet for a friend too!! That's a good friend to fly over and help out like that. Thoughts are with you guys as you try and get answers for your doggie :) Sorry I am not much help, but good with the moral support!! :)

[goldengirl88]

I can tell you that my Tipper is having seizures at nite too. I am suspect of the Vetoryl as she never did it before that. Please research them as I have they are Focal Seizures , or in Tipper's case Myoclonic seizures. Tipper had the worst of them last nite. It scared me to death. You can see dogs having these types of seizures on YouTube. I am gong to be curious what the neurologist says. Tipper's seem to be getting worse. When I wake her they stop immediately and she is looking confused. I may be taking her to a neurologist too. She does not have a macro tumor either. It started as twitching in her legs, then moved to her side, then her abdomen contracts in and out, then her eye started twitching badly. I tried to get it on camera last nite but was too late, she woke up. Tipper only does this at nite when she is sleeping, I have not seen any during the day. Does you dog only do this at nite? Your dog had the breathing issues too right? Tipper had those too, and still does at times. I am hoping we can get to the bottom of this and get it resolved. Blessings
Patti

[molly muffin]

It wouldn't hurt to try karo syrup and see if Meike responds to that, as it is very difficult to get a diagnosis for Reactive Hypoglycemia. The blood sugar is only low during the seizure, not when doing blood tests or at a vets office normally. If Meike reacts positively and quickly, then you have an answer.

Also to be ruled out is epileptic seizures, etc. There are some seizure medications and Marianne has some experience with that. Song's dog Ginger is currently on medications for seizures, this is her thread: http://www.k9cushings.com/forum/showthread.php?t=5801&page=40

There are others of course. I hope the neurologist can help as this must be so very scary for you and your wife.

hugs,
Sharlene and Molly Muffin

[TandKNaskedov]

Okay all, thanks for your help. Here's where we are after tests today:
Bile acid numbers blew up between October and now and doc says we're looking at liver disease: Hepatic encephalopathy.

She's staying a couple of nights with vets to get meds administered and get her back from seizures/blindness. When neuro signs dissipate, a liver biopsy is next to determine what we're looking at.

It appears at this point that she ran into two issues at the same time (Cushing's and liver disease), which I guess isn't surprising as she's been a poor cursed puppy since we got her. The crappy thing is that doc switched to Cushing's test the day of her liver biopsy back in October, based on new symptoms we presented. When she tested positive for Cush, liver was put on backburner. So...crap.

Been reading on HE and it sounds like prognosis can be good if we can figure out the liver issue and treat/manage it. Any experience with this?

[goldengirl88]

I am glad someone figured out what was going on with your baby. Please let us know how she progresses and about her seizures. I am most interested in knowing what the experts say about them. Hoping for a speedy recovery. Blessings
Patti

[frijole]

Bumping this up in case anyone can assist with liver disease

Kim

[TandKNaskedov]

Thanks Patti and Kim

[molly muffin]

I am sure that we have had some liver problems on here, but not sure how often everyone is checking in over the holidays.

What a thing, to have the liver end up being the bigger issue. Remember, with the liver it has good restorative powers. We had Flynn from New Zealand who has had liver masses removed and survived just fine, so lets see what kind of treatment the vet is recommending and go from there.

hugs,
Sharlene and Molly Muffin

[Trish]

Hi, yes Flynn has had liver surgery.. Twice! The first one for a massive low grade hepatocellular carcinoma which was over two years ago now. The second surgery was 5 weeks ago today, again a low grade tumour, possibly adenoma. The first time they took 33% of his liver... it all grew back!! Last month they took another 25%, It has been amazing how well he got through these surgeries and the surgeon said if they are going to get a tumour that is resectable it is good to get them in the liver as it does regenerate. Both his ALP/ALT went very high, but bile acids were normal just prior to this second operation. He never got encephalopathy either, sometimes wondering though with twitching etc... but he still does that now and his numbers are coming down postop.

So if you end up needing surgery very happy to help! Hope you get some answers soon. :)

[lulusmom]

I'm familiar with liver disease but can't really give you anything meaningful without seeing the results of the most recent blood chemistry and bile acid test result. With respect to the blood chemistry, you need only post the high and low values, and please include the normal reference range.

Dogs with hepatic encephalopathy (HE) can have seizures but I think you would have seen more symptoms like excessive drinking and peeing, anorexia and weight loss. The seizures and neuro signs are caused by the build up of toxins, primarily ammonia, due to the liver's inability to metabolize the byproducts. Ammonia builds up and becomes seriously toxic, effecting the central nervous system. Neuro signs and seizures are more likely to be at their worst directly after eating as ammonia is a byproduct of protein. I've seen this happen in tiny dogs I've rescued with HE due to liver shunts. This is a the most common condition in dogs diagnosed with HE. These dogs are usually younger and surgery can correct the problem. Have you noticed that the tics seem to be worse shortly after eating? Once a dog with HE start showing neuro signs or seizures, the vet will usually restrict protein but it sounds like your vet suspects HE but won't be sure until the liver biopsy is done? Right? What liver supplements has your vet prescribed?

Glynda

[goldengirl88]

Just checking in to see how things are going? Hope all is well and gets better for the New Year. Blessings
Patti

[tarano1]

At last my 13 year year old retriever is having the same head tremors and twitching. Diagnosed with cushings two weeks ago. Been on 60mgs vetoryl 1xdaily after an icrease from 30mg 1x daily. Been on meds a week. Her breathing too is bad gasping for air. Nightimes are worse. I too worry about a macro odenema and if meds making it worse. Vet says monitor and mri scan on head if things get worse. HeadTremors were there prior to taking meds now seem worse. Scary to watch

[tarano1]

I see this post is from february 14. How is mieke doing. He sounds just like tara re her symptoms