Bear- Just diagnosed with PDC- Many ?'s

[BearDown]

Hi everyone,
My name is Keith and my dog Bear was just diagnosed with pituitary dependent Cushings. He is a 12 yr old Shepherd mix, about 65lbs. At the start of December I started having him get Adequan shots for his hips. Since then, its kind of been a nightmare. About two weeks into the loading shots I noticed he started drinking water a lot more and asking to go out constantly. He also had two accidents while we were out, and was getting into the trash. Both unusual behavior. Then on Xmas day we left for Chicago and I had my mom watch him. Apparently that night she awoke to him sprinting to the back door but unable to hold his urine before she got there. Then in the morning she called me saying he had peed in the house three times and was constantly asking for water and ravaging food she fed him. I had her take him to my vet and he stayed there for 24 hrs until I was able to get home. The vet tested his urine and glucose levels and they were normal and sent a few other tests away for an endocrinologist to check out.

When I took him from the vet his hunger and water appetite had died down but he had a 103.8 temp and was very lethargic. The next two days would end up being the worst I have ever endured. Bear looked miserable, his eyes glossed over, he refused to get up and move around even to go outside, and I had to carry him up and down the 6 steps to our porch. He was on Baytril but his fever didn't subside and he was having body tremors. On Saturday the vet had me stop the Baytril until we awaited the test results from the lab. On Tuesday, we finally got the results and he was diagnosed with pituitary dependent cushings disease.

This forum has been awesome and has given me a lot of info but only added to my desire to ask questions. Yesterday, the 1st of Jan, I started him on 120mg of Vetoryl a day (6omg pill 2x day). However, I am wondering if it is too much? Since Saturday his fever subsided, and he started moving around more and even barked/semi chased at a squirrel (which made my day). these are his symptoms for the last 4 days pre-Vetoryl:

No appetite ( but will eat hamburger and brown rice)
Very lethargic
Wobbly hips ( more so than his usual hip problems)
occasional body tremors
quick breathing/even seems like he wheezes while sleeping
Peeing and water intake is back to normal
No temperature anymore

After 24 hrs on Vetaryl:
I would say today is a lot like yesterday but maybe more energy. Still no appetite but did have one body tremor.

I would like to see how everyone feels about his symptoms. He seems to only show some of the Cushings symptoms and besides lethargy and appetite they subsided before the medication. I am really wondering if Adequan shots played a role in all of this? I was hesitatant to start him but my vet talked me into them. It seems he hasn't been normal Bear since. This xmas was awful as I feel like I lost my dog over night. I also thought he was on his deathbed those first two nights. I love him so much and just want quality of life to be good. Its nice to see him rebounding a little but from the past few days but I want to make sure I am doing all I can. I don't like the idea of Vetaryl but am giving it a try to see if it helps. I wonder if 60mg a day would be sufficient. I am picking up copies of his tests today so I can post numbers later.

I also bought Cushex in my panic. After reading posts on here I will probably return it, but if someone thinks its worth a try I will give it a go.
Thanks for all your help and I hope to now be a regular contributor to the family here on this forum.

[goldengirl88]

Welcome to the forum. Please stop the Vetoryl immediately. You dog has started with twice the dose recommended. He could go into Addisons if his cortisol dropped too low. Dechra the makers of Vetoryl give a starting dose of 1mg per lb. Your dog has had twice that. You can call Dechra and start a file on your dog they have people there to talk to you and walk you thru this. You dog started out lethargic and on antibiotics. Sometimes when they have other illnesses going on it can skew their Cushings test. Please do the following so we can help you. Get copies of the testing that was done, and give us the abnormal numbers along with the normal range the lab has given as all are different. Do not give any more Vetoryl. Also keep in the back of your mind never give a sick dog Vetoryl. If you dog cannot get up is still lethargic, vomiting, won't eat he may be in Addisons which he needs prednisone. Do you have any? Please get some from the vet asap. If he is in Addisons he will need to have his electrolytes checked. This can be a bad situation if not addressed. As far as the Adequan shots my dog has them every three weeks. She had tremors before the shots so I don't know of any correlation between the two that I have heard of. My dog had breathing problems too and still does at times. Keep in mind this disease needs several different tests to be sure your dog has it. Urine, LDDS, ACTH, Blood, Ultra Sound are all used to confirm this. There are also other diseases that have similar symptoms so you want to make sure of what you dog has. With proper medication, management, and a watchful owner your dog can live it life out. Please do take the Cushex back, doesn't work and is a ripoff. You dog does have many of the signs of Cushings though, and it is usually seen in older dogs. It will all be ok so take a deep breath and come on here and get as educated as you can. You will need it to carefully monitor a vet that is not experienced in this. I would even urge you to have your vet call Dechr866-933-2472. Please never put blind faith in anyone including your vet. Many vets know very little on Cushings and that can be bad news unless the owner is educated and can guide them in what to do. We are all here ready to help you, so you are not alone. We all walk this path together. Blessings
Patti

[lulusmom]

Hi and and welcome to you and Bear.

Please discontinue Vetoryl immediately. You never give Vetoryl to a sick dog and based on the symptoms you gave us, Bear is sick and I doubt it has anything to do with cushing's. Given that the excessive drinking and peeing resolved before you even started Vetoryl; the fever and other symptoms not associated with cushing's, I would have to question the cushing's diagnosis......and given that your vet talked you into giving Vetoryl to a very a sick Bear, I also have to question his/her experience with cushing's, and most certainly Vetoryl.

I am assuming that your vet did a low dose dexamethasone suppression test and this tests is highly likely to yield a false positive result in the face of nonadrenal illness. I'm glad you will be posting test results as it will help us to try to figure out what is going on. You need only post the highs and lows on the blood chemistry and please include the normal reference ranges.

I repeat, no more Vetoryl until Bear is eating normally again and even then. if his appetite is normal, I'd be hard pressed to believe he has cushing's.

Glynda

[molly muffin]

Hello and welcome to the forum Keith and Bear. :)

As the others have already mentioned, basic rule is to never give a sick dog (voimiting, lethargic, diarrhea, etc) cushings medicine. This Is printed on the Dechra website I believe in addition to being on the insert.

Next thing, is that cushings usually doesn't come on fast, over night, and fever is not associated with cushings. Cushings is caused by a tumor on either pituitary or adrenal gland that causes the body to over produce cortisol . It will make them feel hot, and want to lay on a cool floor, etc, but it doesn't that I know of, produce fevers, etc. This sounds like a possible, severe UTI, which would be found by sending away to culture, bacterial infections digestive system maybe of somewhere else. Those are my first thoughts and reasons that the others too are alarmed.
Glynda is one of our most experienced administrators having treated multiple dogs with both available drugs for cushings and working in rescue, so is very much on top of signs, symptoms and treatment.
It is very important if you can post the lab results that the others have asked for in order for us to help you get this sorted out and Bear the best care possible. We just have to figure out what is going on, so you can get it fixed and the labs along with what you are seeing will be very helpful.

I hope that all is okay today with Bear.
welcome again to the forum
Sharlene and Molly Muffin

[Renee]

Hello and welcome.

I agree with everyone else. I would stop the vetoryl for sure, and clear up whatever else may be going on before diagnosing and treating cushings. I think if you had an LDDS or ACTH test done, the results could have been altered by his other issues, the stress of being with your mom, then getting sick, then being boarded at the vets, and you being gone.

My guess would be a very bad bladder infection / UTI, and stress caused by you going on vacation, and possibly some other infection in the body. Whenever I leave home, my pugs literally make themselves physically ill while I am gone.

[BearDown]

Wow,
Thank you or the quick responses. I am going to suspend giving Bear his meds until we figure this out more. I went and had copies of his tests made. I will try and post numbers that are important and in an inteligble way. (it is a foreign language to me) Here goes:

His urinalysis from Dec. 26th:
pH - 8.0 (labeled HIGH) ref range: 5.5-7.0
Microalbuminuria "Canine Reflex"- 4.4 (labeled HIGH) Range: <2.5
Glucose, Ketones, Bilrubinn, Occult Blood,Casts, Crystals, Bacteria, Epithelial Cells- All Negative

CBC Diagnostic test 12/26-
Monocytes- 931 (labeled HIGH) Ref Range:0-840
Neutrophilis- 10906 (High) Ref Range:2060-10600

Blood Chemistry Profile 27 Panel Diagnostic Test 12/26:
AST(SGOT): 88 (High) Ref Range: 15-66 IU/L
ALT (SGPT): 529 (High) Ref Range: 12-118 IU/L
Alk Phosphatase: 486 ( High) Ref Range: 5-131 IU/L
BUN/Creatinine Ratio: 38 (High) ref Range: 4-27
Glucose: 55 ( Low) ref Range: 70-138 mg/DL

Urine Coritsol/Creatinine ratio: 74

These tests were analyzed by Michigan State and were primarily used for his diagnosis I believe:
Cortisol BaseLine test: 365 H ref Range (15-110) nmol/L
Cortisol Low Dose Dex 4h: 30 ref Range (0-30)
Cortisol Low Dose Dex 8h: 143 H ref Range: (0-30)

Please let me know if this helps. I am really confused now by all of this. Thank you all so much for your concern and your help

I am going to try and scan these tests on here some how so everyone can look at it. Are there any specific numbers I should be posting?

[BearDown]

One more symptom that I wanted to add, for about 6 months he has been doing this weird thing with his mouth, where he chomps his teeth together and does what I call "mucking". Its like he has a bunch of peanut butter in his mouth and has to continually lick his lips. I thought he had a tooth infection way back then but the vet checked him and said he didn't think so.

[lulusmom]

Thank you for posting Bear's test results and I'm glad you have discontinued the Vetoryl. I only have a minute and will be back to comment in more detail but I can tell you now that these results are not the usual pattern of abnormalities we see in dogs with cushing's. In my opinion, it looks a lot more like an active bacterial infection. Did your vet rule out Lyme disease? Were all of these tests done on 12/26? I am most interested in when the urine cortisol/creatinine ratio and the low dose dex tests were done. Can you look at the urinalysis results and let me know if you can find something called USG (urine specific gravity) and if so, please post that result. Will be back later.

Glynda

[goldengirl88]

My dog does the very same thing and has done this for 14 months now. I read where this can and does affect their trachea. My dog sometimes acts like she is trying to clear something out of her throat or mouth. No Dr. has been able to tell me what is causing this. I even had my dog to the hospital and they ran a scope down her throat and up her nose and found nothing. I would surely like to know what this is also as it is definitely Cushings related. Blessings
Patti

[BearDown]

Glynda,

urine tests and blood profile were done on 12/26, but the Cortisol tests were done on 12/27 I believe. The 26th was the night he spent in the hospital.

His Urine specific gravity was 1.026 in a Ref range: 1.015-1.050.

Update: His behavior today is less energized than yesterday. His appetite is still next to nothing. And he has had one body tremor that I am aware of. I have not given him vetoryl yet.

Thank you for your help!

[BearDown]

Patti,
I haven't been able to find anything on the mouth behavior. It just seems like it would be annoying for the dogs. I wonder if it is neurological?

[goldengirl88]

I am not sure, but I have asked many people and I cannot get an answer, no one I have asked knows anything about it. I will keep trying to find an answer. I see a neurologist on the 15th and I will ask him the same question. Blessings
Patti

[lulusmom]

Thank you for posting additional information. I am worried about Bear because I don't believe cushing's is his problem. His bloodwork points to a possible bacterial infection and I have no idea why your vet had you discontinue the antibiotic treatment. Symptoms directly related to cushing's do not miraculously resolve without treatment and dogs with cushing's, unless there is another underlying problem, do not have a fourfold (severe) increase in ALT, with correlating increase in AST, which suggests there is some serious trauma to the liver going on. Dogs are the only species on earth with a steroid induced alk phos enzyme and we see alk phos elevations from mild to severe, with mild to no increase in ALT..... and we rarely, if ever, see elevated AST. I believe Bears elevated alk phos is not steroid induced but rather a direct result of liver cell damage. That's pretty obvious given the high ALT and AST.

It was pretty clear that even if Bear had cushing's, there is a lot more going on with Bear than high cortisol and it is also very clear that your vet wasted your hard earned money when he opted to test for cushing's. The LDDS is highly likely to yield false positive results in the face of nonadrenal illness and I would have been shocked if it had been normal. The same goes for the urine cortisol creatinine ratio. The stress of any infection or illness will increase urine cortisol and yield a high ratio. Bear was already sick and unless your vet got a free catch urine specimen from Bear on his first pee of the morning, then he put a needle into Bear's abdomen, through the bladder wall to get a clean specimen, thereby increasing an already stressed out boy. This procedure is called cystocentesis and you never, ever use this procedure to collect a specimen for a UC:CR.

Other things that stick out like a sore thumb that is not associated with cushing's is the very low glucose. This could be a lab error but it could also be from infection. Dogs with cushing's have normal or slightly elevated blood glucose. Dogs with cushing's lose their ability to concentrate their urine so they pee lakes and drink buckets to stay hydrated. This is called polyuria/polydipsia (PU/PD) and dogs with PU/PD have low specific gravity. Bear's is low normal which makes sense as he no longer is drinking and peeing a lot. I'm not a vet but I've treated three cushdogs, and as a small special needs and senior rescuer, I've gone over a lot of blood tests with vets and specialists over the years so I have a better grasp than most laypeople. Having said that, I have no idea what your vet was thinking.

If Bear were my dog, I would get him to an internal medicine specialist as soon as possible to find out what is going on and get him on appropriate treatment. Most specialists require a referral from your gp but some do not. Your vet should be happy to give you a referral so if that's something you are open to, please call your vet today to get a referral and schedule the earliest appointment with the specialist. If you let us know your approximate whereabouts some of our members may be able to give you a name or two of trusted specialists. You can also search for them by state at www.acvim.org

Glynda



Wow,
Thank you or the quick responses. I am going to suspend giving Bear his meds until we figure this out more. I went and had copies of his tests made. I will try and post numbers that are important and in an inteligble way. (it is a foreign language to me) Here goes:

His urinalysis from Dec. 26th:
pH - 8.0 (labeled HIGH) ref range: 5.5-7.0
Microalbuminuria "Canine Reflex"- 4.4 (labeled HIGH) Range: <2.5
Glucose, Ketones, Bilrubinn, Occult Blood,Casts, Crystals, Bacteria, Epithelial Cells- All Negative

CBC Diagnostic test 12/26-
Monocytes- 931 (labeled HIGH) Ref Range:0-840
Neutrophilis- 10906 (High) Ref Range:2060-10600

Blood Chemistry Profile 27 Panel Diagnostic Test 12/26:
AST(SGOT): 88 (High) Ref Range: 15-66 IU/L
ALT (SGPT): 529 (High) Ref Range: 12-118 IU/L
Alk Phosphatase: 486 ( High) Ref Range: 5-131 IU/L
BUN/Creatinine Ratio: 38 (High) ref Range: 4-27
Glucose: 55 ( Low) ref Range: 70-138 mg/DL

Urine Coritsol/Creatinine ratio: 74

These tests were analyzed by Michigan State and were primarily used for his diagnosis I believe:
Cortisol BaseLine test: 365 H ref Range (15-110) nmol/L
Cortisol Low Dose Dex 4h: 30 ref Range (0-30)
Cortisol Low Dose Dex 8h: 143 H ref Range: (0-30)

Please let me know if this helps. I am really confused now by all of this. Thank you all so much for your concern and your help

I am going to try and scan these tests on here some how so everyone can look at it. Are there any specific numbers I should be posting?

[BearDown]

I live in Central Illinois so Champaign-Urbana is probably the closest Internal Medicine Specialist.

Bear has regressed today, he is even turning his nose up to rice and meat, which is a first. I am also very concerned with Bear's diagnosis. Its just so hard to not believe a vet. Yet I do get the feeling that they are new to Cushings and even on his Cortisol report, the endocronoligist stated "there is recognition of a false positive adrenal function test results as a stress response to non-adrenal illness." And then asks if there are clinical features that do not fit well hyperadrenocorticism?

Would there be results in his blood results that would indicate a liver problem?
I am almost maxed out on my credit card with the tests that have already been given. Im just a grad student so I am doing my best to not let money get in the way of figuring this out. But this liver issue scares me.

[lulusmom]

There is a teaching hospital with an internal medicine department at the University of Illinois in Urbana. It doesn't appear that you need a referral but I'd call first to find out. You will need a copy of the tests your gp vet did to take with you. If you don't have a complete file, your vet can probably fax them to the hospital. You can find the contact info using the link below:

http://vetmed.illinois.edu/vth/contactus.html

With respect to your question about liver disease, without further testing there is no way to tell what is causing the extremely high liver values. All I know is that you need to find exactly what is causing it as soon as you can.

Glynda

P.S. This is a teaching hospital so appointments can take a lot longer than the usual vet. Prices are usually not as steep and vet students leave no stone unturned. Make sure you tell them that Bear needs to be seen by an internal medicine specialist.