Brittany newly diagnosed with Cushings and SARDS

[Dekie's Mom]

My name is Jeanene. My family has a 4 year old cocker spaniel named Dylan and a Britany named Dekie who has been recently diagnosed with both Cushings and SARDS. Dekie is a rescue whom we adopted 7 years ago. We believe he is 8 years old but he could be a little older than that. He hurt his back in November and never seemed to recover. We thought the increased urination, incontinence, increased hunger and depression were from the prednisone. But after his back seemed better, his symptoms persisted along with hair loss, drooling, loud nasal breathing when he sleeps and gradual vision problems which have now become total blindness. His fasting bloodwork (I believe it was an ACT that was done over the course of 8 hours) showed pituitary cushings disease. We started him on 30 mg of Vetoryl once a day two days ago and will have a blood draw after 2 weeks. I am sad and feel very overwhelmed; especially about the blindness. Dekie loves to be outside or at the window watching the wildlife in our backyard and now he seems to sleep most of the time. I have ordered some scent patches to help him navigate paths in our house (although he is adapting very quickly) as well as some smell-related toys. He seems to be handling this with much more grace than I am so I am trying to follow his lead. I am appreciative to have found this site and I do have a few questions.

1. I have read about adrenal exhaustion and it's relation to stress. Dekie was severely attacked by our neighbor's new rescue dog (a yellow lab) 2 years ago and spent 3 months and 3 surgeries recovering. He was always a little dog-aggressive but this greatly intensified after the attack. I wonder if that injury or the more recent back injury could have brought this on or hastened it's progression. I'm sure the "why this happened" is common but the suddenness has been difficult.
2. Is there any newer research on the relationship between Cushings disease and SARDS?
3. Is there anything else we should be doing to make him comfortable and to help him adapt.
4. Is it common to see "pack" changes with blindness? Our younger dog seems to been testing the waters about being alpha and I don't know if this natural or if I should be trying to intervene in some way.

Thank you,
Jeanene

[labblab]

Hello Jeanene! Welcome to you and Dekie. I can only imagine what a rough time you have been having, and I am so glad you have found us. Because now you will always have company to walk alongside you two! :)

I will try to address your questions, but my first very important question to you is: for how long a time was Dekie taking the prednisone, at what dose, and for how long had he been off the drug prior to the Cushing's testing. You are absolutely correct that prednisone can be responsible for all the Cushing's symptoms, because in essence, it is causing Cushing's in its own right. Prednisone can also falsely skew the diagnostic testing. So the timing of the prednisone weaning and the subsequent Cushing's testing is very important. It will help us a lot if you will clarify Dekie's entire history with the prednisone.

For the moment, though, I'll proceed on as I would if the prednisone were not part of the picture. The combination of Cushing's and SARDS is definitely a double whammy, and unfortunately, there is still much that remains a mystery about the relationship between the two. If you plug "SARDS" into our forum search function, you will find other threads and other dogs who have also been stricken with blindness in this way. Not all situations are the same, though. You'll find that many dogs do not actually have elevated cortisol levels, even though they exhibit many of the same symptoms of conventional Cushing's. For those dogs, the Cushing's symptoms may ultimately abate even though the blindness remains permanent. For a few dogs, Cushing's does remain part of the picture, and Dekie looks to be one of those. But do not despair! The Cushing's symptoms can indeed be managed.

The blindness can be managed, as well. And as you've already suspected, the dogs themselves often adjust far more quickly than do we humans. I'm including a link to a reply one of our staffers recently posted to another parent facing SARDS. I'm sure Leslie will soon be stopping by personally, but here's some great info in the meantime.

http://www.k9cushings.com/forum/showthread.php?p=135418#post135418

Last but not least (I'm kind of answering your questions backwards :o), I don't think there is any peer-reviewed research that documents a connection between stress and the onset of either SARDS or Cushing's. I will be honest with you, though, and tell you that I am not a fan of "adrenal exhaustion" theorists, particularly because of the treatment recommendation to give prednisone to dogs who may already be suffering from elevated cortisol levels. I am very glad that you are instead opting to lower Dekie's cortisol with the trilostane.

OK, I will hush for now! But I'm certain you will soon be hearing from others and they will have their own questions to ask. Again, I'm so glad you've found us!

Marianne

[Squirt's Mom]

Hi and welcome to you and your babies! :)

Yes, a pup going blind will change the pack behavior. The others see the blindness as a weakness in the pack. So it's not uncommon to see the struggle for the alpha position happen. The thing to remember is, let them work it out. Don't interfere unless it's getting dangerous. In the wild, a blind dog would be cut out of the pack and left to fend for themselves if not outright killed because they will slow the pack and cannot contribute to the support of the pack. However, our babies have something a wild pack doesn't - a human alpha.

I got my first blind pup, who was also deaf, and brought her home to a sighted, hearing Shepherd. It was BAD for a while. A neighbor called me one day at work because the two were fighting and blood was flying over onto her house next door! :eek: When I got home, they were still going at it, both of them torn to pieces (the deaf and blind dog was a Dane). I turned the hose on them and got them separated then spent the rest of the day and night with both of them by my side. They snipped at each other for most of that day but no more fighting. I don't know how they managed to get together in the yard unless someone let the Dane out of her pen where she was isolated since she was new but they never fought like that again. In time, the Shepherd became the Dane's eyes and ears and they were inseparable. Syra, the Shepherd passed then within a short time, Dinah, the Dane, followed.

I hope your babies work things out with much less bloodshed than those two did....and to let you know, they are the ONLY ones who ever fought. I've had blind babies be put in their place in the pack but not attacked like Dinah was. Just give them all the same amount of attention and TLC so they know they are each special to you. ;)

Keep in mind, blindness is usually much harder on us humans to see than it is on our babies who actually experience it. :)

Hugs,
Leslie and the gang

[Dekie's Mom]

Hi Marianne,

I will try to re-trace the meds. I'm fairly certain he was on the prednisone for only about a week in mid-November. I took him back after a week since there was no improvement in his back pain and the 2nd vet at the same practice had a much better handle on his treatment and took him off the Prednisone and put him on something else. I have consistently taken him back to this one vet since then so he would have a better level of continuity of care. He also started limping a week later and was treated for a lump on his paw which was x-rayed and treated with antibiotics and a canine form of Tylenol, I believe, at the emergency vet since it was a Sunday. I did give those records to our regular vet. I will try to get the specifics on all of the meds. It has been a revolving door since November and I am losing track of it all. But I did have a specific conversation with our vet about the Prednisone and he held off on the blood work just to sure. He did also rule out a thyroid condition and diabetes.

I also forgot to mention that Dekie has had pretty significant drainage from his eyes and a runny nose since his attack 2 years ago. We have tried a variety of combinations of antibiotic ointments and Benadryl over the years. He would improve for a little bit and then it would come back. I don't know if this is an early sign of either cushings or SARDS?

Thank you for the info and encouragement. I will check out the link and search for other SARDS posts. I will also round up my paperwork after church and see if I can recreate the meds he's been on.

Thanks again!
Jeanene

[Dekie's Mom]

Leslie,

Thank you for sharing your experience with your dogs. I am going to stay out of the way of my little pack but it hurts to think of Dekie having one more loss.


Marianne,

Here is what I have been able to re-trace about the meds:
-On 11/14 started on 10mg of Prednisone twice a day for 3 days then tapered to 10 mg once a day for 3 days then 5 mg once a day for 2 days. He was also given Tramadol HCL 50mg every 8 hours.
-On 11/22 the Prednisone was discontinued and Methocarbamol 500 mg every 8 hours was added to the Tramadol.
-On 12/8 he was seen at the ER vet for limping and a lump on his paw. His back was still sore. He was started on Cephalexin 500 mg twice a day for 10 days and Vetprofen 50 mg. We discontinued the Vetprofen after 20 days to see if his back had improved and to see if his depressed behavior would improve.
-On 1/7 he was put on Ciprofloxacin 500 mg once a day.
-On 1/13 he was taken off the Cipro and he was tested for diabetes and thyroid which were negative.
On 1/14 he was tested for Cushings.

Thanks!
Jeanene

[molly muffin]

Hello and welcome to the forum.

I am sure that this is very hard to have to watch Dekie go through so many changes.

The running nose and eye drainage is not normally a part of cushings that I am aware of. Have they confirmed that the eye loss is SARDs (retinal), they have some good vet ophthamologist that could take a look at him.
I do think that eventually he will come into his own with the blindness and work out how things will be. I expect the other senses will kick in even stronger now.

So it looks like he was on prednisone for a total of 8 days, and would have been off it for at least 30 days prior to the cushing testing.
Did they do an ACTH (the LDDS is the 8 hour test that it sounds like the vet did) that showed what the cortisol actually was?
How much does Dekie weigh?
So if you started a couple days ago, then at around day 10 - 14, you should be having an ACTH test to see where the cortisol is at now. This should be done at 4 - 6 hours after giving the dose of vetroyl with a meal.
Glad you found us too.
Sharlene and Molly Muffin

[labblab]

Thanks so much for the additional info. And yes, as Sharlene as noted, it looks as though the predisone taper was completed properly and within a sufficient timeframe to permit accurate ACTH testing.

Please keep updating us as to how things are going, OK?

Marianne

[Dekie's Mom]

Sorry for the delay in getting back to you. We had some snow in Virginia Beach two weeks in a row which essentially shuts down our city for days. Silly, I know, but that is the way it is.

I am taking Dekie today for bloodwork. It is day 14 and his blood draw is for 4.5 hours after the med was given. I will see if I can get the test results from the previous bloodwork. He is responding well so far to the Vetoryl. He is 52 lbs and taking 30 mg once a day. His energy is back and he seems to want to engage with us which he has not done in quite a few months. He also seems to be drinking a little bit less but the hair loss is unbelievable. As is his appetite! He has always been a counter surfer but now he is even more determined to get at any food around. I hope both of these improve with treatment? He does have more frequent stools but no diarrhea.

We did not take Dekie to the vet ophthalmologist. He is severely reactive to other dogs, and with his loss of sight this is gotten even worse. The vet felt this was optional due to his symptoms and the Cushings diagnosis since they are sometimes seen together. Do you think this was a mistake?

The eye drainage persists and his nasal congestion seems to be getting worse. I am worried about this because it is affecting his adjustment to the loss of vision. He does not seem to be smelling very well. I bought him a ball which dispenses treats as it rolls but he doesn't smell them when they fall out, even when I put his nose right over them. He was getting around very well but the past few days he is bumping into things more. I guess this could be due to overconfidence in his abilities to get around without sight or maybe the nasal congestion?

The snow has been hard. He always loved to play in the snow and would stay outside until we dragged him in shivering and covered in ice. He now goes out to potty and comes directly back in. We tried to coax him out to play a bit but he didn't stay out long.

I will post again with the test results. Thanks everyone!

[molly muffin]

How did the test going today? Yes, snow can shut down a city pretty fast, especially when it's not super normal or doesn't happen very often.

The nose drainage is worrisome, as that is affecting his sense of smell. As I said, that isn't a cushings symptom that I am aware of. There was a boston I think on the forum, who had severe nose drainage and they had to have a specialist figure it out. I can't remember what the exact cause was though, so I'll look around for it and see if I can find that thread, or maybe one of the other moderators/admins remembers.

Sharlene and Molly Muffin

[molly muffin]

Okay, found it, they did a nasal biopsy, the possibility was that it was aspergilliosis.


Update on last weeks procedure... I spoke with the internist regarding Jigsaw's CT and nasal biopsy results and I got the news that she does have a Pituitary Macroadenoma , but she does not have nasal cancer. The histopathologist could not confirm aspergilliosis, but the internist feels very strongly since I followed up on this issue so quickly, that may be why we did not find the organism. Since she was symptomatic with classic signs, and she did see one suspect plaque, she wants to treat her with voriconazole for the asper, Clavamox for secondary bacterial infection and continue with the Trilostane 1.6mg bid (such a low dose, eh?). So thats the scoop!

So I would have definitely have that looked into.

Sharlene and Molly Muffin

[Dekie's Mom]

Thanks for the info Sharlene. I will ask the vet about that as he thinks it is probably allergies. I also read that some other owners have cushings dogs that snore. Dekie snores but also breathes heavily while awake. They did not mention if they have a loss of smell with it. Should I post that separately to see if I can get more info?


I have the original test results:
Cortisol Pre - 3.3
Cortisol 2 - 1.0
Cortisol 3 - 2.7


Dekie had blood drawn yesterday to check his dosing. I should get results on Monday.

[molly muffin]

I don't recall any of the ones who mention that their dogs snore, having a loss of smell.

My molly snores like a banshee sometimes, but her smelling seems to work fine.

This was the LDDS test right?

What about his monitoring ACTH test results from the 1st? Sorry I took so long, we've been dealing with a back injury to my molly, and it looks like I missed replying to your thread. :( my bad on that.

hugs,
Sharlene and molly muffin