15 year old Shar-Pei / Chow (Emma has passed)

[DrewCraven]

Hey all,

Emma, our 15 year old Shar-Pei / Chow mix was recently diagnosed with Cushings. An ultrasound during examination due to pancreatitis revealed a likely adrenal tumor. The pancreatitis has been treated with antibiotics and a very low fat diet, so Emma seems a lot better and is now eating, not vomiting, and moving more quickly than she was for a while. However, her appetite has now swung in the opposite direction due to the increased cortisol in her system, and she wants to eat all the time. She is also drinking and urinating much more than she used to. In addition, she has recently developed a very particular odor, which I think may be what people are referring to when they talk about 'frito-feet'.

Emma will be 16 in September, so she is clearly too old to be considering invasive adrenal gland surgery, and we fear that most of the treatments available for Cushings will only cause her more stress, so I'm really here to see if the community has any tips for managing the symptoms. In particular, if anyone can advise on managing a dog's overactive appetite, that would be a huge help.

Glad to see such an active community of pet-owners here offering support for this condition.

Drew

[labblab]

Hi Drew,

Welcome to you and Emma. She sounds like a sweetie, and I do hope you will still be able to spend more quality time together. Unfortunately, there are no alternatives to medical treatment that significantly alter the increased hunger, thirst, and urination associated with Cushing's. In terms of hunger, in the absence of treatment, probably the most useful thing might be just to stock up on a supply of low calorie/fat "fillers" that can perhaps allow her to feel more full -- things like salt-free green beans or raw carrots, etc.

I'm hoping that other folks may have some additional suggestions for you. And if Emma's symptoms escalate to the point that you do wish to consider medication, we will be right here to walk alongside you.

Best wishes to both you and Emma,
Marianne

[DrewCraven]

Thanks Marianne. I will be speaking with our vet, now that the pancreatitis has stabilized, to evaluate all of our options. We would like to try some kind of treatment, if it will help ease Emma's symptoms without too much additional stress (and if we can afford it, of course).

I will post an update here once that conversation has taken place.

[molly muffin]

I just want to welcome you to the board also.

I agree if you don't go down the treatment route, then low fat snacks are preferable. That and a doggie door for the having to go in and out so often. Just don't ever withhold the water, as they need that since their kidneys are working so hard.

Maybe a low dose of trilostane would be an option?

Sharlene and molly muffin

[DrewCraven]

We went ahead and had our vet carry out an ACTH Stim test this week, and the lack of significant results indicates Atypical Cushings.

Now we have to decide whether or not to just go ahead and start giving her a low dose of trilostane to just control the symptoms.

There may also be some issue with her liver, given the yellow color of her poop, according to our vet. He's going to check the results from her last liver enzyme test.


a doggie door for the having to go in and out so often

Unfortunately, this is not an option for us. We rent an apartment without a fenced-in yard, and we also have a lot of possums and other animals in the area who we do not want coming into our house (also, we don't want to let the cats out!).

[lulusmom]

Hi and welcome to the forum.

None of the diagnostic tests for cushing's are great so when choosing one, it's important that all factors are taken into consideration. In Emma's case, I believe the acth stimulation test was not the best choice as approximately half of dogs with cortisol secreting tumors will show an exaggerated response on the acth stim test. That means the other half have a false negative result. This is only one of the reasons most specialist do not recommend it for diagnosing cushing's. I therefore wouldn't automatically assume that Emma has atypical cushing's. If Emma's pancreatitis had been completely resolved before testing was done, a low dose dexamethasone suppression (LDDS) test would have been a much better choice of tests for Emma. The LDDS is more prone to false positives in the face of non adrenal illness or any other underlying issue that puts stress on the body, so it is very important that a dog is otherwise healthy before doing an LDDS. You may want to discuss this with your vet and provide him with supporting documentation as provided by a renown veterinary endocrine specialist, Dr. Mark Peterson. I have provided a link below to one of Dr. Peterson's veterinary blogs where he discusses the pitfalls of using the acth stim test for purposes of screening/diagnosing cushing's. It may be worth discussing a refund or at least a discount on an LDDS test with your vet. It may well be that Emma doesn't have elevated cortisol but there is no way to know that without additional testing.

http://endocrinevet.blogspot.com/2011/02/diagnosing-canine-cushings-disease.html

Glynda

[labblab]

Welcome back again,

Just to retrace Emma's history, is the ultrasound imaging of the possible adrenal tumor the only actual test evidence for Cushing's at this point? How about any other abnormalities in her bloodwork or urine tests?

None of the diagnostic Cushing's blood tests are perfect, but one problem with the ACTH stimulation test is that it does a relatively poor job of correctly identifying Cushing's in dogs who suffer from adrenal tumors rather than pituitary tumors. I know it's a bit late to be hearing this :o, but the LDDS probably would have been the preferable blood test to run in the face of a likely adrenal tumor because it is a more sensitive test of Cushing's of both types. So just because the ACTH was "negative" does not necessarily mean that conventional Cushing's has been ruled out in Emma's case. Also, an ACTH that involved measuring all the adrenal hormones, not just cortisol, could have indicated whether or which other hormones may truly be elevated. Unfortunately, only one veterinary lab in the U.S. performs this full adrenal panel, and that is University of Tennesse at Knoxville. But just for future reference, the ACTH test itself can be performed by any vet, and then the blood samples sent to Knoxville for the full analysis.

Given Emma's age, I understand why you are reluctant to launch into either involved diagnostics or involved intervention. However, the difficulty right now is that even though Emma is exhibiting symptoms consistent with Cushing's, we don't know for certain whether she has an adrenal tumor, and even if so, whether or not that tumor is associated with overproduction of any of the adrenal hormones. If your vet is now suspecting some sort of primary liver problem, that in and of itself could account for excessive thirst and urination.

If Emma were mine, I believe I'd still want to pursue some additional diagnostics prior to starting up with trilostane. Also, in instances where cortisol is not highly elevated but other adrenal hormones are, a more benign treatment that can be tried is to give a combination of melatonin and lignans.

Marianne

Edited to add: I see Glynda and I were typing at the same time, so please forgive my duplication of some of the very same things!

[molly muffin]

Hi Drew,
How is Emma doing?
Did they happen to mention what size the adrenal tumor is? If it is small, then perhaps it won't be an issue (and of course doesn't continue to grow)

Yes I do see the reason a doggie door isn't a feasible idea. Animals running wild so to speak, cat out, raccoons and squirrels in.

One thing, with real Atypical, the cortisol levels are normal and the sex hormones are elevated. If she has a secreting adrenal tumor, then the cortisol will be raised and one adrenal gland (the one with the tumor) will be larger than the other adrenal gland. If you have a copy of the ultrasound report you can give it a read to check out.

Sharlene and molly muffin

[DrewCraven]

Hey all,

Just wanted to stop in and let you know that Emma is no longer with us. We made the difficult but humane decision yesterday to put her to sleep at the grand old age of 16 and a half. She could have probably lived a couple of months longer, but the weakness in her back legs caused by the Cushings was beginning to really impact her ability to function independently, so we thought it best to let her go with some dignity. She had a good long life full of love and made a huge impact on us both, and we will miss her greatly.


Thank you all for your support and advice, and I wish you the best with your own beloved animal companions.


Drew

[Spiceysmum]

Drew,
So sorry for your loss. I know how hard it is to make that decision but Emma had a wonderful long life and you should be proud of that.

Linda

[labblab]

Dear Drew,

I, too, am so very sorry to read this news, but we are so grateful that you've returned to let us know. As difficult as it was for you to do, you have given Emma's spirit the gift of release from her tired body. You cradled her with loving care her entire life, right up to her moment of passage.

Emma now joins our other beloved Cushpups on our special memorial thread of honor:

http://www.k9cushings.com/forum/showthread.php?t=6879

We shall never forget her, and we shall always remain here for you, too. Please feel welcome to return to us at any time to talk or to share memories of your special girl.

Always in loving memory of your sweet Emma,
Marianne

[mytil]

I am so very sorry to read about your girl passing. You made the most noble decision in releasing your Emma but I know that does not make the pain any less.

We will always remember and honor her here.
Terry

[Squirt's Mom]

Dear Drew,

I am so sorry to hear about Emma. She lived a good life and I am sure she is grateful to you for all you did on her behalf to make each day as good as it possibly could be for as long as you could.

We are here should you ever need to talk.
Our deepest sympathies,
Leslie and the gang

[Dixie'sMom]

I am so sorry to hear that you lost Emma. I know it must have been a difficult decision for you after having her in your lives for so long. You gave her the last, greatest gift you could which was freedom and release from pain and disability. Bless you.

I'll keep you in my prayers in the coming days and we will cherish Emma's memory here.We are here for you and would love to hear more about Emma if you should ever feel the need to talk.

Hugs,

[molly muffin]

I was so sorry to hear that Emma had passed. :(

My sincerest condolences.

[labblab]

Drew, I've just been to your album to see your newly added photos of Emma. They are such a lovely tribute to your girl throughout your years together. Thank you so much for now sharing them with us all.

http://www.k9cushings.com/forum/album.php?albumid=901

Marianne

[molly muffin]

Oh I went and looked too. Wonderful photos. What a journey. Some I smiled at and some I just said "awwww" So sweet.