Your thoughts on rescue boxer with Cushing's

[pansywags]

My heart sank when I saw one of my favorite boxer rescues post that one of their new dogs tested positive for Cushing's. They thought he was a 3 year old boy but now wonder if he is older because of the Cushing's diagnosis.

I do not have full information as I don't work for the rescue and he isn't my dog, but I am wondering whether some of the experts here might have some commentary on this poor boy based on what I do know.

He came into rescue covered in (presumably motor) oil and with sores all over they think were caused by acid. I don't know what behavioral/appetite/physical symptoms he may be exhibiting.

UCCR results led them to do an ACTH stim which was positive for Cushings. CREA was within limits but BUN and PHOS were elevated - the only test I have a figure on is USG which was 1.006. Abdominal ultrasound showed both adrenals enlarged.

He exhibits some neuro deficits in his face and legs, they say it's like nerve damage. They do not feel he's healthy enough to be put under for a brain scan.

I realize this is all very vague, so I understand if the experts here don't have enough info to weigh in. I guess I'm wondering if perhaps it's not Cushings at all (whether the ACTH may be a false positive due to other issues) and also concerned about possibly medical treatment of a macro (potentially causing it to grow) since he's a brachycephalic breed. From what I know, this rescue's vets are very good but you don't have to read very many stories here to understand that even very good vets can be challenged by Cushing's. Since he is in Southern California I have offered to fund a consult with Dr. Bruyette in Pansy's memory to make sure his diagnosis is confirmed by an expert, but I don't know if they'll take me up on that.

Any thoughts are appreciated - I wish I had more information to share but that's all I have for now.

[labblab]

Since he is in Southern California I have offered to fund a consult with Dr. Bruyette in Pansy's memory to make sure his diagnosis is confirmed by an expert, but I don't know if they'll take me up on that.
Omigoodness, your offer has me in tears, it is so sweet and kind. And it will be wonderful if they will allow you to arrange for the consultation because this dear boy's situation sounds very complicated to me with multiple extreme stressors that might account for cortisol elevation and false positives on the testing. I think your instincts are correct on this one, and it would be the greatest gift for this dog to have a realistic assessment as to diagnosis and also quality-of-life differentials.

Marianne

[Dixie'sMom]

I'm new here so know very little about Cushing's so far, but I wanted to say your offer to help this Boxer is such a wonderful gesture. Your Pansy was a very lucky girl to have a Mom like you. I will read her story and look forward to getting to know you. I'm so sorry for the loss of your baby girl. Bless you.

[Harley PoMMom]

I agree 100% with Marianne, the poor boy is going through so much right now and definitely could be why his cortisol is high and his adrenals are enlarged.

Bless you for offering to fund his vet visit with Dr Bruyette, I hope too that they are willing to do that.

Hugs, Lori

[pansywags]

Thanks to those who've chimed in. Elevated readings due to stress is what I was concerned about. The good news is, whatever situation caused the acid burns is in his past now and I am told he's headed to a foster home so I hope this means a significant reduction in stress for him.

I hope they accept my offer. I feel it's a little dicey because it could be construed as implying their vets aren't good enough, but I also know rescues can't always afford fancy specialists so am hoping they'll see it as an opportunity, and it's a good way for them to get a crash course in Cushing's from an expert for any cushdogs they see in the future. Me, I've had my crash course, I never want another one! The founder and some of the other volunteers know me and my situation with Pansy so I hope they'll take the offer as it was intended, to help this boy get the best outcome possible.

[molly muffin]

It is the greatest gift. Considering what this poor baby has been through I think Cushing diagnosis right now would be highly suspect. The pain of acid burns alone will trigger a cortisol response and if long term situation of such terror might even induce adrenal gland enlargement.

Glynda has worked with many rescues and probably has a good handle on whether or not this abuse could cause false readings. I would think so

You're such a sweetheart.
Hugs
Sharlene and Molly muffin

[Squirt's Mom]

I agree with the others - with all he is dealing with right now the cortisol could be expected to be higher than normal. And nothing more than the situation of not having a stable home could cause him enough stress to taint the test results in my mind not to mention the physical assaults he is dealing with. Bless his heart. :( I so hope the foster home is exceptional and he is able to settle down and start healing inside and out. I also hope the rescue knows what an amazing gift you have offered on his behalf and what an amazing person you are.

Let us know, if you are able to keep in touch with him, how he is doing.

[lulusmom]

Firstly let me say that your offer to sponsor this Boxer's consult with Dr. Bruyette is so very generous and no doubt, Pansy is smiling down on you even more than usual.

The good thing about breed specific rescues is that they are crazy in love with the breed they rescue and are more likely to be intimately familiar with health issues that are commonly seen in their beloved breed. Chances are that a Boxer rescue would definitely know the symptoms and the diagnostic drill for cushing's. I was heavily involved in rescue in So Cal for many, many years and I can't remember one gp vet that worked with rescues who were knowledgable enough to diagnose cushing's or safely direct treatment. I used them to do discounted stim tests but never relied on them for what was usually an incorrect assessment. :D I would have to think that a Boxer rescue would have a vet they trusted to do the diagnostics, so they may not take you up on your offer to pay Dr. Bruyette's fee.

Based on the information you have provided, the only thing I know for sure is that the human being responsible for the condition of this Boxer should be subjected to a severe ass whoopin. Whether the dog has cushing's, there is too little information to be certain but enough to say maybe. A dog with a USG of 1.006 is probably drinking and peeing buckets so that is the biggest red flag. I've seen dogs so stressed that they have shut down completely. They quit eating, cower in corners for days, peed and pooped all over me, as well bit the crap out of me, when I picked them up. 98% of those dogs sit in my lap and shower me with kisses once out of the building and in my car. Their stress level was off the charts for days, yet it did not cause PU/PD or the usual abnormalities on their senior screening that one would see in suspected cushing's. This Boxer also has a high UC:CR and a positive acth stim test. If those tests were done a day or two of coming into rescue, and the USG was normal, I'd definitely have to question the validity of those test results. I don't think that's the case though. Sores all over the body, which the vet is guessing is from acid, are automatically visualized in my mind as calcinosis cutis....and my mind sees any neuro deficit in a brachycephalic dog as an expanding macroadenoma. Boxers just do that to me. :o

Glynda

[pansywags]

I'm overly sensitive to the prospect but the notion of a macro also looms in my mind. If he is not healthy enough to go under for a scan, I don't know how that would be confirmed, but that's putting the cart before the horse at this point.

Thank you all for your review and comments. I'll let you know if I hear from the rescue.

Glynda, I'll be sending you a PM.

[pansywags]

I heard from the rescue today, there have been some tech issues on their side with my messages. Initial response sounds positive for the Bruyette consult offer but we haven't confirmed or worked out payment details. I have a little more information about this boy:

He is hypothyroid. I don't know if he's being treated for that now.
He has a staph infection and is being treated with antibiotics now.
He is not overweight and has no pot belly.
He isn't panting.
There doesn't appear to be any obvious hind leg weakness or muscle wasting.
He doesn't seem ravenous and has refused some treats (but then, there has been great upheaval and he doesn't know where his home is right now)
Good news: there's been some improvement in his neuro deficits.

Someone else is suggesting 4 Marvels powder to the rescue, and I don't really have any information on that so I suggested they just hold tight until he gets to a specialist, and no steroids or NSAIDS in the meantime, that if it is Cushing's, there is no rush to treat (I learned that from all of you!).

I sent some pictures of Pansy's CC for them to compare the wounds and scabs they think came from acid.

He is going to a foster home Tuesday, which should help his overall well-being.

[pansywags]

A quick non-update update: the rescue has not yet accepted my offer but I have heard from them and there are positive indicators that they will - it's been a very busy time for them so I hope to hear more next week.

In the meantime I assume the dog has gone to his foster home as scheduled and hopefully that stability will help him physically and mentally.

[pansywags]

So, I wanted to close the story on this. The rescue has opted to not take me up on my offer for the following reasons:

-This boy has now seen one of their trusted vets who has treated Cushing's for them previously and is being medically treated with good improvements.
-His neuro signs are decreasing and in general health is improving
-His foster dad (who has had other Cushing's dogs) has had a bad experience with Dr. Bruyette in the past. I feel this is probably the main reason they declined, that they feel this would be wasted money/effort. I don't agree, but having had a bad experience with an IMS myself, I can understand how they might feel.

I've communicated my concerns about medical treatment and possible macro tumors but they have a lot more faith in their vet than I do :^) Thanks to everyone who chimed in with good info on this, I will continue to hope this boy improves.

Wishing you all a good weekend!

[lulusmom]

You gave it your best shot and I'm sure the rescue appreciated the offer. Not everyone has the same experience with vets......we don't all have that chemistry that we're looking for in a knowledgable vet. For all we know, the foster dad didn't like Dr. B's prices or his bedside manner. I guess we'll never know but we do know that you're awesome for going above and beyond for this boy. I pray he continues to do well and find his forever home.

[molly muffin]

I agree with everything Glynda just said and I sincerely hope that this dear boy continues to improve every day and finds a wonderful, forever home who will take care of him, give him the love, hugs and kisses he so deserves.

You're awesome for making the offer. It is unfortunately after that, out of your hands.

hugs
Sharlene and molly muffin

[pansywags]

Thanks, here's hoping that medical treatment is right for him and that I'm just being a big fat worrywart.

I really do understand more now that I know someone had a bad experience with Dr. B. If someone offered to pay for my dog to go to the specialist that let me down, I wouldn't accept.

It sounds as though the foster's perception is that a dog had "the kind of Cushing's that's in the eye" (SARDS, maybe?) and that Dr. B couldn't diagnose it and wouldn't return calls because he was stumped. I don't know any of the details and they don't really matter as perception is everything.

I'll be watching to see how his story develops.

[Squirt's Mom]

Let us know if you hear any more about this sweet baby. I hope the perfect furever home is found soon. You are a real angel to try so hard to help.

[molly muffin]

If it is or was SARDS, it is one of the hardest things for a vet to diagnose, as the symptoms are very similar to Cushings. However, I would expect that Dr. B would know quite a bit about SARDS, and if it is or isn't. An an ophthalmologist can help with that, but there is not specific cure for it. Symptoms usually will end up going away on their own but not always. There is no way to bring back the sight that is proven at this time.
I can imagine Any owner or foster, who is not very aware of the syndrome, what happens and other various details, not being happy with any vet or specialist involved in the case.

This is a pretty good article about it, if you are interested: http://www.eyevet.ca/sards.html

I do hope the very best for this boy, who deserves to finally have a fun, peaceful life.

hugs
Sharlene and molly muffin