My dog Gracie - new SARDS diagnosis

[ransons]

Hi! I have a bichon, Gracie who will be 9 in March. Over the last three months, she has progressively become tired and is just not acting like herself. She has a history or herniated disks and has had two surgeries to correct and most recently we were managing that problem with medical management (which has included short treatment periods of prednisone) if she showed signs of irritation. Because of her history, when she started showing symptoms, it took some time to eliminate her back as the cause.

The first symptom that we began to notice was weakness in her backend and constant heavy breathing and panting. We first visited with her neurologist thinking she may be having a flare up/irritation along her spine. After he was unable to pinpoint any particular pain points along her spine and medical management didn't improve the situation, I took her my normal vet where they did some x-rays and blood work. Her liver levels tested high, her blood pressure was high and her liver looked enlarged on the x-ray. Gracie also at this time had symptoms of breathing very heavy all the time. My vet referred me over to an internal specialist.

Once there, Gracie had an ultrasound that showed up clean, no liver issues and blood tests that showed up that there were no liver issues. Her full set of symptoms included, heavy breathing, weakness in the backend, moppiness (just not herself), weight gain due to eating more and excessive thirstiness. The internest felt she had Cushings disease and recommended a urine and ACTH test.

The results of those tests are as follows:

Urine Test -
urine cortisol - 27,
urine creatinine, 171.8 -
urine cortisol/creat ration - 49.
My internist stated that this is an indication of over production of cortisol as my dog weighs 21 pounds and 34 or list is the normal ration for her size.

ACTH Test
Cortisol ug/dl- Baseline - 2.7 (normal range <1 - 5.9) and post ACTH - 12.3 (normal range 6.5 - 17.5)

Androstenedione ng/ml - Baseline - 0.36 (normal range 0.05 - 0.57) and post ACTH - 4.37 (normal range 0.27 - 3.97)

Estradiol pg/ml - Baseline - 155 (normal range 30.8 - 69.9) and post ACTH - 138.3 (normal range - 27.9 - 69.2)

Progesterone ng/ml - Baseline <0.2 (normal range <0.2 - 0.49) and post ACTH - 1.24 (normal range is <0.2 - 1.5)

17 OH Progesterone ng/ml - Baseline - 0.24 (normal range 0.08 - 0.77) and post ACTH - 2.6 (normal range 0.4-1.62)

Testosterone ng/dL - Baseline <15 (normal range <15 - 32) and post ACTH - <15 (normal range is <15 - 45)

Do these test results indicate possible Cushing's diagnosis? My internalist for Gracie is starting her on 3 mg of Melatonin twice a day and Lignan. Also, in the last three weeks, my dog, Gracie has started to bump into things and seems disoriented when walking around. When I reported this new behavior, the thought was that it was unrelated and may be due to senile behaviour and that if it continues the recommendation was to take her to a neurologist.

I have a list of questions for Gracie's internalist as we just got these results back and should get a call from him tomorrow. We are new to all of this and just wanted to see if we could get the groups thoughts and maybe even suggestions on what to ask or probe on. I feel like there is something else going on from her, but that may just be my lack of experience with this illness.

[Squirt's Mom]

Hi and welcome!

If I were you I would ask the vet about SARDS - Sudden Acquired Retinal Degeneration Syndrome. The comment of suddenly bumping into things and seeming disoriented made me think of this condition.

The elevation in the other hormones can mean your baby has Atypical Cushing's, a form in which the cortisol is normal (which is the case for your baby on this test) but one or more of the intermediate, or sex, hormones are elevated. The treatment for Atypical is a COMBINATION of melatonin and lignans, flax or spruce either one. Melatonin alone will help regrow hair and help them relax and sleep better but it is the combination with the lignans that addresses the intermediate hormones per the University of TN in Knoxville. The melatonin is also given twice a day, AM and PM. The lignans given once a day. You can find that info in the Helpful Resources section, the first post.

I'm glad you found us and am sure others will be along soon to chat with you.
Hugs,
Leslie and the gang

[Harley PoMMom]

Hi and welcome to you and Gracie,

I have manually approved your membership so now all your posts will be seen right away. Also please just disregard the validation email that was sent to you from k9cushings.

Dogs receiving prednisone over a period of time can get what's known as Iatrogenic Cushing's. With this type of Cushing's a dog can display the same symptoms as the naturally-occurring Cushing's while the only treatment for Iatrogenic that is needed is to slowly taper the steroid use.


Urine Test -
urine cortisol - 27,
urine creatinine, 171.8 -
urine cortisol/creat ration - 49.
My internist stated that this is an indication of over production of cortisol as my dog weighs 21 pounds and 34 or list is the normal ration for her size.

A high result on an UC:CR does not positively point to Cushing's, any kind of illness or even stress can cause the UC:CR result to be elevated.

Is she getting any medication for the high blood pressure?

Those results you posted look like they are from the University of Tennessee lab, correct? Since Gracie's ACTH stimulation test results are normal she does not have Cushing's. These results point to the Atypical form of Cushing's, where a dog's cortisol is normal but one or other adrenal sex hormones are elevated. The usual treatment for this is the melatonin and lignans. This type treatment will take a while to see improvement, probably around 6 months, so please be patient, yes I do know that can be difficult ;) The melatonin has to be the regular kind no rapid release or fast acting. Here's a link to info regarding this: "Atypical Cushing's"/Congenital adrenal hyperplasia-like syndrome/ Hyperestrinism (http://www.k9cushings.com/forum/showthread.php?t=198)

Regarding the dementia, some members have used Novifit with success, maybe ask the vet about this.

So my recommendation would be to stay the course with the melatonin and lignans, get that high blood pressure checked and controlled, and retest with the UTK adrenal panel in 6 months to see if those hormonal numbers go down.

And, do keep us updated, please!

Hugs, Lori

[ransons]

Thank you for the response. That helps! I was wondering if the symptoms point to atypical. I will ask about SARDS.

[ransons]

Thanks! Her blood pressure is now testing normal, so no concerns there at this time.

[judymaggie]

Hi, Gracie's Mom! My first Cushing's pup, Maggie (I now have #2, Abbie), was diagnosed with atypical Cushing's. Her ACTH profile was very similar to Gracie's. My vet consulted with the folks at UTenn and we decided that the best plan was to insert a melatonin implant along with giving her oral lignans. Process was similiar to inserting a microchip -- I watched it being done and Maggie didn't mind it at all. My vet had actually done similar implants in ferrets but Maggie was his first dog to have one. Maggie did pretty good for a while but then her follow-up ACTH (three months after the implant) showed an increase in cortisol as well so she moved over to "traditional" Cushing's. Do discuss with the internist when to do a follow-up ACTH.

I did learn from Maggie that not all symptoms can be attributed to Cushing's. Definitely ask the internist about the disorientation, etc.

[molly muffin]

I'll just throw this out there for you to consider to, but high BP can cause retinal bleeds, which can come on very quickly, where the retinal bleeds occur in the eye, the sight is lost. Usually focal point sight, but they might still have some peripheral vision, shadows, etc, or not. Complete retinal detachment can occur. A doggie ophamalogist can check and determine if this is what has happened or not. It is unfortunately more common than previously known I think for dogs with high BP. (I am going through this with my dog) So, that too is a possibility. Cataracts also is a possibility. One thing is that if the BP is now controlled and you keep it controlled, and that is the cause, then hopefully there would be no further degeneration.

It does sound like possibly atypical cushings, the question is whether it is caused by the prednisone or naturally occuring.

oh and welcome to the forum :)

[ransons]

Leslie, thank you for pointing me in the direction of SARDS. Based on you pointing this out to me, I took my dog to the optomologist and that is what she has. Very sad day for me today, but after 3 months, I have some answers and we can now focus on how to help Gracie successfully move forward not being able to see.

[labblab]

Welcome from me, too, although I know this news is very upsetting. :o

However, we want you to know that we have other members with SARDS dogs, as well, so please do feel free to remain with us. I am going to change your title so as to reflect your diagnosis, and that will make it easier for our other SARDS parents to spot you. You can also use our forum "Search" function to hunt out other threads re: SARDS pups, too.

Hang in there, OK? We'll still be here to help you in any way we can!

Marianne

[molly muffin]

Okay, so now you know. That maybe is the worst part, not knowing. Now that you know, you can make a plan and around here, we always say, a Plan makes things so much better.

I know there are some things to help out on the market.
Lets see what we can find.

http://www.halosforpaws.com/

http://www.handicappedpets.com/pet-care-articles/handicapped-pet-equipment/163-blind-dog-hoop-harness.html

Leslie bubble wrapped the legs and corners so hers wouldn't hurt themselves.

Rugs everywhere, different textures, etc.

I think the main thing is the importance of reinforcing their confidence in themselves. I throw food and tap where it is at, with their nose, they can find it. This is a huge deal for them. Take them for walks just like always, let them sniff, and leave pee mail for the neighborhood dogs, etc. If you have a window seat, try steps or a ramp, put gates up to areas that aren't safe for them, etc.

It may not be a great day, but it is a beginning.