Recently diagnosed...

[Robert'sGirl]

Hi,
I'm new to this group. My dog had a stroke May 2014, which was initially misdiagnosed as geriatric vestibular disease because her immediate symptoms were classic of that illness; however after two days of improvement she relapsed worse and my vet suggested there might be other things going on. (Prior to that in February she had a parathyroid ectomy which she quickly bounced back from.) She had an MRI and that showed a spot on the left side of her cerebellum indicating an abnormality and suggested a stroke... strokes are apparently rare in dogs, I'm told. Anyway, she has made good progress, but is still a bit wobbly and cannot walk down stairs... she can climb up stairs when she wants to. More recently she has been treated for an abscess on her liver and and ultrasound showed a small mass as well. However, she has a great appetite, and even tries to run occasionally on her walks but doesn't always realize her physical is not keeping up with her mental. There were some other irregularities on her blood work and enzymes, and her adrenyl glands were swollen. She was drinking more water. She was tested for Cushing's disease (an entire day) and the first phase was normal, the second was inconclusive, and the third showed she was in the range. My vet wants to start her on medication in the next week. I need to know what meds to avoid and dosage which will not be too radical. I know my vet will suggest what he thinks is right, but personal experience from owners/dogs who are experiencing this condition are more important to me than "textbook" treatments. I am giving her some herbal supplements daily and she seems to have more energy (or I may be imagining it). Any meds I should avoid at all costs?

[Harley PoMMom]

Hi and welcome to you and your girl!

OMGoodness, I am sorry that your dear girl is going through some much right now and I hope that she will continue to improve.

Could you get copies of all tests that were done on your furbaby and post any abnormalities that are listed. We are especially interested in the test/s that were used to diagnose her Cushing's.

If the test that was performed on your girl took all day, than it probably was the Low Dose Dexamethasone Suppression (LDDS). With the LDDS test three blood draws are done: the first is a baseline; then a low dose of dexamethasone is injected, and blood samples are checked in 4 hours than again at 8 hours.

The LDDS is a more sensitive test (less likely to give a false negative), and from your post is sounds like the results from the LDDS test were negative, is that correct? If you could post those LDDS test results that would be a big help to us.

Regarding the enlarged adrenal glands, any chronic illness can cause the adrenal glands to increase in size, so this isn't indicative to Cushing's only. Also increases in drinking/urinating are common with Liver issues.

The two medications that are usually prescribed for Cushing's are Vetoryl/Trilostane and Lysodren/Mitotane. These are strong drugs and neither one will cure Cushing's, they are given to help abate the symptoms, and should not be administered until a confirmed diagnosis for Cushing's is established.

Cushing's is one of the most difficult canine diseases to diagnose, which makes it one of the most misdiagnosed. There isn't one test that is 100% accurate at diagnosing Cushing's and when a chronic illness is present while testing takes place false positives results are more likely to happen.

Does your girl have any other symptoms associated with Cushing's such as a pot-bellied appearance, panting, loss or thinning of coat, skin issues or muscle wasting? There are other conditions that have overlapping symptoms with cushing's, such as hypothyroidism and diabetes. Did your vet rule these out? As I mentioned before a diagnosis for Cushing's can be challenging which is why multiple testing is done. Also, strong symptoms do play a huge part of the diagnosis for Cushing's and need to be evaluated along with the test result when Cushing' is suspected.

Cushing's is a very graded disease, meaning it progresses at a snail's pace which does give a pet parent time to get a confirmed diagnosis for Cushing's so there is no need to rush into treatment.

We are here for you and your girl, and we will help in any way we can. ;)

Hugs, Lori

[labblab]

Welcome from me, too, Robert -- I am so glad to see you here. ;) :)

Lori has gotten you off to a great start, and I agree 100% with her comments. Now I'll just add a few additional thoughts into the mix.


She was tested for Cushing's disease (an entire day) and the first phase was normal, the second was inconclusive, and the third showed she was in the range.

Like Lori, I am assuming you are referring to an LDDS test. Perhaps what you mean is that her baseline cortisol was normal, but her 8-hour result fell within the diagnostic range for Cushing's? As Lori says, of the two diagnostic blood tests, the LDDS is the least likely to give a "false negative" if a dog truly has the disease. But the flip side is that it is more likely to give a "false positive" in the face of illnesses other than Cushing's. I am especially concerned about your report of a liver abscess and liver mass. Has the mass been biopsied? I would think this would be the primary concern at the moment, especially in the face of elevated liver enzymes and excessive thirst. I would think you would want to rule out acute liver disease before moving onward.

The thing is, even if your dog does have Cushing's, treating the Cushing's may not be best overall choice at the moment. The drugs will not cure the disease, they will only serve to control symptoms. And the only observable symptom you've mentioned so far that is even consistent with Cushing's is the thirst. Also, one and perhaps both of the conventional drugs given to treat Cushing's are to be used only with caution in dogs suffering from primary liver disease.

Can you tell us how old your girl is? She has certainly had a lot of issues to contend with, and depending upon her age, layering the additional demands of Cushing's treatment/monitoring may not gain her significant quality of life at this stage of things. Significantly lowering her cortisol right now might even be a trade-off, depending on whether she has arthritic issues or other problems that are actually benefiting from higher levels of circulating steroid. So I think there is a bit more to consider before launching into treatment right away.

As Lori says, getting us the abnormal lab values and the LDDS results will be a great place to start. Again, I'm so glad you've found us!

Marianne