Greta - 9 yo Dachshund, Possible Cushingoid, IVDD

[kmwilliams6113]

My name is Kristina, and my husband and I have a 9 year old dachshund, Greta. We adopted her about a year and a half ago, so there's much of her health history that we don't know. She was very overweight when we adopted her, and has since gone from 23 lbs to 16.5 lbs, with diet and exercise. We never could get rid of the potbelly, and she's always been a little frail since we adopted her--a limp here and there every few months, prone to upset tummy, etc. She really started having health problems in mid-December last year.

Here's a helpful timeline to start:

12/14 - Routine bloodwork before dental, high liver enzymes; liver ultrasound revealing large liver, but no masses, nodules, etc.; potbelly, zealous diet, all else normal; started on denosyl

1/15/15 - Taken to vet for diarrhea. Vet found her dehydrated, gave her IV for day. Bloodwork showed liver enzymes at same level.

1/17/15 - Bile acid test; normal results.

1/25/15 - Another trip to the vet for diarrhea and dehydration.

2/14/15 - Another trip to the vet for diarrhea. Diarrhea solved, and started on Royal Canin Gastrointestinal Low Fat, which seems to have fixed tummy troubles.

2/21/15 - Dental, including one extraction.

4/3/15 - Greta to vet for rest of semi-annual wellness exam, including full bloodwork and urinalysis. UTI found, antibiotics prescribed. Liver enzymes still elevated, vet finally agrees that Greta has cushings symptoms, as she is increasingly potbellied, losing muscle mass, and losing hair.

4/7/15 - Greta to vet for crying out in pain when lying on her side. Chest and abdominal x-ray reveal slightly enlarged heart, enlarged liver, no other things to report. Abdominal ultrasound showed some gallbladder sludge, minor kidney disease, large liver, slightly enlarged adrenal gland. Tramadol prescribed.

4/8/15 - Greta back to vet, as crying out in pain in the middle of tramadol dose. Physical exam showed pain in neck. X-ray showed possible collapsed disk in neck. All neuro signs still good. Greta admitted to hospital for 24 hours to get pain under control.

4/9/15 - Meet with internal medicine specialist who believes Greta has cushings. Greta discharged with 2 pain medicines and muscle relaxer for neck issue and prescribed strict crate rest. Greta rests all weekend, with pain controlled only at full doses of pain medicines, on strict schedule. Eating and drinking fine, but a little wobbly, and only wants to sleep.

4/13/15 - Greta is currently at the vet for the 8 hour cushings's test. Still in pain from neck issue unless heavily medicated.

We are awaiting test results, but in the meantime, would love to hear from anyone who has experienced an IVDD issue with a cushings dog, or suspected cushings dog.

[Harley PoMMom]

Hi Kristina,

Welcome to you and Greta! 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.

I have only a moment to post but wanted to welcome you both. I will get back a bit later with my reply, but I am sure other members will be by soon to share their knowledge and support.

Hugs, Lori

[kmwilliams6113]

Greta did well for her low dose dex 8 hour test today, and we should have results Tuesday or Wednesday. As to the IVDD neck issue, the vet examined Greta between pain med doses and reported no reflex issues (which means the disc problem in her neck hasn't impacted her down the spine). Great news!

Post 8-hour test, Greta is definitely drinking more water and is perkier than she has been in days. The cortisone injection aspect of the test may be having a good side benefit for the pain in her neck--at least temporarily having an anti-inflammatory effect. What are normal things to see in your dog after the 8 hour test?

[Harley PoMMom]

Ok, I'm back with some thoughts :eek:

I am a bit worried that the LDDS test was performed while Greta has issues with pain in her neck. Any kind of non-adrenal illness and even stress can yield false positive results from a LDDS test.

To me it doesn't seem that Greta is displaying the usual Cushing's symptoms, the common clinical symptoms seen in dogs with Cushing's are: excessive drinking and peeing, I mean peeing rivers and drinking buckets upon buckets of water; voracious appetite, they are like little hoover vacuum cleaners looking for any crumb they can find; panting; loss or thinning of coat; skin issues; muscle wasting; muscle weakness, especially in the hind quarters; exercise intolerant; difficulty or unable to go up steps or jump on furniture.

Besides the increases in the liver enzymes are there any other abnormal levels marked on her CBC/chemistry panel? Abnormalities generally seen on a chemistry panel are increased levels in cholesterol, triglycerides, a low BUN, a mild to severe increase in ALKP and usually there are only mild elevations in the ALT; on the CBC it might show an increase in the number of red blood cells (RBC’s) and/or an increase in platelets, there is also white blood cell abnormalitie which is called a "stress leukogram".

I am sure once we all put our heads together we will be able to figure out what is going on with dear Greta, and remember we are here for you both and we will help in any way we can.

Hugs, Lori

[kmwilliams6113]

Thanks, Lori.

Greta has every symptom of Cushing's except the heavy water consumption and frequent urination, so its a bit of a mystery. She asks to go out to pee more often than her brother littermate (same age and breed, so decent comparison), but its nowhere near excessive. She's got the thinning coat, potbelly, losing muscle, raging hunger, skin issues, and generally gets tired faster than her brother. She is definitely infection-prone... every other month or so in the past 1.5 years since we've adopted her, it's a tummy trouble, a UTI, a limp here and there, an ear infection... and repeated. The not drinking buckets of water is why she hasn't been tested up until now and we pursued the liver function tests, but those all showed a perfectly functioning liver.

As of a week ago, her triglycerides were high, as was her platelet count, but all else was normal. Her urinalysis showed a UTI, but everything else looked fine.

It's odd, but given her susceptibility to getting infections and the hair loss, muscle loss, etc., there's got to be something internal making her spend more time unwell than the normal 9 year old dachshund.

[kmwilliams6113]

Also, for what it's worth, so far we've talked with the internal specialist about resolving Greta's neck pain first, and then after she is healed, addressing the Cushing's or whatever is causing the rest of her body to be unwell. An anti-inflammatory (NSAID) or steroid (like prednisone) is normally given with pain medicine and crate rest to treat a dog with a disk problem, as the anti-inflammatory/steroid reduces swelling around the problem disk and keeps the inflamed material from protruding further into the spine. However, with the vet suspecting Cushings' but it not being diagnosed, she wanted to run the low-dex test first, prior to prescribing the anti-inflammatory or steroid, as to make the smartest choice about which we put into Greta's body to heal the neck, given the other side effects it could have. For five days, Greta's been only taking pain medicine and is on strict crate rest, and is still in pain, but no physical signs that the swelling around the disk is causing other impact on the spine, which is great given that our treatment isn't as complete as it might be without the lingering Cushings' question.

[Harley PoMMom]

I also want to mention that dogs with Cushing's have increased levels of circulating cortisol, which is the body's natural steroidal anti-inflammatory so they are self medicating themselves. Sometimes when treatment starts dogs may show signs of arthritis because that elevated cortisol is decreased and unmasks that arthritic pain.

Sure wish they could talk to us, ain't?

[kmwilliams6113]

Wish they could talk, yes, and man, are they complicated little souls!

Greta really is perkier than she's been in a week post low-dose test. She's 10 min past when the muscle relaxer for her neck is due, and no signs of pain... and for the past 5 days, she's cried in pain promptly when the medicine has run out. Very interesting...

[Harley PoMMom]

Dexamethasone is the medication used in the LDDS test, and it is a strong steroid, I've read that it is 25 times more potent than cortisol. :eek:

Glad it's effects are helping Greta. Usually side effects are not seen with the LDDS test. Some dogs do have a reaction to the stimulating agent used in the ACTH stimulation test, it makes them hyper active.

[kmwilliams6113]

The vet called, and Miss Greta does indeed have Cushings. Here are her measurements from the low-dose dex test:

pre 3.5
4 hour: 4.4
post (8 hour): 4.3

We have talked with the vet, and the current plan is to let Greta's neck IVDD issue heal, let her no longer need pain medicines and let them wash out of her system, and then treat the Cushings, unless the Cushings becomes the more urgent health issue.

[molly muffin]

Hello and welcome to the forum.

Yes poor dear she does seem to have consistent non suppression on the LDDS test, although being in pain from a disc injury I agree, has to take priority. I am guessing they have said she needs limited activity during this healing time. Are they giving her steroids now? like prednisone? If so, she will need to be weaned slowly off anything like that eventually and then treat the cushings. As you said, hopefully that won't become a problem in the meantime. Just watch the kidneys and liver, as high cortisol can affect those and also can affect the blood pressure.

I'm glad you were able to figure out the disc problem as it is good to know what you are facing so you can make a plan. Sounds like you and have your vet are working well as a team.

[kmwilliams6113]

Molly, thanks for your note. We'll treat the neck by pen rest for 6-8 weeks and pain medicines for the first two of those (we're about 5 days in), but given her not having any troubles using her limbs and pain starting to subside, she's currently not on any anti-inflammatory medicines. That's usually part of medically treating a disc episode, but the vet was hesitant to do that last week before we had a cushings diagnosis. Giving a steroid or NSAID to an untreated cushings dog in itself can have its own set of problems, as you'd imagine. The vet and I spoke yesterday about adding an anti-inflammatory but voted to wait on today's diagnosis, and a few hours later, Greta seemed to have turned a pain corner (for the better) with her neck. She's a complicated girl, but we're actually relieved to have more answers today.

[molly muffin]

Oh good to hear that she hasn't need the anti-inflammatory meds. Mine was on 6 week rest last winter and had a dickens of a time keeping from running and jumping. Went with the doggie play pen option.
We did do an intial 4 day on 3 day off, repeat of anti-inflammatory which yes, you are right, is a challenge with a cush dog. We went with the mildest one we could find to go easy on her liver.

Glad to hear that Greta is doing better!

[kmwilliams6113]

Molly, I knew I couldn't be the only one with a cushings dog who also had a disc problem! Was your pup injured and needing the anti-inflammatory after the cushings was already being treated? Also, which anti-inflammatory did ya'll use? So far Greta still seems to be improving without one, so we're hoping that continues--knock on wood!

Also, for anyone on the forum that had a physically injured pup at the same time as a cushings diagnosis, how long did you wait for the physical injury to heal before treating the cushings? The vet agrees with me that we should at least let Greta finish her pain medicine and no longer have neck pain before we treat the cushings, but given that the body takes time to heal (6-8 weeks for disc injuries), I wonder about whether we need to wait the 6-8 weeks to let those natural steroids her body is making keep the disc inflammation down so it heals completely, then treat the cushings. But, 2 months is a while to wait, and she looks a whole lot worse today than she did say at Christmas--muscle loss, coat, potbelly, etc.

[molly muffin]

No molly wasn't at that time being treated for high cortisol. She took about 5 - 6 weeks of restricted mobility, no steps, no jumping, no running around like a wild thing to get better. I don't think her disc problems were as bad as Gretas.

We started the cushings treatment in October, so fall of that year, while the disc problem was in the winter, january I think it was or maybe February, it becomes a blur sometimes. :)

Molly took Tolfenamic acid a non-steroidal anti-inflammatory analgesic . She had 1.5 pills once a day with food for days, then 3 days off and then repeat.

I agree that you don't want her to be in any pain when you think about starting to lower cortisol levels. The chances of that pain coming back and being even stronger are too great.

[kmwilliams6113]

Our Greta girl is much improved from two weeks ago, so we're very relieved. She will continue on pen rest for her neck issue for the next 6 weeks, and we've weaned her off the muscle relaxer and are currently tapering off the pain medicine. She isn't showing any signs of pain, and is much perkier.

She does still have a UTI (first diagnosed 4/4), and has been prescribed another 3 weeks of antibiotics. The culture showed E.Coli bacteria growing rampantly, so we definitely need to get that addressed. She acts like she doesn't know she even has a UTI, so that's probably the cushings.

We are planning to start her on Trilostane 10 mg a day on May 6, which will be one month after the neck injury, in hopes that the extra cortisol will help her neck heal completely, before we treat the Cushings. That will be about 5 days of overlap with the UTI antibiotics and the start of cushings medicine. Greta has a delicate tummy, so I'm a little concerned with the overlap. Does anyone have any experience to share or advice on starting cushings treatment while there is an active infection (possibly) elsewhere in the body?

[kmwilliams6113]

Also, can anyone recommend a great vet/internal medicine specialist in Austin, Texas. We will be living just west of downtown Austin. Google tells me that the internal medicine specialists are in South Austin and Round Rock, which can be up to an hour away in rush hour, so we're hoping to use (1) an internal medicine specialist when truly needed and (2) a vet very close to where we are living, who can understand Greta's cushings diagnosis and communicate well with the internal medicine specialist. We have found a great internal medicine specialist here in Dallas about 2 miles from home, that practices with a 24/7 clinic with terrific general practice vets, but we are moving to Austin in May and likely won't be that lucky.

[molly muffin]

Hi, have you looked at this one? http://www.austinvet.net/southwest-austin-vet/

Do a google search for west austin vet hospital and then look for reviews etc. I hope you are able to find some good ones in your area. No one wants to fight traffic in an emergency.

Antibiotics and trilostane should be fine with each other. If she exhibits an upset tummy, then you can try pepcid about 30 minutes before giving her the medication in the mornings.

[LtlBtyRam]

Hoping things continue to get better.

[Harley PoMMom]

We have found a great internal medicine specialist here in Dallas about 2 miles from home, that practices with a 24/7 clinic with terrific general practice vets, but we are moving to Austin in May and likely won't be that lucky.

I would ask them if they could refer you to an IMS in Austin??

[kmwilliams6113]

Does anyone have experience submitting claims to pet insurance for their pup--both initial diagnosis and treatment costs? Our 9 year old dachshund Greta was diagnosed with cushings a week or so ago, and we'll treat it and care for her even if insurance won't cover it, but it'd sure be nice if we could get it covered. The wrinkle is that before we started insurance, she tested with slightly high liver enzymes one time when sick with gastroenteritis. All the other symptoms have really shown since about last December/January, and we started a workup of her liver and then cushings then at vet direction. I submitted a claim for a liver ultrasound in December, and the pet insurance company said that because there was a once prior test with elevated enzymes--a symptom--all future things that involved elevated liver enzymes would not be covered. But, they posited that if the ultrasound found cancer, which thankfully it did not, they would cover it. So, we now have a diagnosis of cushings, and have run all the liver tests and the vet tells us her liver is big, but perfectly fine.

So, any tips on the pet insurance appeal? :)

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about pet insurance into Greta’s original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thanks!

[molly muffin]

Gosh I don't know. Did the cushings diagnosis come after? I would think that you could perhaps submit the cushings testing and see if they will cover that.

Insurance don't like to cover anything that was there prior to getting the insurance.

[kmwilliams6113]

Our Greta girl is doing much better than she was a month ago, when I first posted here. She has been pain free in her neck (disk issue) for nearly three weeks, and is much perkier.

The bad news is that over the last couple days, she's added another symptoms to her list of cushings symptoms--drinking more water, and having accidents in her bed at night. She's never been one to soil her bed, and isn't waking me up to go out, but I've woken up to wet bedding of hers a couple mornings now. I've got to think she's peeing in her sleep, as she's always been so good about asking to go out and seems embarrassed. We have ordered the Trislotane and will start it on Sunday. In the meantime, lots of bedding changes. Is this the normal sign of increased urination from cushings dogs--bed wetting? Or should we investigate as being from another cause?

[Harley PoMMom]

An UTI and/or diabetes can cause a dog to drink/urinate more. I see that Greta did have an UTI back in early April, has her urine been cultured since then? The diabetes can be checked via a blood draw or an urine sample.

Hugs, Lori

[kmwilliams6113]

Greta is almost done with her second round of antibiotics for the UTI and will go back to the vet next Wednesday to have her urine re-tested.

[kmwilliams6113]

I spoke to the vet earlier, and she thinks the cushings and UTI that we're having difficulty getting rid of are the main cause of the accidents, but that Greta likely has an old lady bladder and is a little incontinent. She is prescribing phenylpropanolamine 2x per a day, with the hope that once the cushings is treated, the problem will resolve and we can reduce or remove the phenylpropanolamine. Whew!

We start the trisoltane tomorrow AM to treat the cushings.

[LauraA]

My girl had absolutely no control over her bladder at all, and she hated it. I had to wash towels several times a day. We ruled out a UTI in her case as we had to send a culture away as her urine was so dilute. My vet didn't want to start her on anything for the incontinence as we were starting the Vetoryl and she wanted to see if that would help before we added anymore drugs. Fortunately in my case within a week she had bladder control back and she and I were both a lot happier for it. Hopefully Greta's bladder responds as positively as Bulger's bladder did to the Vetoryl/Trilostane :D

[kmwilliams6113]

Thanks, Laura. We started the trilostane this morning at 10 mg per day, around 5:45 am. No side effects apparent between then and when I left for work at 9, so praying for a good rest of the day for our Greta!

[molly muffin]

She should do okay on 10mg. Cross fingers this helps with the bladder problems. It is so embarrassing for them. Poor baby.

[kmwilliams6113]

Well, our Greta girl has been on trislotane 10 mg per day for 7 days now, and no negative side effects. She's drinking a little less and not having any more accidents. But, we took her in yesterday for a sterile urine sample, and she still has a UTI, so back on antibiotics she goes. All the markers in the urine were the same--dilution, showing bacteria, etc. The only change was an elevated white blood cell count, which wasn't present at the prior urinalysis. The last few days, she's woken me up asking to be covered with a blanket in the middle of the night. She normally runs warm to the touch, but her stomach has been a little cool. Still eating and acting the same otherwise.

[Harley PoMMom]

Since her UTI still looms it may be beneficial to have an urine culture and sensitivity test done, this kind of test can tell exactly what bacteria is growing in the urine and then the appropriate antibiotic can be prescribed.

Glad to hear Greta is doing well on her treatment!

Hugs, Lori

[kmwilliams6113]

You're definitely right. We had a culture and sensitivity test done between the first two rounds of antibiotics and are having it done again.

[molly muffin]

Let us know what the culture shows. Some of these uti can be hard to get rid of.

[kmwilliams6113]

Greta's urine culture showed an abundance of e-coli in her urine, and the bacteria has become resistant to the antibiotics they had her on. The vet has prescribed a different antibiotics, which Greta will start this evening, and we'll re-test her urine in 10 days while still on antibiotics to confirm that it is working. Poor girl!

Greta also did them stim test today to see how her cushings treatment is going. Will post results when we get it.

[molly muffin]

Well e-coli is the hardest to get rid of, we've had a few members who have gone through and it is never an easy one.

Hoping to hear good results on the stim test.

[kmwilliams6113]

We got Miss Greta's 10 day STIM test results back.

Pre: 1.8
Post: 7.3

Her post is higher than we'd like, but we're going to keep at the 10 mg per day level until we reach 30 days after starting, at which time we'll test again and adjust if needed. So far, no side effects, but no noticeable improvements either.

[kmwilliams6113]

We started Greta on trislotane on May 8 at 10 mg, and to be honest, I've barely noticed any change, at all. She had a spike of water consumption the couple days before treatment started but seems back to normal. She had started having accidents a few days before treatment started, and those are gone, but the vet also put her on Prion to help with the bladder. She's still very hungry, still has quite the potbelly, and continues to have hair thinning. And, she still has the UTI she's been trying to fight off for almost two months now, which has become resistant to several antibiotics. I know results aren't overnight, but any thoughts on how fast the cushings symptoms tend to go away?

[molly muffin]

Low and slow wins the day. Those aren't bad numbers at all. The post can come down a bit to say under 5. ug if the symptoms haven't improved. You can expect a further drop thought on this dose usually.

[molly muffin]

Well the UTI doesn't help with the drinking and peeing, so until that finally resolves, it is probably going to be more difficult to say when those symptoms will alleviate. Usually you see a change in the eating and drinking within the first month though if the cortisol is coming within proper range. Like I said though, the UTI contributes to those same symptoms.

[kmwilliams6113]

We got Miss Greta's 27 day STIM test results back (we did 27 instead of 30 to fit it in before leaving for vacation).

Pre: 2.1
Post: 7.2

One huge improvement is that the new antibiotics seems to be able to handle her UTI, so perhaps the cushings being treated is helping. We did a urine culture on May 28, while on antibiotics, and there was no growth on the culture. We are finishing the course of antibiotics and will re-test 3-5 days after.

Otherwise, after 28 days of the 10 mg trislotane, we're not noticing much difference. She weighed less on her last visit than the prior, despite the same amount of food intake. Her drinking is about the same, but it never was high. She seems a tad less hungry, but not much difference. She hadn't had any accidents for a few weeks since starting the trislotane and prion, but this morning, after spending nearly two hours outside hunting squirrels and panting, she was a little leaky inside. She was laying there, and all of a sudden had a puddle. We're chalking that up to a little too much excitement, and perhaps some cortisol levels still too high. She still has a potbelly, and we haven't noticed any coat improvement.

So, the vet recommends sticking with 10 mg per day and retesting in two months.

Any thoughts from those with similar experiences?

[molly muffin]

Some symptoms it takes longer to resolve than others. If the symptoms don't respond at this level then you might want to go up just a tad to see if getting under 5 ug will help with that. It's up to you if you want to wait and see or do that now.
Sounds like she has a bit if energy being out playing for a couple hours. I can tell you my Molly would have wanted her nap long before then. Lol.

I am just guessing here but I'd think that exercise would loosen up some muscles that might contribute to the leaking episode afterwards. As it isn't a regular occurrence any more that makes it even more likely. She sounds like she is doing very well. Glad the UTI seems to be clearing up.

[kmwilliams6113]

Well, it’s been 2.5 months since we started treating Greta’s cushings disease with 10 mg trislostane per day, and I think we’ve made some good progress. She had been losing significant muscle mass and her coat deteriorating since January, and now, it’s maybe a little better, but at worst, stabilized since the beginning of May when we started treatment, and not getting worse. She started getting a leaky bladder around the beginning of May, right before we started her on the cushings treatment. Between the trislostane and adding Proin, that seems to be resolved. We’ve been treating her for a UTI since the beginning of April with multiple rounds of antibiotics, urine cultures, etc., and cross our fingers, hopefully that’s been resolved too. She goes in Wednesday for the post-antibiotics urine culture. She tends to get overheated, but it’s so dang hot in Texas right now, so she has about the same tolerance for the heat as I do. We’re watching how long she hunts in the yard and limiting her time so she doesn’t get too hot.

One negative side effect that we’ve noticed in the last month or so is that her gait seems stiffer, and her arthritis seems to bother her more. She spends more time laying down resting and isn’t as peppy. She’s eating great, and if there’s a squirrel or bird in the yard, she’s quick to hunt it, but just in general, she’s laying around more and moves a little slower inside. She’s on a joint supplement and fish oil (has been since we adopted her), and she doesn’t seem to be visibly limping or hurting, so I’m not sure it’s to the point where I would want to start a daily pain medicine. Seems to me that this is the natural side effect of less steroid in the body—her body isn’t self-medicating her arthritis as well. If she’s a happy girl and not hurting, she can spend her days in old age on cozy beds and just relaxing, and that’s fine by me—I don’t necessarily want to turn her into a puppy again. Besides plenty of comfy beds, letting her set her pace, a joint supplement and fish oil, any advice?

She’ll do her next cushings test and checkup in a couple weeks, and depending on her numbers and how she’s feeling at that time, we’ll think about any adjustments. I know it’s a balance between fighting the ill effects of cushings—especially it making it difficult for her to fight infections and the strain on organs—with her arthritis. Any thoughts on balancing the two?

[Harley PoMMom]

I've seen some members have success with Adequan for their arthritic dog. So glad to hear that Greta is doing well with her treatment!

Hugs, Lori

[kmwilliams6113]

Greta will hit the 3 month mark at the beginning of August for being on trislotane 10 mg per day. I know she needs to do another ACTH test to evaluate cortisol levels. She hasn't had bloodwork done since the beginning of April, but has had several urine cultures for the pesky and persistent UTI. How often do ya'll have biochemistry panels run on your cushings dogs?

[kmwilliams6113]

After 4 months, several rounds of antibiotics, countless urine cultures, Greta is UTI free!!!

And, I'll take this as a sign we're conquering one cushings side effect--inability to fight infections and the lurking UTI!

[molly muffin]

That is excellent news! Yay a. Glad that uti is gone now.

I have a chemistry every few months usually. I don't have one with every ACTH test. Just often enough to catch anything that might be off.