Hello and Symptoms of Cushing's in German Shepherd

[smfree]

Hi! My name is Susan, and I am new to this forum. I have a 10-year-old German Shepherd named Bella who had surgery for GDV (bloat/torsion) on Feb. 25, 2015. Her lactate level was 9.62 at time of surgery. Since 2 weeks post surgery, she has been extremely anxious between 6 and 7 am (on average) nearly EVERY morning. No vets can tell me what's going on. However, I began thinking about how cortisol is highest in the morning, and I'm wondering if Cushing's might be a consideration. She has physical symptoms (increased thirst, lethargy, more shedding, panting, muscle weakness for more than a year, comedones on groin, has a bony appearance to her head, to name a few), but her standard labs are normal at this time, except her white cells are all decreasing. She just had an ultrasound, and one adrenal gland was normal, and the other was not seen. I have spent so much money since her surgery that getting Cushing's testing is not in the picture now. Can a dog have physical signs of Cushing's but have normal labs, considering it's a progressive disease? Considering her high stress at the time of surgery, I'm wondering if now she has greater cortisol spikes in the morning that contribute to her extreme restlessness. In addition, her head seems to bother her (she holds her head differently now and paws at it more often). I appreciate any insight that you all may have. Cushing's seems to be a viable possibility. Wishing you all a good day, Susan

[smfree]

Does anyone have any insight about possible Cushing's in my German Shepherd?

[labblab]

Hello Susan, and welcome to you and Bella!

I first read your post several hours ago, and have been mulling over your question throughout the day. I wish I could say that I now have something brilliant to write, but I'm afraid I do not. Because the long and the short of it is, it's possible that Bella has Cushing's, but difficult to confirm at this stage without additional diagnostics. As you are already aware, she does exhibit certain overt symptoms that are consistent with the disease, but it is unusual for there to be so few abnormalities in terms of blood and urine testing. It is disappointing that both adrenal glands were not visualized on the ultrasound, because that also leaves us without potentially important information.

I think her morning anxiety may be a "red herring," because Cushpups consistently suffer from elevated cortisol levels, not just at an isolated time in the morning. So I cannot make heads nor tails of that particular symptom. Nor can I associate the head pawing with Cushing's, other than the remote possibility that she might suffer from a large pituitary tumor that is causing both Cushing's symptoms and also actual discomfort in her head. Unfortunately, that would take very expensive imaging of the head to prove or disprove.

Probaby the least expensive thing you could do would be to wait another 30-60 days and repeat her basic blood and urine testing in order to see whether any related abnormalities finally appear. Unfortunately, before embarking on actual Cushing's treatment, I do think you would need more formal confirmation of the diagnosis, and that would additionally require at least one of the two diagnostic Cushing's blood tests (ACTH stimulation test or LDDS test). It would also be nice to repeat the ultrasound in hopes of visualizing both adrenals, and also obtaining good views of her other internal organs. For this, I would want to make sure that the ultrasound was performed on high resolution equipment with an experienced professional making the interpretation. Most GP vets don't have this capability, so you may need a referral to a specialty practice for this.

For the time being, unfortunately, I think you are left with several question marks. And that's why it took me so long to compose a reply to you! :o :o

Marianne

[smfree]

Oh, thanks so much Marianne! How I wish this were more simple. Bella didn't tolerate the ultrasound well. She whimpered like I've never seen her do so ever. I just keep trying to figure this out:

1. Highly stressed when she bloated/torsed (her lactate was 9.62 but did go down to normal ranges the next day).

2. Bloated again less than a week after surgery (tacked at surgery, so no torsion).

3. Less than 2 weeks after surgery, she became highly sensitive to the normal garbage truck, which never used to faze her. From then on, it's been every morning getting up between 5:30 and around 6, and being in panic/restless/panting mode until around 7:30.

4. Just the other day thought of cortisol levels being high in the morning, and maybe she spikes then. She does pant at various times throughout the day and follows me around most of the time. The really stressful behavior only happens very early in the morning.

5. When I Googled about cortisol, I found out about Cushing's.

6. Something seems to have to be related to recovery from surgery and the deep stress she was in when she originally bloated/torsed.

As mentioned, my funds are depleting, as I've spent thousands of dollars on her care since February. We see the vet again on Tuesday, and I will mention this.

You mention getting labs done in a month or 2, and I'll be sure to do that. The original ultrasound was done just last week at our local emergency clinic by a radiologist. However, it was a normal scan, not a 3- or 4D one. Wishing that they could just do an x-ray of her head, but the radiologist said only CT or MRI would be needed.

Many, many thanks for your reply. I appreciate it so much.

Susan

[molly muffin]

Hmmm. I am actually wondering not about high cortisol but about low. The reason I say this because when they have lower cortisol and may it be Addison even but just low then they tend to exhibit the same sort of symptoms as high cortisol drinking, lethargy etc but also anxiety. Loud noise makes them jump, things they never reacted to before they tend to now react to.

So I am just wondering. The only way to know that for sure would be a through an ACTH test to check the cortisol levels. M

You might want to take a look at our helpful resource section
http://www.k9cushings.com/forum/showthread.php?t=212

Maybe one of these could help you with an ACTH test.

Welcome to the forum.

[smfree]

Thanks so much, Molly! I will check out the resource and discuss this with the vet tomorrow. Wishing you a great week!