Intro for 14 yo Ridgeback

[Ember]

Hi, and thanks for providing this forum. I am new to this diagnosis, and also have been a moderator for a Lymphoma dog group so let me apologize in advance for asking a bunch of questions right off the bat! i know that can be annoying.

Ember is 14 and a few months. She is a 4 year survivor of lymphoma. She currently has hind end weakness (can still walk, but stumbles sometimes, and jumping up on the bed or couch requires help). She has severe spondylosis, which is definitely compressing the nerves to her back legs. She also has markedly enlarged adrenal glands. They are both evenly enlarged, so the diagnosis (without doing an MRI) is pituitary tumor. She had an ACTH stim test 3 weeks ago which was 'mildly' positive for Cushings. I don't have the numbers, and that was the word used by the vet who got the test result.

She does have increased hunger, but no thirst and urination troubles. Her fur is normal, no skin problems. All other blood work is normal except for kidneys which are slightly abnormal. We assume there was some damage from chemo for lymphoma there, as that's when it got skewed and has not progressed. She has had recurrent UTIs in the past few months which are getting expensive to treat and I'm sure are uncomfortable for her.

She currently is on Proin for spay-incontinence (many many years), Tramadol and Gabapentin for back pain. Pred helps her mobility but makes her a starving ravenous beast, so we have tapered that down to maybe once a week if she really is 'low' in the back end.

The question is...do we treat for Cushings based on this? I understand that the excess cortisol is probably helping her mobility. But I also think it might be more appropriate to manage that in other ways. (We could do NSAIDs if we stop the pred, for example.)

It's tough when you get to this point, when even the vets don't have a clear choice of a treatment plan. My goal is to keep her comfortable and happy - before this, it's been obvious what we needed to do to accomplish that.

Opinions and advice are greatly appreciated. As I said, I'm sorry to join and suddenly bomb the forum with a big post but, well, here we are...

-Johanna

[labblab]

Hello Johanna, and welcome to you and Ember! Kudos to you both for her cancer survivorship. She sounds like such a sweetie, and I hope you two will continue to have much more quality time together.

Wow, the decision whether or not to treat the Cushing's would be a tough one in this situation. If I am understanding you correctly, the recurrent UTIs are really the only issue that would prompt you to pursue treatment, and in doing so, you run the risk of worsening her pain and inflammatory mobility issues.

For a dog of Ember's age, my personal advice is usually totally dependent upon quality of life. For younger dogs, we are concerned about halting silent internal damage that can result from chronic cortisol elevation. But for seniors who are already nearing the end of their natural lifespans, I worry less about preventing chronic changes and more about quality of life trade-offs. Given what you have written, I'm afraid I can't give you much guidance beyond what you are already thinking :o. Is the discomfort/expense of the recurrent UTIs worse than a possible increase in orthopedic/nerve pain and the need/expense/stress for Ember to frequently return to the vet for monitoring blood draws and the cost of the Cushing's drug itself?

I don't think there is necessarily any wrong answer here, although I do have a bit of worry as to the actual validity of the Cushing's diagnosis, given so few corroborating symptoms and a "weak" diagnostic ACTH test. Adrenal glands can become enlarged and cortisol levels elevated due to organ/systemic stresses other than Cushing's. Does she exhibit any other lab abnormalities that are common with Cushing's, such as elevated liver enzymes and cholesterol? At a minimum, virtually all Cushpups exhibit elevated ALKP. Given Ember's history and also her chronic pain, I'm not sure I yet feel 100% confident of the Cushing's diagnosis. So if it were me, that might be another reason to hold off on initiating treatment right at the moment.

Marianne

[Harley PoMMom]

Hi Johanna,

Marianne has gotten you off to a really good start so the only thing I want to add is, when a dog gets recurrent UTI's it may help having an urine culture and sensitivity test done so the exact bacteria is known and the proper antibiotic can be prescribed, has this test been done recently?

Hugs, Lori

[judymaggie]

Hi, Johanna & Ember! Lori and Marianne have way more knowledge than I do about all things Cushing's but I did want to bring up that you mentioned Ember is on prednisone. Prednisone can cause what is known as iatrogenic Cushing's as opposed to Cushing's caused by a pituitary or adrenal gland tumor. Withdrawal of the prednisone can eliminate the Cushing's symptoms. If I am reading your post incorrectly, just ignore!

[Ember]

Oh, thank you all for the replies! It is VERY helpful to hear what you're saying about quality of life, because that is how I'm leaning but want to make sure...well, that other people would agree.

Yes, the only real issue is the UTIs. We could put her on pulse antibiotics and just prevent them. Lori, They have done a culture each time, and it though the bacteria type is sometimes different, all of them have responded to two weeks of Clavamox. Because of the back leg weakness, she squats very low so we think she's getting contaminated from that.

Lab, no all her bloodwork is normal. She's never had elevated cholesterol or ALKP. Her fur is normal, and she doesn't have a pot-belly, and she doesn't have polydipsia either. Her vet thought Cushings, if she in fact has it, might be causing muscle wasting so that really is the only thing we'd be aiming for in treating it.

Judy, she was on a regular dose (for her size) of pred for a few months - one pill every other day. It helped her legs but turned her into a hungry monster. We have cut it back to a half pill maybe once or twice a week. Before the test, we had her off it completely for three weeks so it wouldn't mess with the results. (Oh and your beagle is adorable! Our other dog is a 4 year old beagle. )

All your advice is reassuring. I want to make sure I'm making reasonable decisions for her, and it helps a lot to hear from others with experience. I think we will try to get a hold on managing the UTIs for now.

Thanks again! Wishing you the best with your pups.

-Johanna

[molly muffin]

I just want to say hello and welcome to the forum too. I can't really add anything other than what the others have already said which I completely agree with.

The prednisone might be a contributer to the cortisol results and with the problems she has with her back and legs, quality of life is where I would be most focused. It is never a give that the strength would return to the back legs, it might or might not and if her cortisol is brought down, then she is not likely to try the movements that would help to reinforce muscle due to the pain.
It's a rough spot to be in for her. :(