Desperately Seeking Answers!!!

[BeagleMOM13]

I have a 13 year old beagle which is the sweetest angel. She was diagnosed with Cushings about 1 1/2 years ago. Now we are dealing with a new crisis.

She began with a limp about 2 1/2 weeks ago. Treated with pain meds Tramadol and Rimadyl-nothing changed. Went on prednisione-bam! 60% improvement 24 hours. 80% next day. But took her to neurologist anyway because of previous intervertebral disc disease and surgery her sister. Had neuro diagnosed an affected neck but we agreed on crate rest for 4 weeks-no surgery.

Then the real crisis began. Water diarrhea and extreme lethargy. Off to the regular vet. They did blood work and said hemocrit and platletts very low. So went to emergency room. Spent 3 nights in hospital. Told no explanation on ultrasound (had previous liver tumor removed year ago). Got blood transfusion and greatly improved but declined bit next day.

No she is home and can barely walk. She has not been getting Cushings med these last days. Is lethargic and has low fever. We have spent so much $ and still don't have a diagnosis. Her hemocrit and platelets keep dropping. I am in despair watching her suffer and being in the dark about what is happening.

I don't know if this is anything to do with Cushings, cancer, a bleed somewhere, autoimmune or all the other things vets have said. I would be so appreciative to get feedback or ideas from other owners.

[labblab]

Did she receive the Rimadyl and the prednisone simultaneously? If so, this can greatly increase the risk of serious internal GI bleeding. Even when taken alone, NSAIDS such as Rimadyl carry this risk -- it is amplified when taken in combo with steroids (or in conjunction with elevated cortisol levels associated with uncontrolled Cushing's.) Diarrhea, lethargy, and anemia could all be associated with an ill reaction to Rimadyl. If so, she may remain in need of transfusions and/or other IV support until the crisis has passed. Here's a link to some related info.

http://www.fda.gov/downloads/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/DrugLabels/UCM050408.pdf

However, diarrhea and extreme lethargy can also be associated with a cortisol level that has dropped too low, or blood chemistries that are out of balance due to overdosing with Cushing's meds. I am assuming her potassium and sodium levels were checked and stabilized at the ER, but I'm wondering whether her cortisol level was checked, as well. Since the prednisone helped her so enormously, there is always the possibility that her Cushing's meds have been over suppressing her cortisol production and even though she is off the meds, her adrenal glands have not yet rebounded sufficiently to supply her body with enough natural cortisol. So it would be very important right now to know whether her cortisol level is either too high or too low. Can you tell us more about her overall dosing history and any recent monitoring ACTH testing?

Thanks very much for any additional info, and I'm so sorry your girl is having such a rough time right now!

Marianne

[SandyH]

Sounds to me she may have IMHA, Immune Mediated Hemolytic Anemia, ITP or a combo of both, Evans Syndrome. Did she come out of the hospital on lots steroids-pred, cyclosporine, azathiaprine? What this disease is that for some unknown reason the white blood cells attack the healthy red blood cells causing anemia. Treatment is high dose steroids to suppress the immune system until the red blood cells can regenerate enough to fight.Transfusions are needed until the steroids kick in. Combining Cushings with this is very difficult as the steroids needed to treat this works against the Cushings meds. This disease is common in cockers and we deal with this too much on our cocker forum. PM me if you have this dx and I can send you links that can give you lots of info. Sending good thoughts to your sweetie.

[labblab]

Sandy, thanks very much for that information. Here's a helpful link I found that seems to do a good job of explaining these disorders and the diagnostics involved.

http://c.ymcdn.com/sites/www.kvma.org/resource/resmgr/imported/6-02-Evans%20Syndrome-A%20Case%20Study%20and%20the%20Technicians%20Role. pdf

[judymaggie]

Hello -- just wanted to welcome a fellow beagle lover! My Abbie will be 13 in a week and is my second Cush pup --- the first, Maggie, also a beagle. You have already received excellent guidance from Sandy and Marianne. I will be sending healing thoughts that your pup gets through her latest crisis quickly.

[molly muffin]

Oh my goodness your poor baby. I do think that an internal bleed from NSAIDS needs to be ruled out and a check of her cortisol to see if she is too low would be worth checking into.

I do hope she improves and starts to feel better.