Nutmeg, My 13 Year Old Beagle

[graybison]

A newbie here in the Seattle area.

Nutmeg, my lovable 13 year old beagle, has all the classic symptoms of Cushing's:

Increased thirst and urination (polydipsia and polyuria, respectively)
Increased hunger.
Increased panting.
Pot-bellied abdomen.
Obesity.
Fat pads on the neck and shoulders.
Loss of hair. (This is a new sympton, with shedding tufts on her hindquarters and shoulders)
Lack of energy.

I had been seeing a vet who suspected either Cushing's or diabetes (cleared up diabetes symptoms with fluid infusions of 150 ml per week), but never tested her for Cushing's, and who wanted Nutmeg to come back in 6 months unless symptoms worsened. It's been 5 months and they have worsened, so I tried to set an office visit with the vet only to find out she had moved out of the area. I have made an appointment for next Wednesday with another vet Nutmeg had seen when she was younger. The records have all been transferred over to the vet we will visit next week.

In the interim week, I have two questions with which, perhaps, some of you have experience and/or advice regarding:

1. The tufting hair: Best to brush or not to brush?
2. Urinary Incontinence: (This is also new, now occurring in the house). My wife wants me to limit Nutmeg's water intake (which worries me) or crate her (oh, the howling!); my answer is more frequent trips outside with her, every 1.5 - 2 hours, round the clock (yawn!).

Finally, for when I meet with the vet next week, should I be asking for an ACTH Stimulation Test for my pooch? I am not sure about her taking the UCCR Dexamethasone Suppression Test, since her urine is so diluted. What other questions should I be asking the vet?

Thank you all in advance,
Wayne

[Joan2517]

Hi and welcome to you and Nutmeg....first do not withhold water. They actually need it for reasons that some of the more knowledgeable members will explain.

When my Lena started having accidents, we just attributed it to old age, but like Nutmeg, she had all the other symptoms, but I knew nothing of Cushing's at the time. We put down wee wee pads, and she learned to use those. My husband and I both work full time, so that solved that problem. I was lucky as she usually only had to get up once during the night at around 4:30 or so, which was a lot easier than some of the other members have it...so maybe that could be an alternative to crating, which seems unfair as she can't help it.

You will get lots of advice and support here, and many, many questions. We are a nosy bunch! But it helps....

[Budsters Mom]

Hello and welcome. I only have a second to post right now, but others will be along shortly.

Please do not limit Nutmeg's water. In the event Cushings is a factor, then tons of water is needed to rehydrate. Uncontrolled Cushings causes pups to pee and pee and pee.... Limiting water can be very dangerous, even life threatening. I have to side with you on this one. More frequent trips outside is crucial. Penning to a floored area would be advisable when away from home. You could try pee pads, but a dog that is used to going out, may balk at the idea or not have a clue as to what they are for. My little Rosie, would hold it until she bursts, rather than pee anywhere in the house. She is not a Cush dog.

Kathy

[Renee]

Hi there - I'm sure you get the picture, but I'll just repeat everyone else. Do not withhold water. The reason cushings dogs drink so much is because their kidneys are 'always running', meaning they will pee whether they have water or not, thus to withhold water can cause the kidneys to shut down.

As for your question on where to start with the new vet, I would plan to run a full bloodwork panel and urine culture & sensitivity. The bloodpanel will help you to note if diabetes or thyroid are at play here and give you other markers that could indicate cushings (such as elevated ALP). Those two diseases can often mimic cushings, so best to rule those out. The culture and sensitivity will provide useful information on whether your girl has a UTI or not. Most cushings dogs at diagnosis have an undiagnosed UTI and you'll want to clear that up before moving on to any cushings test. Don't bother with a urinalysis - it's not a sensitive enough test when dealing with dilute urine.

Assuming you rule out the diabetes or thyroid, the next step for cushings testing should be the LDDS, not the ACTH. There are reason that an ACTH may be needed in some cases for diagnostics, but in general, the LDDS is considered the 'gold standard'.

I must compliment you on finding us now and asking such good questions. It's always best to come to a vet appointment prepared and educated. It helps set the tone with the vet. Go ahead and get in the habit of asking for copies of all testing done from here on out, too. If your girl turns out to have cushings, you'll want to keep copies of everything.

In the interim for dealing with the peeing, you might consider peepee pads or putting a diaper on Nutmeg and getting in the habit of taking her outside as often as possible. I did a diaper for my girl at night, then we moved and installed a dog door, which was a godsend. There are great diapers on the market the days. One of the best is the peekeeper, which you purchase online. The peekeeper is an excellent investment and I have one for my incontinent pug.

[DoxieMama]

Hi Wayne! My neighbor across the state. :) Welcome to you and Nutmeg. Kathy and Joan (and Renee too!) already covered it but I'm going to reiterate anyway because it is just that important - do not limit her water.

I am at work and had someone come to my desk after starting my message, so Renee has covered all the thoughts I had already.

I'm so glad you found us. Please keep us updated on Nutmeg's progress.

Shana

[judymaggie]

Welcome to you and Nutmeg! My beagle, Abbie, sends a big ar-o-o-o to Nutmeg. Unfortunately, beagles outnumber many breeds that are prone to Cushing's. My Abbie is my second Cush pup and the folks here helped me get through many difficult times as well as celebrated the good ones with me.

I agree with Renee that it is a good idea to start with a complete blood and urine work-up. If, indeed, Nutmeg has Cushing's, it is a very slow moving disease and the time that is needed to go through a thorough diagnostic period will not negatively affect treatment. If Nutmeg does have a UTI, that could affect the outcome of any Cushing's tests and the results would not be reliable. Thus, the need to rule that out first.

In addition to maintaining your own file of test results, we would ask that you post any abnormal values along with their normal ranges as this will enable us to provide you with better feedback. With respect to the blood chemistry and complete blood count (CBC), you need only post the highs and lows. The urinalysis will have information about specific gravity, protein, glucose, etc. Does Nutmeg have any underlying illness that she is taking medication for? And if so, what is it and what is the medication? Is she taking any supplements, medications or herbs?

Just one thought about the frequent urination -- my Abbie is now 13 and has been showing signs of dementia for a while. Although her cortisol is controlled by treatment with Vetoryl, she has to go out to pee every couple of hours during her waking hours and has had a few accidents in the house. A recent urinalysis, culture and sensitivity were all normal so we are led to believe that the dementia is affecting her urination habits. I am saying this only because, even though Cushing's may be the reason for Nutmeg's urinary issues, there could be other factors as well.

With regard to her "tufts" of hair, I would gently brush her to remove them. She might well feel more comfortable and this would also give you a better view of her skin to make certain there are not any underlying issues.

[graybison]

Thank you all for the warm welcome to the forums and the advice. There will be no limiting of my girl's access to water, thanks to your universal advice. And thanks for the suggestions regarding dealing with her "accidents" and tufting hair.

Nutmeggie surprised me last night by actually jumping up on the bed with me, which she hasn't been able to do in weeks. She even played with some of toys for a short time which has been rare lately.

I'll be back to share what the vet tells me later next week.

This is a wonderful, caring community.

Wayne