10yr old Chocolate Lab with Cushing's/ beloved Cedar has passed

[J12345T]

Hi All,

I have stumbled upon this forum with equal parts relief and worry. Our lovely 10yr old female chocolate lab 'Cedar' was diagnosed with Cushing's disease about 6 months ago. She displayed most of the common symptoms but initial blood tests proved negative. On the advice of our vet we carried out a secondary test (a challenge test?) that showed a positive result. Since that time Cedar has been on Vitirol daily and showed a marked improvement in her coat, her enlarged liver and her general well being.

The one aspect that did not show much improvement was the weakness in her hind quarters. In the last week (what we thought was) that problem appeared to get much much worse. Cedar was unsteady on her feet and even stumbling. She also started to exhibit strange behaviour which I now believe to be 'petit mals' or small seizures. On our vets advice we opted for an MRI last Wednesday to look for possible brain tumours. The MRI required sedation and showed no tumours in Cedar's brain but did confirm pituitary Cushing's.

Cedar had a terrible time 'recovering' from the sedation with symptoms that I can only describe as stroke like. We are now 48 hours since the MRI and she is still very unwell. She has 'episodes' which seem to last 30-45 mins where she pants, paces, is wobbly and stumbles and walks in circles, has a vacant look in her eyes and her tongue hangs out. She is just not herself.

She will eventually settle and lie down where she will finally come back around to a 'version' of her normal self.

We are very concerned of course and our vet has suggested to start her on Aspirin to reduce any blood clotting which we have done; and to give her some time...

We have no real diagnosis and are only really guessing as to what is wrong. I don't want to subject her to any more stressful visits to the vet or any other diagnostic procedures (a spinal tap was suggested!).

I'd really appreciate any insight or suggestions from the members here. It is a very worrying and difficult time as I'm sure everyone here can attest to..

Many thanks,

James.

[Joan2517]

Hello James and welcome. I'm so sorry that Cedar is having such a hard time. You will get plenty of help here. Others who are much more knowledgeable than I am will be along to ask lots of questions and help you through this. We're a big family!

[labblab]

Hello James, and welcome to you and sweet Cedar although I am certainly sorry for her worsening problems. I have a couple of quick questions that will help guide us with further feedback.

First of all, can you tell us how much Cedar weighs and also what her daily dose of Vetoryl has been? Also, has she been receiving monitoring ACTH tests during the six months of treatment? If so, how recently has she been tested and what was the result? The reason why I ask is because some of the symptoms that you describe could simply be related to drug overdosing. So I am hoping that your vet tested both her cortisol level and basic blood chemistries before even advancing to the MRI.

Secondly, you have told us that the MRI did not reveal any additional brain tumors, but what about the tumor on her pituitary gland that is presumably causing the Cushing's? Was it visualized and how large was it? Dogs that experience neurological problems as a result of Cushing's do not typically have additional brain tumors -- it's just that the pituitary tumor has expanded to the point that it is placing pressure on other sensitive areas of the brain.

And last but not least, I'm assuming the MRI did not reveal any evidence of stroke damage?

Thanks in advance to your answers to all these questions! And once again, a big welcome to you and your girl.

Marianne

[Harley PoMMom]

Another very important thing is when a dog is acting unwell or just not acting their usual self, the Vetoryl should be withheld until the dog is better. In light of Cedar's recent symptoms I would stop the Vetoryl until it is known where her cortisol level is. Keep us updated, please.

Hugs, Lori

[J12345T]

Hi All,

Thanks for you responses.

Cedar weighs 30kg (66lbs) and she is receiving one tablet of Vetoryl (60mg) once with her breakfast (dose unchanged). When we first noticed the deterioration (which prompted the MRI) we did withhold her dose for a day. If anything it appeared to make her worse but of course it was just one day and very subjective.

I was mistaken with my 6 months. She has actually only been on Veroryl since the beginning of April. She didn't have a pre-treatment test but has had ACTH stimulation test periodically during her treatment. Her most recent test was 22 June where her levels were good. There was a blood test carried out before the MRI with a note on the report stating "blood work available from the primary vet demonstrate apparent control of her historical Cushing's"...

We don't have the MRI report yet however, speaking with the vet he said her pituitary gland was "lit up like a Christmas tree" after giving contrast dye, confirming pituitary Cushing's. There was no mention of an abnormally large tumour or indeed any other tumour. The only thing they said was a slight irregularity in symmetry of her brain however, that could be due to a slight misalignment of her head in the machine...

Cedar is slightly better in the mornings (this morning) but seems to deteriorate during the day. At the start of her episodes she has a noticeable 'electric shock' in her head. She then appears to start 'seeing things' in that her head moves slowly from side to side as if she is looking at something that is moving. She then becomes unsettled and won't stop pacing and turns in left hand circles for ~45-60 mins. She is also very unsteady on her feet during these times with her mouth slightly open and her tongue hanging out. This happens ~5 times a day from ~1pm. She seems to sleep well at night. Another thing we noticed when she began deteriorating was that her eyes looked 'different'. I can't explain exactly however, they just look different (slight blue tinge??)...

We are also giving her Aspirin (150mg) morning and night thinking stroke and to perhaps relieve any pain which may be present.

Thanks so much again for your kind words and assistance.

James.

[DoxieMama]

Hi James,

Though it could be stroke and I'm certainly no expert, your description of her episodes makes me think of vestibular disease. http://thebark.com/content/idiopathic-or-old-dog-vestibular-disease

I do hope you find some answers and relief for Cedar.

Shana

[J12345T]

Hi Shana,

I considered Vestibular Disease too however, her eye movements don't seem to be nystagmus ie. the rapid flicking of the eyes left and right as you'd see in someone who was dizzy.

What Cedar does is slowly look left and right with her head. Her eyes don't flick..

It certainly is possible however, given her walking in circles...

As an update, she has seemed a little better today. Fewer episodes (so far) and a little more settled. I guess time will tell...

Many thanks,

James.

[SasAndYunah]

Hi James, welcome from me as well :)

I do not have any advise regarding regarding Cedar's condition although it does sound epilepsy-like to me (having had an epileptic dog myself). Actually, it sounds more like the aura episodes before the actual seizures.

But I wanted to comment on the aspirine. Was it prescribed by the vet and since when is Cedar taking the aspirine? Because, to the best of my knowledge, dogs should not be given aspirine (unless very shortterm and under the strict supervision of a vet) since it is toxic for dogs and has some bad side effects. It can actual cause bleedings in dogs (as it can in humans too) and interacts negatively with quite a few other medications and other serious side effects that will kill the dog (kidneys, liver, etc). So just wanted to make sure you know all this and that the vet is supervising the asperine use.

Our best to you and Cedar,

Saskia and Quincy :)

[Squirt's Mom]

I'll be back for a proper welcome in a bit but this statement scares the CRAP outta me if it is what it sounds like -


She didn't have a pre-treatment test....

Are you saying she had NO testing for Cushing's prior to starting the Vetoryl?!

[molly muffin]

Welcome to the forum. I would stop the trilostane until Cedar is showing no signs of the neurological issues and is doing better.

It would be good to know the size of the pituitary tumor. In pituitary cushings, it is a tumor of the pituitary that causes the cushings. In some cases, the tumor is large enough to put pressure on other areas of the brain, causing neurological symptoms. In these cases, it is called a macro tumor (one that has grown) and the higher levels of cortisol actually help the inflammation that is put on the brain.
This is of course speculation without knowing the size of the tumor, etc but it is something that can be discussed with your vet, who should have the MRI result. It doesn't hurt to stop the vetroyl until you know more.

[J12345T]

Hi All,

Re Squirt's Mom. My poorly worded sentence I'm sorry. By pre-treatment I meant pre-MRI. Sorry for the confusion. She did of course have blood tests before beginning Vetroyl.

The aspirin was on the advice of the vet although, I agree that it is only appropriate for the short term.

Re stopping Vetroyl. The vet hasn't suggested that however, I'll put it to them and see what they think...

We are trying to get a copy of the MRI report (it's Sunday here today) as we'd like to find out the size of the pituitary tumour too..

Cedar had another quiet night. The only change is that the 'electric shock' symptom has now become a more prolonged 'jaw snapping' (about 6-7 times in a row). That said she seems to be more coherent after the episodes than previously..

It is all very strange..

Thanks again.

James.
:confused:

[J12345T]

Hi All,

I managed to get a couple of Cedar's episodes on video this afternoon. The video can be found at:-

https://youtu.be/752pKQMTVjo

Sorry for the average quality however, I was trying to comfort her as well. :(

I'd be interested to hear if anyone has seen this type of thing before...

Many thanks.

James.

[dsbailey]

Welcome James,

I've never seen anything like it, which isn't saying much but I wanted to say "Hang in there dude", I'm sure you'll figure out how to fix this sweet girl. I'm sure it freaks you out more than her so keep that in mind too.

Darrell and Lolita

[Squirt's Mom]

James, thank you for relieving this old broad's mind about the testing. ~~whew~~

I have a question about her eyes during these episodes - do you notice them moving side to side? There is a condition called Vestibular that looks a lot like a stroke or seizure and one of the big clues is what is called nystagmus in which the eyes move side to side, up and down, or even rotate. They can get naseated and perhaps vomit. The circling and unsteadiness on the feet is another clue for this condition. I had an itty bitty man, my Brick, who developed this condition in his elder years and it scare me to pieces to see it at first. It would take him a long time sometimes to get over the circling. He was blind so his eyes didn't give any clues. Here are some links on Vestibular.

http://www.vcahospitals.com/main/pet-health-information/article/animal-health/vestibular-disease-in-dogs/856

http://vestibular.org/sites/default/files/page_files/Vestibular%20disease%20in%20dogs%20and%20cats.pdf

And a youtube video -
https://www.youtube.com/watch?v=zcX0-UWig1s

Now... Welcome to you and Cedar! :) (I love that name, btw!) I am very glad you and your sweet girl have found us and I look forward to getting to know you both better. We will be here to help in any way we can. Ya'll are now part of our little family here at K9C and you can trust that you will never be alone. Just holler and someone will be along to talk with you as soon as possible. We may not have the answers but we always have soft shoulders and warm hands.

Hugs,
Leslie and the gang

[labblab]

Hi again, James. I wish I had something brilliant to contribute, but I really don't :o. Having had a Lab with seizure disorder though, myself, I have to agree with Saskia that the video does suggest some type of seizure issue to me, too. It's not so much the circling, but more the head jerking that makes me wonder about that. My own girl exhibited some strange repetitive behavior that involved flicking her head for several years before finally suffering from full grand mal seizures. And immediately prior to the grand mals, she would wander, pant, and look agitated and distant just before collapsing -- as Saskia said, there was an aura that preceded the full seizure. So Cedar's behavior looks a little bit like those auras to me.

You've done a great job by taking a video, though. If your vet hasn't seen the behavior, I would definitely show this to him. And if you have access to an actual neurologist in your area, this would be super helpful to show him/her.

Cedar looks like such a sweetheart, though! I surely understand why you are so worried and you are wanting to help her as best you can. We are so glad you're both part of our family, and I do hope we will be able to help, as well.

Marianne

[judymaggie]

Hi, James! Cedar is definitely a sweet looking pup and can totally understand why you want to get to the bottom of her issues. I, also, had a dog with seizures and relied heavily on the Epi Guardian Angels website to educate myself about seizures and associated issues. Here is a link to their website:

http://www.canine-epilepsy-guardian-angels.com/site_map.htm

I bet you are tired of reading by now but I do encourage you to take some time and look at the website.

[J12345T]

Hi All,

Thanks once again for the kind words. I'll try to answer as best as I can.

Squirt's Mom re Vestibular Disorder. Cedar doesn't display the flicking eyes before, during or after her episodes. The only thing is that she moves her head as if following something that she can see...

Judymaggie. Thanks for the link. There is a whole lot of information there that will take me time to digest. That said it did point me to a link showing dogs that exhibit 'fly snapping' seizure behaviour. They seem to be snapping at fly's or other things they are seeing in a seizure type of manner. Looks similar to Cedar's behaviour...

I finally have the written copy of the MRI report and it just raises more questions than answers. The conclusion was:-

"Largely unremarkable study apart from subtle increase size of pituitary likely associated with PDH (adenoma). No structural abnormalities, infiltrative changes or mass lesions evident."

So no macro pituitary tumour or any other tumours. No evidence of stroke or anything else...:confused:

On advice we will with hold Vetoryl for the time being and have stopped the aspirin and take a wait and see approach. She had a few episodes early this morning however, has been fine since then.

I'll keep you posted.

Many thanks,

James.

[Harley PoMMom]

Hi All,

She displayed most of the common symptoms but initial blood tests proved negative. On the advice of our vet we carried out a secondary test (a challenge test?) that showed a positive result. Since that time Cedar has been on Vitirol daily and showed a marked improvement in her coat, her enlarged liver and her general well being.

The MRI required sedation and showed no tumours in Cedar's brain but did confirm pituitary Cushing's.

James.

Could you get a copy of those tests (initial blood tests and secondary test (a challenge test?)) that were done on Cedar and post those results?

Also, I'm not familiar with Vitirol, what is it?



We don't have the MRI report yet however, speaking with the vet he said her pituitary gland was "lit up like a Christmas tree" after giving contrast dye, confirming pituitary Cushing's. There was no mention of an abnormally large tumour or indeed any other tumour.


Since the MRI found no tumors on the pituitary gland than I believe that would rule out pituitary Cushing's which leaves an adrenal tumor as the only other option for the Cushing's. An abdominal ultrasound or the LDDS (low-dose dexamethasone) can help in diagnosing this type of Cushing's.

Lori

[SasAndYunah]

I know, it's a Cushing's board but let me tell a bit more about epilepsy as my Boncuk displayed. Way before he had his first actual grand mal seizure, and I mean at least a year before, he would have these "episodes" that I later recognized as being aura's. He did the fly snapping thing, he did the "seeing things flying around" thing, he would go hide underneath furniture and be scared (for no apparent reason), etc... he displayed a whole range of behaviours before the actual seizures began. Once he had the seizures, that same behaviour would 100% sure predict a seizure coming on...and it always did, no exceptions. But I just wanted to tell you that he did have these "aura's" way before he actual experienced seizures. And his epilepsy remained without an actual cause...and thus it was called "idiopathic". So there is no need for tumors being found and it stll can be epilepsy. But there are numerous causes and they all will have to be ruled out...and therefore you would indeed need to see a neurologist. Still not saying that it is epilepsy/aura's , could be a million different things I'm afraid :) But just wanted to let you know that the "strange behaviour" can occur even before there are actual seizures.

I do hope you can get it all figured out,

All our best,

Saskia and Quincy :)

[J12345T]

Hi All,

We have been with holding Cedar's Vertoryl (Trilostane)now for a few days and whether coincidentally or not, Cedar is improving. She is still having episodes but they are fewer and further between and they don't seem to bother her so much. We are seeing a return of the panting symptom and she seems to be drinking a little more. She is brighter and more alert and certainly a lot stronger (happy to go up and down the stairs by herself). She is still exhibiting strange 'repetitive' behaviour (ie. wants to come inside immediately after she has been put out and vice versa. Will make 4-5 left circles for no real reason. Seems to forget what she is doing. Is 'seeing' things...).

I have a full print out of her medical history now but they don't include many of her actual levels for her various blood tests. A summary below:-

9 Feb. Gribbles ACTH Stim test. Result Negative.

15 Feb. Skin biopsies. Result "very thin skin".

24 Mar. Repeat CBC/SAP and ionised calcium to Gribbles. Result USG 1.014 pH 6.0, trace prot, rest all neg. Neg sediment exam.

5 Apr. LDDST performed. No suppression of cortisol @4 and 8hrs confirms Cushing's. Started Vetoryl 60mg/d.

27 Apr. ACTH Stim test. No results listed. I've assumed OK?

19 May. ACTH Stim test. Results 71 low end of range (40-250 on meds), but correlates very well with clinical signs.

22 Jun. ACTH Stim test. No results listed. I assumed all OK..

Then Cedar went down hill as I've described in this thread..

So Cedar didn't test typically for Cushing's and it was only 'confirmed' via the low dose DST test and clinically due to her symptoms and her reaction once on Vetoryl.

The MRI report talks about her pituitary being 'lit up' with the contrast dye. I take that to mean it is over active per Cushing's but there is no mention of a tumour. Maybe the tumour is too small to see on the MRI?? I'd be very surprised if she had an over active pituitary AND an adrenal tumour. That'd be too weird..

Re epilepsy. I can't rule it out as it certainly seems to fit in some ways however, again how rare would it be to develop BOTH pituitary Cushing's AND idiopathic epilepsy in the same year??

For now we'll just keep doing what we're doing and see what happens.

Thanks to you all again.

James.

[Joan2517]

I'm happy she is starting to do better, James.

[Squirt's Mom]

I, too, am glad you are seeing improvements, James. My curiosity would get the better of me, tho, and I would be chasing down that person who stated the pituitary was "lit up" and ask exactly what that meant. ;)

[J12345T]

Hi Squirt's Mom,

Yes me too. We're speaking with the vet again this week.

Cheers,

James.

[J12345T]

Hi All,

It is with great sadness that I report the passing of our beloved Cedar. :-((. It is a somewhat tragic story but may be of benefit to others here..

After taking her off the Vetoryl in August Cedar improved steadily and got to a point where she was happy, walking, sniffing and enjoying life again. It was really great and looking back now I'm so glad we got to have that time with her. We took her to the beach again and she ran around like she was a puppy (well almost).

Last week we went on a family holiday to a boating/water area 4 hrs drive from where we live. We have done this with Cedar for years and although she never loved boating she certainly loved the new smells, beaches, bush walks and being with us.

Last Thursday night I was bringing her back from the beach after her final toilet for the evening. It was ~9pm and dark. When I tried to transfer her from the small dinghy to the bigger boat she baulked and fell in the water. We splashed around for a few seconds before I could pull her back into the dinghy and then back onto the bigger boat. Apart from being wet she seemed very much OK.

Very unusually, at 5:30am the next morning she woke us up seeming to need to go to the toilet again. I got dressed and took her to the beach where she urinated. I noticed she was shaking on the beach but thought she was just a bit scared from what had happened the night before. She was fine when we got back to the boat so we went to sleep for another few hours.

At 9am I got up to give her her breakfast and she wasn't interested. This sent alarm bells off and we set off for the nearest vet practice ~1hr away. By the time we got there Cedar was unable to walk and was very unwell. She had blood in her abdomen and they put her on an IV drip. We transferred to a larger practice ~30 mins away for an ultrasound.

The ultrasound showed what the vet thought was an hemangiosarcoma. His advice was to operate and remove it due to the very high risk of future bleeds and a painful fatal rupture.

It turned out that the mass was in fact a 7cm adrenal cortex tumour. The histology couldn't tell if it was an adenoma or carcenoma but was undoubtedly related to the Cushing's.

Cedar survived the operation and seemed to be doing well but died during the night (~4am). We were (are) devastated and took Cedar back home with us that afternoon and buried her in our garden at sunset that evening.

So the lesson for us is that Cedar probably never had Pituitary Cushing's. She had the much rarer Adrenal Cushing's which although we tried, was never properly diagnosed. The vets told us that treatment for either was the same so they didn't consider it vital to differentiate. This was bad for Cedar because the tumour was so large and (as it turned out) fragile.

Her exact cause of death is not really known but it appears that a combination of the tumour, the trauma of falling in the water and the bleeding were to blame. That said my wife and I (in hindsight) noticed a decline in her weight, her toileting patterns and her general well being over the week prior. We feel her kidney's were probably starting to fail as her urinating was becoming excessive and light in colour.

A tragic tale and a significant loss for our small family which we are feeling acutely. I think it will take quite some time to get over it and come to terms with our loss. They certainly work their way into your heart..

Many thanks for all your help and support.

James.

[DoxieMama]

Oh, James, I am so sorry for your loss.

[judymaggie]

James, my condolences to you and your family on Cedar's passing. It does sound like she enjoyed her last outing.

[Harley PoMMom]

Oh James,

I am so sorry for the loss of your dear Cedar and my heart goes out to you at this most painful time.

Please know that Cedar will always be honored and remembered here amidst all our beloved pups who have passed on. After writing this reply, I will be adding her name to our memorial thread of honor and she will forever be a member of our family, and shall never be forgotten.

With Heartfelt Sympathy,
Lori

[Joan2517]

Oh, James...how sad. I am so sorry for your loss of Cedar. I'm glad you were able to spend good times with her after taking her off the Vetoryl. It sounds like she was a very happy girl. It is so hard to lose them under any circumstances. My condolences to you and your family.

Joan

[mypuppy]

Dear James,

Very saddened you lost your precious Cedar. I highly believe she is romping around with my chocolate girl and all of our other beautiful babies who have left us.

Praying for strength for you and your family and your sweet Cedar.

Tight hugs
Jeanette

[molly muffin]

James, I am so sorry to read of the passing of dear Cedar.
It is such a huge hole they leave in our hearts and in our lives. Nothing feels right without them there, like somehow the world tilted just a tad in the wrong direction and we want to tilt it back to where it was, yet we cannot and that hurts too.
My sincerest condolences.

[Scoovale]

I am very sorry for your loss. Thank you for sharing this story with us, it will for sure help other dogs and dog´s owners.

valentina