10 yr old Chihuahua has cushings

[Mz M]

Hello. My name is Barb and I am from London, ON. I have 2 sweet, happy Chihuahua's, Angel and his sister Poppi. Yesterday Poppi was diagnosed with cushings based on an ultrasound. I had noticed that she had lost a bit of weight and sometimes she would hold her front paw up but it wasn't sore or swollen. She had become ravenous and her eyes started looking "milky". We noticed that her abdomen was swollen, and her chest "clicked" or "hiccupped" when she breathed. I took her to the vet's on the 17th of November and he did blood testing. On the 18th he took xrays. He prescribed Apo Furesemide 20 mg. It had no effect, so he said that was a good thing, no fluid on the lungs. He did some more blood testing a couple of days later and diagnosed her with pancreatis. For about a week and a half Poppi has been on Detoxafen-L, amoxil and metronidazole. Tonight I noticed her abdomen is larger. Tomorrow I have her booked for the test which tells him what type of cushings she has. I feel so helpless...what do I do?

[Harley PoMMom]

Hi Barb,

Welcome to you and Poppi! With our new members we ask a lot of questions, this is not because we are nosy, instead, it allows us to provide you with our best possible feedback. So here are some questions that I have

Could you get copies of all tests that were done on your girl and post any abnormalities that are listed? With respect to the blood chemistry and complete blood count (CBC), you need only post the highs and lows and please include the normal reference ranges. Were the adrenal glands visualized on the ultrasound? Does Poppi display any of these common Cushing's symptoms: increased drinking/urinating, a ravenous appetite, exercise intolerance, and difficulty or unable to go up steps or jump on furniture? I see that she was also diagnosed with pancreatitis, how was this found?

Cushing's is one of the most difficult canine diseases to diagnose, which makes it one of the most misdiagnosed. One of the things that makes Cushing's so challenging is that there is not one test that can 100% accurately identify it, so vets have to perform multiple diagnostic tests to validate a Cushing's diagnosis. Also the tests used to diagnose Cushing's test can yield false positive results in the face of non adrenal illnesses or even stress. Is Poppi going through a pancreatitis episode now? If so, I would withhold having any tests for Cushing's performed until the pancreatitis is under control.

Please know we are here to help in any way we can, and please do not hesitate to ask all the questions you have.

Hugs, Lori

[molly muffin]

Hello neighbor. I'm a bit up the road in Mississauga, but do have friends in London.

I'm a bit concerned about doing cushing testing on Poppi until she is over the pancreatis, as it is a bodies natural response to produce cortisol when anything is going on in the body. This can cause false positives on the cushings test. So that is a concern.

Was a full cbc done? If so what was out of range, high/low. Also was Blood pressure checked, and was her heart checked?

When you say diagnosed with cushings via an ultrasound is that because there was an increase in adrenal size?

I am guessing they want to do an LDDS test tomorrow? Have you considered going to a Internal Medicine Specialist? I ended up doing that with my dog.

Welcome again and we look forward to hearing more about Poppi.

[Mz M]

Lori and Sharlene...thank you so much for your responses. I haven't responded until now because I was waiting for the test results. The vet called me a few minutes ago and confirmed that she does have cushings disease. I won't have a copy of the lab results until early next week. It was performed in Mississauga and the vet called me after hours, so he may not know how to forward it to me. I'll tell you what I know, but pardon my ignorance, I am not at all familiar with medical jargon.

I took her to the vets around the 16th of November because Poppi was not herself. Her abdomen was bloated (40 cm diameter), she was ravenous (I couldn't feed her enough), thirsty and her legs were weak. The vet did a LaserCyte and Catalyst One. I have those results if they would help anyone. Next he had x-rays taken. At that point he diagnosed her with pancreatis. She doesn't have any of the symptoms of pancreatis though, so I believe he misdiagnosed her with that. Her symptoms are more in-line with diabetes. Next we had an ultrasound done. The "final impression" on that was hepatitis or endocrine-induced Hepatopathy from onset of cushing's disease. Next we did another blood test, but I have no idea what it's called. The invoice refers to Cortrosyn and IDEXX ACTH stimulation Testing. That's the test that confirm she has the disease.

I stopped feeding them commercial food on Wednesday and started making their food. A site I found online had a great recipe and she is responding well to it. Has anyone tried alternative methods for treating this disease instead of just relying on western meds? I'm referring to acupuncture and herbs.

This is just heartbreaking. She's the sweetest, happiest little girl. Sigh...sometimes life really sucks.

[molly muffin]

What wa high or low on the other test you mentioned the vet did?
I think loris dog had pancreatis but no outward symptoms. It does happen.
Pancreatis could affect any Cushing's testing too.

[Harley PoMMom]

Yep, Sharlene is right, my Harley was diagnosed with pancreatitis, it was found during an ultrasound and later confirmed with a spec cPL test. Harley never displayed any symptoms of pancreatitis, with some dogs a loss of appetite with abdominal tenderness is noticed but not with my boy, and he did have a healthy appetite ;)

If pancreatitis is suspected I recommend having that spec cPL test performed because not only can it be used for diagnostic purposes it also can be performed to monitor the pancreatitis. With pancreatitis there is the acute and chronic form and both can cause diabetes in a dog which is one reason to get a confirmed diagnosis so the appropriate measures are taken to help heal that pancreas.

It would help us a great deal if you could get those test result copies and post them here, we need only the abnormal levels with their normal reference ranges. ;)

I know how upsetting it is to hear this news regarding your precious girl and we do completely understand but just know we are here for you both and will help in any way we can.

Hugs, Lori

PS: here is a link to info regarding the spec cPL test: http://www.idexx.com.au/smallanimal/reference-laboratories/testmenu/innovative-tests/spec-cpl.html

[Mz M]

These are all the test results I have:

Nov 17, 2016 (1:31 pm)
LaserCyte

Results Reference Interval
MCHC 38.9 g/dL 30.0-37.5 High
LYM 0.44x10^9/L 0.50-4.90 Low
PLT 577 K/?L 175-500 High

Nov 17, 2016 (1:37 pm)
Catalyst One

CREA 24?mol/L 44-159 Low
PHOS 2.24 mmol/L 0.81-2.20 High
ALB 40 g/L 22-39 High
ALT 251 U/L 10-125 High
ALKP 1106 U/L 23-212 High
GGT 36 U/L 0-11 High
AMYL 414 U/L 500-1500 Low
LIPA 3690 U/L 200-1800 High
K 5.9 mmol/L 3.5-5.8 High
CI 1050mmol/L 109-122 Low
TT4 11 nmol/L 13-51 Low

[Mz M]

Nov 19th

Test Results Ref Units
Hemolysis Normal
Icterus Normal
Lipemia Normal
Bile Acids(Pre) 2.0 0- 7.0 umol/L
Bile Acids (Post) 24.0 0-15.0 umol/L

Special Chemistry

Spec Cpl-Canine 455 0-200 ug/L

Nov 28th

Ultra Sound Examination
Radiology
1. Mildly enlarged liver
2. Mild mixed lung changes in right caudal(?) lung lobe

Ultrasound
1. Moderately enlarged but homogenous liver
2. Liver extends beyond cranial abdomen and the gall bladder is not obstructed
3. Both adrenal glands are mildly enlarged with maintained silhouettes
4. Fine opaque nepholiths are present in kidneys
5. Normal pancreas

Echocardiography

Right Adrenal = 1.8x.8 cm
Left Adrenal = 2.4x.8

Final Impression: Moderately hepatomegaly
possibly. Hepatitis or endocrine-induced Hepatopathy from onset of cushings disease

[Mz M]

Dec 1st

Endocrinology

Cortisol (Pre) 176 28-120 nmol/L
Cortisol (Post) >1380 220-550 nmol/L

We also had xrays taken, but I don't have any of that paperwork. Poppi was taking 1 cc of Metronidazole for the pancreatis. She is still extremely hungry, her abdomen has decreased significantly in size, thirst is normal. Sometimes her front legs are limp and she has a difficult time getting up. She hasn't jumped up on the couch for a month or so, she will do stairs still. She has a horrible, loud clicking sound on her right side midway down her body when she breathes. Her breathing is laboured. She is lethargic and doesn't get cold like she has in previous winters.

As soon as she was diagnosed, I stopped feeding her Hills food from the vets and started making her fresh food. Big improvement. We haven't started her on any medicine yet, but each day I give her 2 tsp of ground flax (lignans), 6 mg of melatonin, probiotics, 1/4 tsp Ascenta Canine Omega 3 and 1/4 tsp NP Chai Hu Jia Long Gu Mu Li Tang grans (Chinese herb...not spelling error). I also try to give her 25 drops of Unda-Spleninum each day.

I was extremely disappointed with the vet who diagnosed her. He wasn't offering any hope, so I consulted a holistic pharmacist on Tuesday. He provided some remedies to help offset Poppis test results. I met with a holistic vet on Friday. She went over all the test results and examined Poppi. She is not convinced that it is cushings. She will go over her medical records next week and then I will meet with her again. If she is unable to diagnose Poppi, I will try an intern.

Sorry I wrote so much, but I am trying to include anything I can think of.

I appreciate all your help.

Barb

[molly muffin]

Hi Barb, I've been away in BC, so haven't been on the forum. How is Poppi doing with the holistic treatment?

She sure does seem to have a lot going on with those results. Has the pancreatic numbers improved?

[Mz M]

Hi Sharlene. Hope you had a great trip to BC...it is beautiful out there!! Merry Christmas to you!! I posted all of Poppi's test results and am hoping for some opinions from the people on this site. Poppi's doing okay...considering. The holistic vet isn't convinced she has cushing's because she's having issues with her front legs and her breathing. More X-rays scheduled for this coming Thurs. Her nose has always been wet and drippy, but recently it's become very dry. We started applying coconut oil to it, so hope that helps till I can talk to the vet. I noticed her brother holding up his paw like poppi started doing a few months ago. I feel sick and panicky at the thought of him getting this too!! I'll get his blood checked this week. (God I hope he's ok).

Barb

[Harley PoMMom]

Hi Barb,

I'm going to take a stab at deciphering Poppi's test results and share some of my thoughts, but this is just my opinion. ;)



Nov 17, 2016 (1:37 pm)
Catalyst One
ALT 251 U/L 10-125 High
ALKP 1106 U/L 23-212 High
GGT 36 U/L 0-11 High


All three of these are liver enzymes but the ALT and GGT are more specific to the liver, I also see her bile acid test was high which could mean her liver isn't functioning as well as it should be.


Nov 19th

Bile Acids(Pre) 2.0 0- 7.0 umol/L
Bile Acids (Post) 24.0 0-15.0 umol/L

Special Chemistry

Spec Cpl-Canine 455 0-200 ug/L



The 455 does indicate pacreatitis, did the vet mention to start her on a very low fat diet? Some other things that help with pancreatitis is to feed her 3-4 small meals throughout the day, also it is important that she keep hydrated.


Ultrasound

4. Fine opaque nepholiths are present in kidneys


Nephrolith is an another word for a kidney stone and should be monitored because sometimes not all stones are passed and can obstruct the ureter.



Dec 1st
Endocrinology

Cortisol (Pre) 176 28-120 nmol/L
Cortisol (Post) >1380 220-550 nmol/L



Converting her post # to ug/dl units = 50 ug/dl...that's pretty high, so there is something going on that is causing the cortisol to become elevated but this doesn't necessarily mean that it is definitely Cushing's as other non-adrenal illnesses can increase the cortisol levels such as that pancreatitis and kidney stone.

Hugs, Lori

[Mz M]

Hi Lori!

Thx for your input. I received no direction or guidance from my vet of 20+ years. He diagnosed her, gave us two types of antibiotics and that was it. I asked him about trilaste (?) and he said the side effects could be awful, but we could discuss it. He said she would only live for 1-1 1/2 yrs either way. I was aware of the kidney stones, but when I asked him what to do about them...his advice was to do nothing. Talk about disheartening. I have since started working with a holistic vet and pharmacist. Immediately after the diagnosis, I began making the dogs food. Extremely healthy, grain free and low fat. She does eat many times throughout the day, her appetite has decreased only slightly. She has many (!) supplements throughout the day to deal with each of the issues, but she is not taking any western medication. As I mentioned in a previous post, the new vet is not convinced that Poppi has cushings.

[molly muffin]

I don't think it is definite that Poppi does have cushings and there would be no point in pursuing cushings, while the pancrease numbers are elevated.

You will want to retest the pancrease and liver and see if those are normalizing. It can take time.
Hopefully once the pancreatic episode is past, the liver values will adjust downwards and then you can see where you are at with Poppi.
I so hope that you aren't facing the same thing with both your furbabies!