Altira's Husky Elly Possible Cushing's

[Altira]

Hello Angels!

This is Janis Beghtol. I've been here before with my Kira (adrenal Cushing's) and Mira (cancer).

Can anyone tell me what iostonic Cushing's is?

[labblab]

Janis, hey there girl!!!!! :)

We are usually always so glad to see you, but not at the expense of there being something wrong...:o :(

No, I've not heard of isotonic Cushing's, either. Can you tell us more about what's going on for Elly?

Marianne

[Altira]

Current Senior Panel
Dr. Horn
(Regular Vet)

SDMA - Perfect
Blood Chemistry - Perfect
Thyroid - Perfect
Hematology - Perfect

Urinalysis (In-clinic)
WBC = None to rare
RBC = 6-20/HPF
sqEPI = None to rare
naEPI = 1-2/HPF
Hya Cast = None to rare
NoHya Cast = None to rare
CaOxDi = None to rare
Struvite = None to rare
UnClass = None to rare
Collection = Cystocentesis
Color = Straw (never heard that before)
Clarity = Clear
Sp Gravity = 1.000
pH = 9.0
PRO = Neg
GLU = Neg
KET = Neg
BLD = 50 Ery/uL
BIL = Neg
UBG = norm
LEU = Neg

Dr. Horn wants to test her for Cushing's. Do any of you agree?

The previous post I wrote was from something Dr. Mar, Elly's eye specialist said. Elly has a luxated eye and we are using steroid eye drops multiple times a day, for 1 year and 3 months now to try and save it. She mentioned iostonic (I think) Cushing's on my phone recorder.

[Altira]

Marianne!!! my heart all a-flutter angel!

[labblab]

OK, the eye vet is talking about Iatrogenic Cushing's. This refers to the creation of Cushing's symptoms due to the use of supplemental steroids. As far as the body is concerned, elevated natural cortisol levels and excessive use of supplemental steroids can result in identical problems. So I'm assuming the concern is that the longterm use of the steroidal eye drops is producing negative systemic changes for Elly.

As far as the labs you've posted, the only abnormality I think I'm seeing is a low specific gravity to her urine. This would imply that her urine is quite dilute -- is she drinking and peeing a lot? Are any other of her values marked as being too high or too low on the report? How about any other observable symptoms or problems?

[Altira]

OK, the eye vet is talking about Iatrogenic Cushing's. This refers to the creation of Cushing's symptoms due to the use of supplemental steroids. As far as the body is concerned, elevated natural cortisol levels and excessive use of supplemental steroids can result in identical problems. So I'm assuming the concern is that the longterm use of the steroidal eye drops is producing negative systemic changes for Elly.

As far as the labs you've posted, the only abnormality I think I'm seeing is a low specific gravity to her urine. This would imply that her urine is quite dilute -- is she drinking and peeing a lot? Are any other of her values marked as being too high or too low on the report? How about any other observable symptoms or problems?

This isn't making me feel any better... Would stopping all steroid intake help or is it too late?

ALKP = 20 L ref 23-212
This is the only one out of the referance range. All others are like dead center.

Urine is probably dilute due to water intake. Yes she pees a lot when she goes. She pees on the cement which is odd for her. I'm feeding her less but she's still gaining weight.

Iatrogenic - thanks, now that I have the correct word I'll look that up.

[labblab]

With Cushing's, ALKP would be high rather than low. So it sounds as though the dilute urine and weight gains are the only obvious issues for Elly. Why does Dr. Horn want to test for it, anyway? Are those the reasons she is giving?

With Iatrogenic Cushing's, the issues can basically be reversed simply by gradually weaning the dog off the steroids. So procedurally, that part of things is simple. However, you have to weigh the risks and benefits of doing that in terms of the condition for which the steroids are being given. Are there alternative treatment options? Will the dog be worse off or more uncomfortable if the steroids are discontinued?

It sounds as though Ella's eye vet is well aware of the nature of the possible problem, so that is good since probably she would be the one who can best help you evaluate the issues and options. Please let us know how things develop, OK?

Marianne

[Altira]

If we stop the steroid eye drops the lens in her eye could pop out again. And likely the eye will have too be removed then. In the beginning it went back on its own. We trapped with lens Behind the pupil with eye drops that keep her pupil small. She has some vision in that eye. Shadows maybe. Three drops twice a day. Every 12 hours. That inludes glaucoma meds and a antibiotic. I keep Records of it all. There may be steroids in all three I'm not sure. The chances that it will happen to the other Eye are very good. We could lose her vision completely. Lose both eyes. We are fighting to save what vision that she has it all right now. We could also stop the steroids if we wanted to. And possibly stop the Cushing's. That's my choice blindness or Cushing's. I will stop the steriods. In fact we already have except one. The vet suggested other options. I write her and she leaves messages. Her last message ended with the word cushings. That's why I'm here. She is concerned about it too. Hopefully we will get to talk today. I can't sleep. This will be devistating to me. My Elly with no eyes. But I know cushings is way worse. We just aren't sure it's cushings yet. I'm not sure why the regular suspects it really. Steroids can cause her symptoms I think too. Anyway. It's been a long 15 months so far. She has a bad reaction to the meds. Goop and thick stuff drains down her face. We think she is allergic to it. She had it tested. It's not bacteria. I have to wash her at least twice a day. Meds have to be on time. I have all these alarms that go off to remind me. Bud has to pull off the side of the road sometimes because I have to do A series of eye drops which have to be fifteen minutes apart. Poor Elly. Often I use an eye cup filled with eye wash. She's such a good girl.

[Joan2517]

How old is Elly now? Is she showing other symptoms such as drinking and peeing more?

[Squirt's Mom]

Hey Janis!

Dang, girl! Another one?! Elly is in a tough position but as mom to blind dogs I can tell you they do adjust, usually much easier than we do. Marianne has you off on a great start...I just wanted to say howdy and love you!
Leslie

[labblab]

We just aren't sure it's cushings yet. I'm not sure why the regular suspects it really. Steroids can cause her symptoms I think too.

Hey Janis, I just want to clarify with you that if the vet is mentioning Iatrogenic Cushing's, that's exactly what she means -- it's the supplemental steroids themselves that are causing the symptoms. It's not a naturally-arising problem with Ella's own cortisol or adrenal gland functioning. So this would be very different from Kira's situation, and pretty easily reversible.

From what I can tell so far, there's really nothing wrong with Elly other than the dilute urine, so I don't think this is an urgent matter. You have time to sort it out and decide whether switching eyedrops is a good idea. One thing to warn you is not to abruptly stop steroidal supplements in any form. You need to follow a tapering dosing schedule if you're going to discontinue them, so definitely consult with the eye vet before stopping any drops. There are two reasons for this. Abruptly stopping may cause damage to the eye. But also, Elly's adrenal glands may need some time to adjust to producing a sufficient amount of natural cortisol again once the supplemental steroid is decreased.

Also, I'm especially glad that Leslie has stopped by. She has had a lot of experience dealing with blindness in furbabies. We surely hope that this won't become an issue for Elly, but if it does at any point in the future, I know Leslie will be able to offer enormous support to you.

Marianne

[lulusmom]

Hi Janis, and welcome back, though I'm sorry for the reasons you have to be here.

Unadulterated water has a specific gravity of 1.000 and I don't believe I've ever seen a dog with a USG that low. Did Elly have previous urine tests done that yielded a low USG? Did her excessive drinking and peeing start suddenly or was it gradual? I ask because while central diabetes insipidus isn't all that common, some of us have lived with it in our dogs. My Jojo's excessive drinking and peeing never resolved with cushing's treatment so we did a trial with desmopressin eye drops. Unfortunately he didn't respond to those either so his specialist ultimately diagnosed nephrogenic diabetes insipidus. Dogs with this form don't drink and pee a lot because they have too little antidiuretic hormone (ADH), they simply don't respond to it. This form can be genetic or acquired. Oddly Siberian Huskie's are on the list of breeds predisposed to NDI; however, this problem becomes apparent when a dog is weeks old, not years old so I think genetics can be ruled out.

The one thing that is odd is that if the steroidal eye drops are causing the problem, you would frequently see some lab abnormalities and more symptoms that are commonly associated with cushing's. Elly's labs are unremarkable as it relates to cushing's so it does make me wonder if there may be more than steroids at play. You may want to consider a trial with desmopressin acetate. I used eye drops for Jojo but since Elly has enough going on with her eyes, there is a nasal spray available that would probably be better. There may even be a pill form but I'm not sure. Desmopressin acetate is a synthetic form of ADH so if Elly ADH deficient, she should respond to the treatment rather quickly. If she doesn't respond within a week, lack of ADH is probably not the problem and she could have nephrogenic diabetes insipidus or iatrogenic cushing's.

I hope that you and yours are otherwise doing well.

Hugs,
Glynda

[Altira]

I feel like the luckiest girl in the world! Great news. The eyedrops Ellie is using right now contains no steroids. It also constricts her pupil which keeps the lens inside her eye. On top of thaT all the goop and junk that's been collecting and dripping from her eye is going away. We are hoping that all the symptoms of Cushing's will go away now. We will give her one month for that. Then we'll go visit Dr. Mar again. I am most pleased

You Angels sure have waved a hopeful wond over us, maybe a happy conclusion for once in this ever so sad place. I read one thread last night and was reminded of what a devistating place this can be and the wonderful work you guys do to help and comfort others. Thanks to you all for chiming in. Dr Mar does not see good reason to test for cushings right now. Elly was also taking2.5mg of prednisone every other day. Hardly a dangerous among but I will stop doing that too.

Well I was so excited to tell you all about this I will now go back and read the new posts that I hadn't read yet.

[Altira]

Glynda, we will be watching for these things. Yes she has taken a pill form before combined with the Latanoprost she is getting right now. She did well with it. But the glaucoma didn't respond well so that's why we stopped. We are not worrying about glaucoma at the moment. Just getting her off of steroids right now and see what happens. Thank you!

Elly will be 9 in April. We adopted her in January 2015. When we lost Kira. She had a couple other major problems will allergies and at one point was hacking up white phlegm for hours. And the inside of her ears were black! Dr Rossi a few thousand dollars later and fists full of prednisone those problems are currently gone, allergic rhinitous. I'm amazed that her blood work was so good.

Leslie, my heart goes pitter pat sweetie. If Ellie should go blind at some point I'll be knocking at your door, I promise

My gosh Marianne, Glynda, Leslie ... you all have been here for such a long time.

Hello Sibble, Joan. Seems we have new angels here. Welcome.

XXXXXOOOO

[Joan2517]

Hi Janis,

Sibble says hello, and is happy for your news!

Hugs,
Joan

[molly muffin]

Hi Janis! Wow, good to see a good update on Elly. My heart dropped when I saw your thread and thought, oh my gosh, not something with Elly now too!!

I'm so glad that the eye drops which are so important to her vision don't have steroids so you can continue those. Good news! Do keep us posted on how you and Elly are doing.

Hugs!