Odd Cushing's Symptoms???

[sjpitcher]

Hello! I've been reading on your site for a few weeks. My dogs was just diagnosed with adrenal gland tumor cushing's.

But my dog, Happi, (14 yr old lhaso apso) is not acting like the typical dog with cushings and I can't get or find an explanation.

Happi sleeps all day every day except for occasional bathroom breaks. She stopped eating two months ago, following dental surgery. Other than lethargy and high BP, she has no cushing's symptoms EXCEPT 3-4 hours after she eats (takes appetite stimulant to force eating), she starts drinking excessively for 3-4 hours. The routine is the same every night. I give her the app stimulant between 4-5pm. If she eats, it's between 5-8pm. Then around 10/11pm every night, she starts drinking excessively and keeps this up until about 2am. From 2am until 10ish the next night, she drinks normally.

My vet keeps saying she doesn't eat bc of the high BP and says to keep giving her the app stimulant. Last week vet started Happi on BP medicine. And this week, vet start Happi on 10mg of Vetoryl. She's scheduled for blood work and another low dex test in two weeks to see how she's doing.

Prior to dental surgery, Happi was eating less and getting her to eat was a struggle. She occasionally had trembles that subsided after 20-30 minutes that I thought were bc she was cold. She took 5-8 short walks around the yard and one long walk every day. She played every night. She seemed healthy and happy. The vet had been pushing me to get her teeth cleaned and so when I got the money together, I scheduled the appointment.

I picked Happi up after dental cleaning and she seemed out of it and traumatized. Shaking. Out of her mind. I acquainted it with the trauma of having never been anywhere overnight and anesthesia. But dog I dropped off for her teeth to be cleaned has never returned to me. That was over two months ago.

Ten days after dental surgery I called vet and said something was wrong. Happi was lethargic and not eating and her personality was gone and her stomach gurgled something awful. Brought Happi in to be checked. Vet examined her mouth and thought everything looked fine. She thought maybe Happi had developed an ulcer from the metacam after surgery. She prescribed ulcer medicine and appetite stimulant. She gave her a cortisone shot (never explained why) and under the skin antibiotics...in case there was an infection. Told me to wait a week before grooming Happi (bc I asked if I should wait). One week later, Happi was eating, seemed a little better but still lethargic, still gurgling stomach. Groomer came over to groom Happi. Called me from her mobile truck that Happi was completely resisting being groomed. Groomer struggled with her and now Happi was limping. Groomer was agitated. I grabbed my other dog and went to the truck. I gave her Sassy and took Happi back into the house. Happi was melting down into hysteria. Shaking uncontrollable. I grabbed a heating pad and put it on the sofa. I held Happi while I blew her dry. I wrapped her in a dry towel and put her on the heating pad and sat with her until groomer came back with Sassy. Made another vet appointment for Happi for the next day.

Vet did blood work and found nothing out of the ordinary. Vet did a urine analysis and found nothing. Vet did a urine culture and said it would take a couple of days for results and asked me to leave dog so that when the ultrasound tech came that day, they could do a ultrasound.

Ultrasound showed a tumor on her adrenal gland. Vet wanted to delay low dex test until results of urine culture. Urine culture was negative. Low dex test was done and vet said Happi had cushings. The day the low dex test was done, Happi melted down at vet. They checked her blood pressure and said it was dangerously high. Vet put Happi on BP medicine and said to come back in a week.

I took Happi back on Wednesday and her blood pressure was still sky high. Vet changed her BP medicine and started Happi on vetoryl.

Now Happi won't eat even with app stimulant.

Based on everything I've read, Happi is not typical. I can't find any explanation for why she won't eat. I can't get over the fact that Happi was energetic and seemingly healthy before dental surgery and now is a blob on the couch. I can't reconcile the symptoms of cushings with her symptoms.

I don't have any test results bc vet always tells me verbally on phone or during appointment. I do have her results from December 2016 bc I saw a different vet at the practice and she gave them to me.

Can anyone tell me anything about why Happi won't eat, and only exhibits cushing's symptoms after eating...except for the high BP and lethargy?

She's suffering. I'm doing everything I know to do to help this dog but nothing is helping. Maybe after a couple of weeks of taking vetoryl, she'll feel better but I'm not convinced that her symptoms are related to cushing's.

Susan

[labblab]

Hello Susan, and welcome to you and little Happi. I am so sorry, though, about all the problems you are experiencing. Like you, I have to wonder whether something dramatic happened during that dental cleaning since her behavior changed so radically on that day.

Unfortunately, I don't have a lot of time to post write now even though there are a number of issues with Happi that I'd like to address. However, I do want to give you the link to an article that discusses a very unusual form of Cushing's in which the symptoms manifest after meals. I don't know that Happi really fits this profile, but I wanted to give you the link so that you can at least take a look.

http://veterinarymedicine.dvm360.com/meal-induced-hyperadrenocorticism-dogs-not-be-overlooked

It may be tomorrow before I have the chance to return and write more. But once again, welcome, and I'm really glad you've found us.

Marianne

[sjpitcher]

Thank you so much Marianne. Silly but just having you reply, made me cry. It's killing me to watch her like this and not be able to help her. I search for answers all night long, every night.

I read that article today and I wondered "is it possible" that she does have a tumor but the symptoms are only triggered when she eats. Though that doesn't explain the lethargy the rest of the time.

I'll look forward to hearing more from you.

Thank you so much - Susan

[molly muffin]

Hello and welcome from me too.

Holy wow. Okay the very first thing I will say is you should Never give cushing meds to a dog that will not eat. They need to be eating to obsorb the medication and not just a snack kind off thing.

Next I'm having some trust (alot actually) issues with your vet. Can you get a copy from you vet of all the test results from right before the dental up to now, includuing cushings test, etc.

Everything you have said points to a highly tramautizing incident during cleaning and possibly something else Not eating afterwards like she isn't could be a sign of her teeth hurting her so much she can't and the stimlant forces her to hungry enough to do so even if she is in pain.

Then can you post any abnormal high low results from those tests here for us to look at.

And as soon as you get those results, I'd ask if it is possible to take her to see a specialist or at the very least another vet not associated with the current vet you see. I just feel like something is wrong from that cleaning. It is possible that she even got an infection from the cleaning and that would be bad, if not looked into and can cause any cushings test to reflect high cortisol falsely. (cortisol being risen due to pain or other issue)

Cortisol will increase in reaction to many things not just cushings. She wasn't exhibing signs of cushings before the dental I am guessing from what you have said. The signs even now don't point to cushings.
I'm disturbed that your vet went down the cushings roads, when it is completely obvious that there is something seriously going on in relation to that dental.

Hang in there and lets see where this leads, but please don't administer vetroyl at this point.

[DoxieMama]

Hi Susan, welcome to you and Happi.

Just curious, did the vet say anything about how she was acting when you picked her up from the dental? Or about anything that might have happened during (or afterward)? I'm assuming they didn't or you would have mentioned that already. But like Sharlene, it sounds to me like something happened that day.

I'm also wondering if she still trembles occasionally, like you mentioned before the dental. Does her tummy still gurgle a lot or has that subsided?

Sorry for just providing more questions! I hope you can get her in to see another vet, as Sharlene suggested, not associated with the current one. If you have copies of all the tests done, I'm sure that will be helpful to them also.

[sjpitcher]

Thank you Molly Muffin,

I have been making sure dog eats a meal before giving the vetoryl. I made the mistake of giving meds on a snack or treat and it's not enough. But since Happi is not wanting to eat even with the app stim, it's really challenging.

I think she was traumatized at vet during dental also or the anesthesia has harmed her...taken her personality. I'm more apt to think the "trauma" was being left at the vet. She hasn't outside her home since being spayed as a puppy. I left her at the vet for two days to minimize the trauma of moving. Instead, I could have inadvertently traumatized her more. The vet said everything went very well with the dental surgery. Vet said her teeth were in great condition, just lots and lots of tartar/plaque (???) but cleaned up beautiful except two teeth needed to be pulled. Said one was infected and infection was deep.

I will get printed copies of all blood work, low dex and urinalysis tomorrow. Will post for review.

I'm starting to believe as you stated that the vet visits, groomer, anyone but me and family, trigger trauma from vet overnite/dental. Her blood pressure rises and I'm sure so does her cortisol. So any test done at the vets could read positive when they are simply bc she's now scared to death of the vet. I read one vet's blog and he said never do low dex test if animal is sick. So my vet shouldn't have done the test when Happi was sick, not eating and had high BP.

I don't think Happi's teeth are hurting but I'm not ruling out a lingering infection...perhaps in the bone. She has had two doses of antibiotics since having her teeth cleaned but maybe she needed longer dosing???

Also my sister pointed out that when the vet gave Happi a cortisone shot...for no apparent reason...when I brought her back to vet ten days after dental surgery...that cortisone could still have been present in Happi's system if it was a long acting shot...and that too could have effected the low dex test.

Happi drank less water last night during the 10/11pm to 2am period when she normally drinks a ton. Could it be the vetoryl or was it bc she ate less last night??? Don't know.

I read another vet blog that said never treat cushings unless you have physical signs of cushings. So I need my vet to tell me what physical sign she sees bc I see none.

Finally, Happi seems to be having discomfort in her stomach, sides today. Tender to touch. This seems new bc vet keeps pressing her stomach to see if there is tenderness.

Also today, I gave her BP med and app stim on an empty stomach bc she wouldn't eat and neither require she take with food. But she was wimpery shortly afterwards. I tried to get her to eat. Put out chicken, cooked ground beef, dog food. Eventually she was circling the bowls, like she wanted to eat but wouldn't. I looked in fridge for anything else that I could offer her. Cheese - no. Cold leftover steak? I don't give this to my dogs anymore bc they are old and they don't digest it well. But I grabbed a strip and sat on floor with Happi, tearing very small pieces off. She would eat the really raw steak. Spit out anything really cooked or with fat. But she ate a decent amount. But now she seems unsettled. I may end up with an emergency vet visit today.

I'm wondering if it's Conn's Sydrome. I'm continuing to scour the internet. Will ask my vet for a referral to the North Carolina Vet School tomorrow or I'll make an appointment with the Veterinary Specialty Hospital up the road. They did Sassy's surgery when she was kicked by a deer (long story) and they did an excellent job. They are also who my vet is calling for information. I know this bc they called me direct and asked if I wanted to bring Happi in. I'm sure a professional no-no but I stuck with my vet.

I'll get all Happi's test results posted tomorrow. I thank you so much for your reply.

Susan

[Squirt's Mom]

Hi Susan, welcome to you and Happi! :)

I want to let you know that it is possible to have a growth or tumor on the adrenal gland that is NOT secreting cortisol...is that is not causing a dog to have Cushing's. There is a fairly rare tumor called a pheochromocytoma. One of it's hallmark signs is high blood pressure. It can cause false positive on Cushing's test and cause some of the same signs as Cushing's....but it not Cushing's. Here are some links on that -

https://www.addl.purdue.edu/newsletters/2007/Spring/CP.htm

http://www.petmd.com/dog/conditions/cancer/c_dg_pheochromocytoma

http://www.cliniciansbrief.com/sites/default/files/attachments/Adrenal%20Mass%20in%20a%20Dog.pdf

One of my babies has a growth on her left adrenal gland and due to other health issues we cannot operate on her. So her vet has chosen to treat with Lysodren - claiming if it was a tumor Lyso would not cause it to shrink but if NOT a tumor it would shrink. It is shrinking. However they still think she has Cushing's...but I'm not convinced. Maybe just stubborn but.... ;)

Don't jump on the Cushing's bandwagon just yet. Like Marianne, I feel something happened while at the vet for the dental. I just boarded mine for the very first time and one of them came home very very upset. I was worried about her for the first few days but thankfully she has returned to her normal self. But that stay was very traumatic for her so I can see at the very least simply being away from home and mom plus being kept in a small cage they can't get out of, around strange people, hurting, strange smells and sounds...yeah it can have an effect on dogs who are extra sensitive. So whether someone goofed causing Happi to suffer somehow or just the experience - these changes you are seeing happened then. Cushing's just does not come on that fast.

I third the suggestion to see another vet - an IMS (Internal Medicine Specialist) if possible. ;) And do STOP the Vetoryl for now. We never ever give these meds to a dog who is acting unwell.

Glad you found us and look forward to getting to know you both better as time passes. You need to know you and Happi now have a new family and we will be by your side all the way.

Hugs,
Leslie and the gang

[sjpitcher]

Doxie Mama,

I gave a long reply to Molly Muffin but didn't address your question of whether she trembles any other time. The answer is yes, when at vet, around groomer, around strangers, around anything out of the ordinary. She seems scared all the time now. I think she's going blind and she is hard of hearing and that might contribute to her fearfulness.

[sjpitcher]

Squirt's Mom,

Vet originally thought pheo tumor but bc the low dex test was positive, she said it was cushings.

I will search today for a local IMS or ask vet for referral to North Carolina State Veterinary School...not sure which is best.

[sjpitcher]

Squirt's Mom,

Didn't thank you so....THANK YOU!

It could still be a pheo tumor. The more I learn, the less convinced it's cushings.

[judymaggie]

Susan -- I wanted to add my "welcome" to you and Happi! You both have really been through it. You have received some excellent guidance already. When deciding between a local IMS and the veterinary school, you already have had a good experience at the IMS. One downside of a veterinary school is that much of your time there will be working with veterinary students, not vets. You might find that a private IMS will provide more personalized attention and, since they have already reached out to you, that sounds like a good option to me.

[Tealster]

Susan:

Did they check your dogs' pancreas? If the sides hurt sometimes it can be that.

Also, dental work can be very painful and lead to infection which can effect the heart too.

Get a new Vet.

[sjpitcher]

Squirt's Mom,

I think you are right! Pheo tumor. And cushing's wouldn't come on that fast. I've been researching since you and others responded.

Last night I was convinced Happi had pheo tumor and food induced cushings. But tonight, I think it's just pheo.

Happi was whimpering last night. Uncomfortable. I racked my brain and realized this followed my giving the appetite stimulant. I researched the drug and discovered it can cause racing heart and rapid breathing. Trachardia. I talked with a nurse at emergency vet and they told me if it worsened to bring her in. It didn't.

Happy threw up after I came her BP meds this morning. I had had it!! Everything I do to help my dog makes her worse. I called vet. She is out until Wednesday. I was so discouraged I decided I was going to put Happi to sleep to end our suffering.

I didn't give appetite stimulant tonight. Happi didn't eat much. Baby food, little chicken and some bread. She wanted to eat but wouldn't. But I felt she had enough in her stomach that I could give her BP med and vetoryl. I know it was said I shouldn't bc no one believes Happi has cushings but Happi drank less last night so I couldn't stop vetoryl if it was helping and bc I believed she might have food induced cushings.

It's almost 2am and Happi has been asleep for three hours and she hasn't gotten up to drink once. Is this bc she has cushings and vetoryl is working? Is it bc she didn't eat much? And then it hit me, is it bc she didn't have the appetite stimulant???

I researched the drug. It's a good drug. Its mirtazapine. But it can cause excessive drinking. And worse, it can cause hypertension crisis in dogs with pheo tumors. Is this crazy??? Vet prescribed it for Happi about 7-10 days after dental surgery bc she thought Happi had an ulcer from metacam following the surgery. Happi has been on it for six or seven weeks.

This is all theoretical at this point but it it could be mirtazapine that's caused the hypertension and excessive drinking at night. The rest of her symptoms could be from the pheo tumor. Of course a pheo tumor is not great news but always better to have correct diagnosis.

I can't explain the low dex test results except as you, others and I said, it could be the hypertension and stress that caused a false result. One thing I read last night was if there are no cushings symptoms, don't treat cushings.

I've documented everything and I'll be talking with Happis vet on Wednesday but she's gonna have to take me thru why I'm wrong and she's right with medical facts or I'm getting a specialist.

I'm stopping the mirtazapine forever. I'll research stopping the BP medicine tomorrow. But I'm wondering, is it dangerous to stop vetoryl tomorrow or should I wait to talk to vet?

You and others have been so great in your responses!! I'm so grateful. You got me headed in the right direction, documented what I read and kept me thinking about this until I got a more reasonable explanation.

Thank you.

Susan

[Harley PoMMom]

I'm sorry that Happi is having these issues. :( And there is no danger in stopping the Vetoryl, in fact since she is not eating normally it is best to withhold it because Vetoryl should be given with a meal to be properly absorbed.

What BP medication is she taking? Some BP drugs can cause nausea. I'm wondering if her tummy tenderness is from pancreatitis as this can cause that and it also may make a dog have inappetence. The tests used to diagnose pancreatitis are the Precision PSL or spec cPL.

A supplement that you may want to research for her tummy issues is slippery elm bark (SEB), I'm including this excerpt about SEB:
It coats and soothes the mouth, throat, stomach, and intestines. It also contains antioxidants that help relieve inflammatory bowel conditions. Slippery elm also causes reflux stimulation of nerve endings in the gastrointestinal tract leading to increased mucus secretion. The increased mucus production may protect the gastrointestinal tract against ulcers and excess acidity.

Slippery elm (http://umm.edu/health/medical/altmed/herb/slippery-elm/)

One word of caution with Slippery Elm it that may interfere with absorption of some medications, so it is advised to give SEB a couple hours before/after any medications.

Lori

[sjpitcher]

Here are Happi's blood test results from 5/24

Hematology
5/24/17 8:33 AM 5/16/17 5/11/17 3:13 PM
TEST RESULT REFERENCE VALUE
RBC 8.31 5.65 - 8.87 M/µL 8.77 7.29
Hematocrit 51.2 37.3 - 61.7 % 53.0 46.6
Hemoglobin 18.1 13.1 - 20.5 g/dL 19.0 16.7
MCV 61.6 61.6 - 73.5 fL 60.4 64
MCH 21.8 21.2 - 25.9 pg 21.7 22.9
MCHC 35.4 32.0 - 37.9 g/dL 35.8 35.8
RDW 19.0 13.6 - 21.7 % 20.4
% Reticulocyte 1.1 % 1.1 0.9
Reticulocyte 88.9 10 - 110 K/µL 93.8 66
WBC 13.53 5.05 - 16.76 K/µL 10.35 14.4
% Neutrophil 77.0 % 71.6 81.6
% Lymphocyte 14.0 % 15.8 11.9
% Monocyte 4.6 % 5.2 4.2
% Eosinophil 4.0 % 7.3 2.2
% Basophil 0.4 % 0.1 0.1
Neutrophil 10.41 2.95 - 11.64 K/µL 7.4 11.75
Lymphocyte 1.9 1.05 - 5.1 K/µL 1.64 1.714
Monocyte 0.62 0.16 - 1.12 K/µL 0.54 0.605
Eosinophil 0.54 0.06 - 1.23 K/µL 0.76 0.317
Basophil 0.06 0 - 0.1 K/µL 0.01 0.014
Platelet 486 148 - 484 K/µL H 469 453
MPV 8.3 8.7 - 13.2 fL L 9.1
PDW 9.8 9.1 - 19.4 fL 10.8
Plateletcrit 0.40 0.14 - 0.46 % 0.43


URBC MONO LYM NEU BASO EOS
Chemistry
5/24/17 8:40 AM 5/16/17 5/11/17 3:01 PM
TEST RESULT REFERENCE VALUE
Glucose 101 70 - 143 mg/dL 92 76
Creatinine 1.2 0.5 - 1.8 mg/dL 1.4 1.6
BUN 44 7 - 27 mg/dL H 28 42
BUN:Creatinine Ratio
37 20 26.3
Phosphorus 3.9 2.5 - 6.8 mg/dL 3.5
Calcium 10.6 7.9 - 12.0 mg/dL 9.1
Sodium 153 144 - 160 mmol/L 157 151
Potassium 3.5 3.5 - 5.8 mmol/L 3.3 3.6
Na:K Ratio 44 48 42
Chloride 114 109 - 122 mmol/L 117 110
Total Protein 6.6 5.2 - 8.2 g/dL 6.7 5.5
Albumin 3.4 2.2 - 3.9 g/dL 3.1 2.7
Globulin 3.2 2.5 - 4.5 g/dL 3.6 2.8
Alb:Glob Ratio 1.1 0.9 1.0
ALT 116 10 - 125 U/L 48 42

Chemistry (continued)
TEST RESULT REFERENCE VALUE
ALP 21 23 - 212 U/L L 16 14
GGT 5 0 - 11 U/L 6
Bilirubin - Total 0.1 0.0 - 0.9 mg/dL 0.1
Cholesterol 217 110 - 320 mg/dL 201
Osmolality 312 mmol/kg 31

[sjpitcher]

I spoke with Happi's vet today. I asked her about Happi not having typical Cushing's symptoms and how the low dex test could have been influenced by how sick she was when the test was done. Mentioned food induced Cushings. But when I mentioned Conn's Syndrome (Hyperaldosteronism) she said she hadn't heard of it....said she'd probably recognize it by medical name Hyperaldosteronism. She was not aware or had forgotten this rare condition and asked if I was referencing something for humans or cats. She jumped on internet and got up to speed quickly. She then said Happi's electrolytes didn't support it bc her potassium was normal. I said "was it?" She quickly checked and said no, it wasn't. She apologized for skipping over this in her analysis and then said she wanted to refer me to a specialist. She called the same specialist she had consulted with to get the Cushing's diagnosis and called me back. Said specialist still believed Happi's blood test results support a diagnosis of Cushings but that it was possible that it was Conn's syndrome instead and that she'd run tests if I brought Happi in. I don't want to make an appointment with the specialist until people on this forum review Happi's results.

What do you all think?

[Harley PoMMom]

The good majority of dogs (80-90%) with Cushing's have a very elevated ALP. Other lab anomalies generally found in cushdogs are high cholesterol and triglyceride levels. They also have what is referred to as a "stress leukogram," which refers to a specific white blood cell distribution in the blood. This includes a high total white blood cell count with increased numbers of neutrophils (NEU) and monocytes (MONO) and decreased numbers of lymphocytes (LYM) and eosinophils (EOS. I'm not seeing these anomalies in Happi's blood work. Is Happi's urine dilute?

I think a Cushing's diagnosis is questionable because her blood work does not show the abnormal levels that are commonly seen in Cushdogs and along with Happi's lack of symptoms, this makes me believe that something else is going on.

Hugs, Lori

[sjpitcher]

Lori,

Thank you so much!!!

How should I proceed in your recommendation? I'm a little reluctant to go to the specialist who my vet consulted because the specialist thought it was Cushings...you know what I'm saying? Would you find someone completely new or go to the vet recommended specialist?

Susan

[sjpitcher]

I don't know about her urine. Here's the urinanalys that I received.

Urinalysis (continued)
TEST RESULT
Non-Squamous Epithelial Cells
None to rare
Mucus NONE SEEN
Casts NONE SEEN
Hyaline Casts None to rare
Non-Hyaline Casts
None to rare
Crystals NONE SEEN
Calcium Oxalate Dihydrate Crystals
None to rare
Struvite Crystals None to rare
Unclassified Crystals
1 - 5 /HPF

[molly muffin]

Looking at these tests results, they don't say cushings to me and along with not having cushing symptoms, I am not inclined to think that is the issue. I also wouldn't suspect a pheo tumor unless an ultrasound confirmed there was a tumor present. Nor do I think food induced cushings. I don't think cushings at all.

It could be the various medications causing an issue, in her reaction to any of them. No one can say how any given dog will react, just the typical.

BUN could be raised just due to stress, dehydration during the test. That one I wouldn't worry about. (it was the most elevated of any test results)

My thought is I'm going with the deep tooth infection being the over all problem. (just a guess) but a deep infection can get into the rest of the body. You don't want it to become septic. Is she still on antibiotics still? Instead of the appetite stimulant, maybe try enticing with food, if that isn't helping her any. Smelly foods, or foods that you can supplement with to entice her. Smellly is often good. Maybe a tripe.

[sjpitcher]

Thank you!! All who responded.

Your input and counsel pushed me to find a new vet. New vet wanted telephone discussion first. About ten minutes into it, vet said, bring dog in now. She feared Addisons. And since dog had been put on vetoryl felt it was an emergency. Happi was tested for Addisons there and it was negative. Vet said, like you all said, blood work was not indicative of cushings. Also said the low dex test was inconclusive and Happi never should have been put on vetoryl. Happi is now scheduled for the pheochromocytoma blood test on Monday. It will be analyzed by university of California at Davis.

Happis old vet, the vet I've used for all my pets for 30 years made so many mistakes that it's beyond comprehension. At this point, it's more likely that Happi has a non functioning tumor and a bad stomach ulcer that didn't heal bc vet kept prescribing more and more drugs. Most of Happis symptoms have disappeared since taking her off all medications but sulcafate. She's still not eating and I'll see what vet suggests on Monday.

You all helped me so much and really did drive me not to accept my vets diagnosis and to find a new vet.

Thabj you so much!!!