Cushings? Or something else?

[Lilly]

Hello, IÂ’m from Belgium so forgive me for my bad English.

My Chihuahua is 13,5 yo en is being diagnosed at the moment for Cushings. She have had 1 test with urine and it showed a high level of cortisol.
We have to do now a 3 - days urine test with dexamethason.

Her symptoms are:
A huge pot - belly
Muscle weakness. She can not walk without slipping anymore.
Really bad smelling farts!
And she sleeps a lot.
No longer want to go out for a walk. And if we go, only for 10 minutes.

I read that the most common symptoms are excessive drinking, peeing, eating. But thatÂ’s something I not notice.

What do you think. Can it be CD?
Or has she symptoms of another disease? What tests can I ask and for what?

Thanks in advance!

[labblab]

Hello and welcome! No need at all to apologize for your English — you’re doing a wonderful job! There’s no way at all that I’d be able to write in a language other than my own. So I’m very impressed with what you are doing:-))).

Moving on to your questions, I’m afraid I would be questioning a Cushing’s diagnosis, myself, since your girl lacks many classic outward symptoms. Any major illness or stress on a dog’s body can elevate cortisol levels — not just Cushing’s. For this reason, even if diagnostic tests give “positive” result for Cushing’s based on high cortisol levels, the diagnosis remains questionable when observable symptoms are missing since other physical issues could be stressing the body.

For the benefit of our American readers, the 3-day dexamethasone urine test is commonly used in Europe, and fills the same role as our LDDS blood test here. So it’s an appropriate test to be performed when Cushing’s is suspected. But just as is true for our LDDS, I believe it is also vulnerable to “false positives” when physical issues other than Cushing’s may be physically stressing a dog.

At this point, my main question to you would be whether your girl has exhibited abnormal numbers on any of her other blood or urine tests. There are certain abnormalities that commonly occur due to Cushing’s. Since she doesn’t show classic outward symptoms other than the pot belly and weakness, I’m wondering whether there are lab results that would be found with Cushing’s. Or with any other illness, for that matter. If not, and even if her 3-day test turns out to be positive for Cushing’s, a very helpful next step may be an abdominal ultrasound. Especially given her pot belly, it could be very helpful to directly image her abdominal area to look for any abnormalities with her major organs, including her adrenal glands. So that would be a specific test I’d ask my vet about if she were my own dog.

In the meantime, we’ll look forward to learning more about any other blood and urine test results that you may have. And once again, welcome to you both!

Marianne

[Joan2517]

Hi and welcome from me, too. I think Marianne is right that more testing should be done. If you have any recent blood work it would help to see the results. Only post the Highs and Lows with the reference numbers. I have had two Cushing's dogs and they had all the typical Cushing's symptoms, which is why I would question a Cushing's diagnosis for your girl.

I also have a Chihuahua named Doree. She is 17 or 18 and is the matron of all of our furbabies. They are characters, are they not?

[Lilly]

At this point, my main question to you would be whether your girl has exhibited abnormal numbers on any of her other blood or urine tests. There are certain abnormalities that commonly occur due to Cushing’s. Since she doesn’t show classic outward symptoms other than the pot belly and weakness, I’m wondering whether there are lab results that would be found with Cushing’s. Or with any other illness, for that matter. If not, and even if her 3-day test turns out to be positive for Cushing’s, a very helpful next step may be an abdominal ultrasound. Especially given her pot belly, it could be very helpful to directly image her abdominal area to look for any abnormalities with her major organs, including her adrenal glands. So that would be a specific test I’d ask my vet about if she were my own dog.

Marianne


Thank you for your reply!
Today I started with the urine test, after the weekend I will bring everything to the vet.
When I have the results I ask for a blood test and an abdominal ultrasound.
I keep you updated.

[Lilly]

I also have a Chihuahua named Doree. She is 17 or 18 and is the matron of all of our furbabies. They are characters, are they not?

What a beautiful age!
Yes, they are amazing.
Her name is Mini and is such a lovely lady. Always sweet and soft… and stubborn ;)

[Lilly]

Hi, I’m back with the results of the 3 day urine test with dexamethasone.

Day 1: 17,71*
Day 2: 13,96*
Day 3: 0,71

* > 5: Cushings highly suspicious.
She definitely has Cushings on the pituitary :(


My vet is currently undergoing further training about Cushings, she will be back on Monday and discuss the Vetoryl thing with us.
Because Mini has a lot of stress in the car and at the vet my husband and I want minimum hassle for her with appointments.
The vet will start with a very little dose Vetoryl so she is safe and follow up can become limited.

But there is an other concern….
Her protein/creatinine ratio is 3,96. The reference is < 0,5.
So now I’m scared she has kidney failure also. The Vet wants to investigate this further but for the well-being of Mini she said we can wait after the start whit the Vetoryl, maybe it becomes better also and that's one less investigation.

What do you think? Has Cushings an effect on the kidneys?

[labblab]

Hello and welcome back. Thank you for posting those test results. I know you surely wish there was nothing at all wrong with Mini, but at least now you have a diagnosis and can put together a plan that will help her. So we hope that will be a good thing.

As far as the kidney test, I hope I may be able to ease your worry a little bit by telling you that, in some dogs, uncontrolled Cushing’s is known to cause protein to be passed in the urine. This does not mean that Mini’s kidneys have failed, but it does mean that the disease is likely having an effect on the ability of her kidneys to filter totally properly. I think your vet’s approach to this makes sense, though. It’s possible that once the Cushing’s is better controlled, the problem with the protein in the urine may also improve. If not, your vet may add in another medication that is known to be helpful, and may also ask you to cut down somewhat on the amount of protein that you feed Mini. But for the moment, it makes sense to me to focus on getting a safe start with the Vetoryl. Then, if the protein in the urine still persists, you can add more treatment. But the Vetoryl itself may end up helping.

Thank you again for checking back in, and please do let us know how things are going for Mini.

Marianne

[Squirt's Mom]

Just FYI, there is a relatively new test for kidney disease that lets us know MUCH sooner than we used to if the kidneys are impaired. It is called the SDMA and it is by the IDEXX lab. Any vet can use this test even if they regularly use another lab. If Mini's vet isn't familiar with it that is not uncommon. Here is a link about the test you can share with them:

https://www.idexx.com/en/veterinary/reference-laboratories/sdma/get-started/

This is NOT to say I think there is a real issue with her kidneys...Marianne is spot on about the effect Cushing's has on the kidneys but this is a great test to have in our arsenal and I want alllll vets to learn about it. ;) I was told my Tilly was in kidney failure based on her creatine and BUN but the SDMA proved that wrong and her values have returned to normal so I am very impressed with this SDMA test to say the least.

[Lilly]

@ labblab

I feel more reassured with your words!
Mini her health decline with small steps every week since January, I’m afraid of everything now.

She was nauseous the last 3 days right after her food, we think her big liver pressed against her stomach, today we gave smaller portions and it seems to help. But for me it is AGAIN another sign that she is sick.

[Lilly]

@ Squirt’s Mom

Thank you for your sharing about the test. I looked it up in my own language and it’s very interesting.
The vet can test with minimum impact for her.

[Lilly]

Yesterday I got the results of the blood test, it was on the phone so I don’t have numbers yet.
Everything related to Cushings was not so good.
The abdominal ultrasound showed an enlarged liver and adrenal glands.
Friday I get the results from her kidneys.

But there is another problem. She has Gallbladder Mucocele, the value what should have been maximum 9 is with her 123.
She needs medication for this also.

Tomorrow we start with the Vetoryl, 1 x 5mg. I am a little bit nervous…

Anyone have experience with gallbladder mucocele?

[labblab]

Hello again! By now, I’m guessing you’ve already given Mini her first dose of Vetoryl and I’m surely hoping that she is doing well with it. We’ve forgotten to ask how much she weighs, but knowing that she is a chihuahua, I’m guessing that 5 mg. is a good place to start.

As far as the ultrasound, I know it’s upsetting but an enlarged liver and adrenal glands are typically found in dogs with Cushing’s. If both adrenal glands are enlarged, then that is more support for the diagnosis that Mini’s Cushing’s is caused by a pituitary tumor. Cushing’s is also known to be a cause of gallbladder mucoceles, and we’ve had other dogs here with that problem. I don’t know very much about mucoceles, myself, but I do believe that medication can be helpful.

Mini’s adrenal glands will likely never return to normal size, but we’ll hope to see improvement with both her liver and her gallbladder once her medication treatment has had a chance to start working. I know this must be a very scary time for you, but you’re doing all the right things to take care of Mini! We’ll be very anxious to know how things go for her this week.

Marianne

[Lilly]

Yesterday I got the results of her kidneys, it was also bad :(
On top of the rest she got chronic kidney disease, stage 2 of 4. She needs medication for this but the vet wants to wait because she said it’s too much at once with the other medication.

This morning she got her third Vetoryl, she weighs 3,8kg, so far she’s not sic.
She sleeps a lot and doesn’t want to sit on the couch with us, or walk,… I think we’ll lose her in a while :(

[labblab]

I’m so sorry to hear that kidney problems are now added to the list, too. But I’ll surely hope that if her Cushing’s can be better controlled, then you’ll end up with improvement in all these other areas, as well. I know how hard it must be to see her slowing down so much, though. It is a worry and a sadness. We’ll surely hope you’ll soon see some improvement. But if not, you’ve been doing everything in your power to help her and you are filling her days with love. That’s the greatest gift of all, no matter what the future brings.

We’ll always be here for you to talk to, no matter what. Sending my warmest thoughts to you both,
Marianne

[Lilly]

Thank you for your support, I’am happy I found this forum.
I keep you updated!

[Lilly]

Mini started vomiting on Saturday. On Sunday we didn’t give Vetoryl and called the vet.
Mini is not extremely lethargic and still begging for food so the vet doesn’t think it is because of the Vetoryl but more from her other diseases, gallbladder or kidneys.
This morning she was given Vetoryl again and now she is vomiting again. I am scared now and want stop the Vetoryl.
The vet has prescribed Emeprid for her nausea, so do you think we can give the Emeprid a chance and wait and see. Or do we go back to the vet?

[labblab]

If it was me, I would call the vet and tell them the vomiting started again after giving the Vetoryl and that you want to wait several days now before trying to give any more Vetoryl. If the vomiting stops while she’s off the Vetoryl but starts right back up again with another dose, it seems much more likely to me that it’s the Vetoryl itself that’s upsetting her stomach. Your vet may want to see her today, regardless. And of course if she worsens or seems more generally unwell, you’d also want to take her in. The vomiting may indeed be unrelated to the Vetoryl. But if you end up stopping it twice and then have it immediately begin again after a dose of Vetoryl, I think you have more evidence that it’s the Vetoryl that she’s reacting to.

Marianne

[Lilly]

If it was me, I would call the vet and tell them the vomiting started again after giving the Vetoryl and that you want to wait several days now before trying to give any more Vetoryl. If the vomiting stops while she’s off the Vetoryl but starts right back up again with another dose, it seems much more likely to me that it’s the Vetoryl itself that’s upsetting her stomach. Your vet may want to see her today, regardless. And of course if she worsens or seems more generally unwell, you’d also want to take her in. The vomiting may indeed be unrelated to the Vetoryl. But if you end up stopping it twice and then have it immediately begin again after a dose of Vetoryl, I think you have more evidence that it’s the Vetoryl that she’s reacting to.

Marianne

Thank you! I give it a try for a few days.

[labblab]

Just checking back to see how Mini is doing — doing well, I hope!

Marianne

[Lilly]

Just checking back to see how Mini is doing — doing well, I hope!

Marianne


Thank you for your concern.

Her nausea is not from the Vetoryl but from her other illnesses. We tried to stop the Emeprid and she started vomiting within a few hours.
I called the vet again and she said I can give the Emeprid for another 5 days, if she doesn’t stop vomiting than we have to look further.
We have an appointment on Friday for another blood test.

There are times that she seems fine and there are times that she looks sick and quiet, she sleeps a lot.
She begs for food al the time when she opens one aye. There are times when we’re not sure if she’s still enjoying life…

[labblab]

I’m very sorry to hear that Mini is still having these problems. I know it must be a great worry to you. Hopefully the testing on Friday will offer some helpful information, and the Emeprid will ease her stomach in the meantime. We’ll surely be keeping you all in our thoughts until we learn more.

Marianne

[Lilly]

Hello there!

I have the latest results of Mini her blood work.

Liver was still to high, but better:
Bilirubin total 2,56 Max 1,71
ALT 161 Max 70
Gamma GT 71 Max 9
Alkaline phosphatase ALP 481 Max 111

Kidneys are worsening
Potassium 6,1 Max 5,6
Chloride 103 Min 106
Urea 12,2 Max 9,49
Phosphate 2,15 Max 1,88
Sdma 19,1 Max 14
Creatinine 75,2 63,8


Neutrophils 85,1 Max 77
Lymphocytes 7,7 Min 12
Thrombocytes 12 999000 Max 510000
Albumine 50 Max 44
Cortisol 138 Max 40
Reticulocyten index 2,8 Max 2


She still vomits occasionally and her cortisol is still too high. The vet has increased her Vetoryl to 2 x 5mg a day.
What do you think of her blood results? I think that te vet doesn’t want to make me scared. But I only see a dog that sleeps a lot and has bad blood results and is always hungry.

[labblab]

I'm really sorry that Mini's bloodwork is not improving. Again, I'm not a vet, but I'm thinking that the worsening kidney values would be the greatest worry right now. Since she has elevations in her creatinine, her urea (here in the U.S. that is referred to in labs as BUN), and also her SDMA reading, I'm wondering whether her kidneys need to take top priority over everything else. I don't know whether your vet is asking you to change her diet (lowering the amount of protein a bit?) or adding any supplemental healthy omega-3 fatty acids (fish oil, etc.)? Also, even though her cortisol is still running higher than you wish, there are specific warnings about giving Vetoryl to dogs who are suffering from kidney dysfunction. The kidneys play an important role in metabolizing and clearing the drug from a dog's body, and if the kidneys are are not working properly, I believe there can be a danger in the Vetoryl accumulating in the body. So I really hope your vet may be communicating with the makers of Vetoryl in order to decide whether Mini's kidney elevations are high enough to be considered an issue with her taking the medication. Perhaps not, but especially now that the dose is being increased, I'd welcome Dechra's guidance about that.

Unfortunately, there are different things that can be causing Mini to vomit. But kidney issues could be one of those things. So again, as I say, I think that's the area that I'd want to focus on right now. I'm so sorry you and Mini are still having such a hard time!

Sending healing wishes to your sweet girl,
Marianne

[Joan2517]

If she were my dog, I would stop the Vetoryl. I stopped it many times with Gable if he wasn't feeling well, and then restarted when he seemed better. I didn't know better with Lena. If I did, I would have stopped it. Stopping it seems to me to be the lesser of all her other problems. It won't hurt her to stop....

[Lilly]

Thanks to both for thinking along with me.

It's been a rough week...
One lucky thing is that she hasn't vomited anymore. The vet is really convinced that the dose of Vetoryl is not too much. I called her 3 times this week :rolleyes:
She eats, drinks and pees a lot. Her urine test was also bad, the density was reduced to 1.011 and the protein loss is still severe at 3.25. The vet has prescribed Fortekor for this.

The new problem is that her gums are inflamed and she has pain while eating. The vet was reluctant to give her painkillers because of her kidneys.
Now she is on antibiotics and in 3 weeks we will have her teeth clean up, the anaesthesia is a risk for her but we have no other choice.

We are reluctant to let her go through all this, but we don't know how long she will live right now. Maybe another year and you can't do that with bad teeth... It's so difficult…

[labblab]

I surely do understand how difficult these decisions are for you. I know you are working your hardest to make Mini as comfortable as possible, though, and she is so lucky that you are taking care of her. In these situations, I think we always worry whether we’re making mistakes. I know that I probably *have* made many mistakes with my own dogs over the years. But we do the best we can, given what we are seeing and what we’ve been told. And you’re doing exactly that right now. Please continue to update us in the coming days, and know that we’re always here supporting you and sweet Mini.

Marianne

[Lilly]

Today Mini has gone to heaven…
Tis morning she was showing pain and looked terrible, we had have to let her go.
We are devastated…

[labblab]

Oh Lilly, I’m so very sorry. I know the pain of losing her is so sharp and so raw. Truly, you did everything that was within your power to try to help her. But it was clear that she was a very sick little girl, and now you’ve given her the final gift of releasing her from her pain. But now your own hearts are hurting, oh so much. Thank you so much for telling us what has happened, though. We will always honor her here among our family of Cushing’s Angels. And we’ll always be here for you to talk to. At any time.

I know there’s nothing I can say right now to ease your own pain. But I’ll be lighting a candle of my own tonight, in loving memory of your sweet Mini. And my heart is with you and your family.

Sending so many hugs across the miles,
Marianne

[Joan2517]

I'm so sorry, Lilly...it's devastating when we try so hard and nothing seems to work. We can only do what we can do with the knowledge we have. Mini knew how much you loved her, and she loved you unconditionally.

[Lilly]

Thank you for your kind words.

The pain is really sharp now, it needs time. The only consolation is that she is no longer in pain, and that she is now with her friend Bas, our little fur boy who went to heaven 7 years ago.

[labblab]

I just wanted to reach out to you again, on this first day after. For me in the past, awakening on that first morning after is probably the very worst moment of all. When I remember what has happened and what I've lost. When I know that nothing can be changed. The pain seems unbearable.

Being able to come to our family here and write about my feelings has always been my solace. If it will help you in any way, too, we're surely here and will stay by your side. Mini has now been added to our special memorial thread of honor:

https://www.k9cushings.com/forum/showthread.php?9294-Remembering-All-Who-Have-Left-Us-(2020-2021-2022)

If you'd ever wish for us to add a photo link to her memorial line, it would be our privilege to do so. At any time now or in the future, you can also always add a tribute thread of your own to our "In Loving Memory" forum. But most importantly, you can always come right back here again to share stories or memories or just to tell us how you're doing.

Best wishes to you and your family always. And please know that Mini will always be honored by her family here, as well.

Marianne

[Lilly]

Thank you so much for adding Mini to the memorial list!
When I saw her name I cried. My little girl, never forgotten.

My husband and I cried a lot this weekend, but we know time will ease the pain.

Thank you for everything.

[Squirt's Mom]

Dear Lilly,

I am just so so sorry to hear about your sweet Mini. We are never ready no matter the circumstances for "that" day to arrive. I have no doubt that Mini left this life filled with the love you gave her all those years and she will carry that love with her always. One day we will all see our babies again....I firmly believe this. When your job here is done and it is your time to cross that Great Divide, your precious little girl will fly across the Bridge into your arms with Bas right behind, both of them covering your face with kisses. Til then, know you are being watched over just as you watched over them.

My deepest sympathies,
Leslie


The Last Battle

If it should be that I grow frail and weak
And pain should keep me from my sleep,
Then will you do what must be done,
For this — the last battle — can’t be won.
You will be sad I understand,
But don’t let grief then stay your hand,
For on this day, more than the rest,
Your love and friendship must stand the test.

We have had so many happy years,
You wouldn’t want me to suffer so.
When the time comes, please, let me go.
Take me to where to my needs they’ll tend,
Only, stay with me till the end
And hold me firm and speak to me
Until my eyes no longer see.

I know in time you will agree
It is a kindness you do to me.
Although my tail its last has waved,
From pain and suffering I have been saved.
Don’t grieve that it must be you
Who has to decide this thing to do;
We’ve been so close — we two — these years,
Don’t let your heart hold any tears.

Unknown