Shado: 12 yrs. Shepherd Cross (Cushings Symptoms/LDDST inconclusive/Tumor present)

I am writing to seek your guidance regarding my girl, Shado.

Background and Symptoms:

Shado first presented with noticeable symptoms in February 2025. She has been exhibiting excessive thirst, increased hunger, frequent urination, and panting. Given these symptoms, my vet initially suspected Cushing’s disease or Addison’s disease. However, after performing a Low-Dose Dexamethasone Suppression Test (LDDST), the results came back negative for Cushing’s disease. Thyroid and diabetes tests were also conducted and returned normal results, but her symptoms persisted.

Diagnostic Findings:

In light of her ongoing symptoms, we proceeded with an abdominal ultrasound, which revealed a mildly heterogeneous, hyperechoic mass in the cranial pole of the right adrenal gland, measuring approximately 3.3 cm in length and 3.7 cm in height. My regular vet at Dewdney Hospital, along with the radiologist, suggested we wait for six weeks and repeat the ultrasound to monitor any potential growth of the mass. However, the veterinarian at Sea to Sky, who is currently treating Shado, has recommended surgery as an option. I am hesitant about proceeding with surgery due to the risks involved.

Shado's Medical History:

To provide a bit of background on Shado, she was originally a foster dog, and we adopted her at the age of 4 months. She had some excitable incontinence up until around the age of 1, but this resolved on its own, and she has otherwise been healthy.

In 2020, Shado developed dryness and crusting on her nose, which I managed with a nose balm. However, by July 2024, the condition worsened, and I took her to the vet at Alpenlofts. She was prescribed a low dose of Vanectyl P. Within hours of starting the medication, Shado began urinating involuntarily. This incontinence persisted even after we discontinued the medication, which led us to try Stilbestrol for a week. While this helped reduce the frequency of urination, she still had leaks and continued to require diapers at home.

Shado also has arthritis, for which I occasionally give her gabapentin (200mg) to help with pain. I’ve been using CBD oil as well to help with her overall comfort.

Recent Emotional Stress:

I would like to mention that we recently faced the loss of another dog, our boy Saber, who passed away on December 30, 2024, at 14.9 months old. Saber’s condition was undiagnosed, and now I believe it could be Cushing’s or Addison’s disease, but the diagnosis was mismanaged by the vets and critical care team, and after 10 days of suffering, we made the difficult decision to end his pain. We are still grieving his loss and now, with Shado's ongoing issues, we are feeling quite overwhelmed.

Next Steps and Requests:

Given Shado’s complex symptoms, I am requesting an ACTH stimulation test, as this has not been performed yet. Additionally, we are planning to proceed with the follow-up ultrasound in six weeks to monitor the adrenal mass. I am also trying to find an endocrine specialist, though there are few available in British Columbia, which has proven challenging.

I am hoping for your advice on the best course of action or if there are other potential treatments or management options we should explore first.

I deeply appreciate any guidance you can provide and look forward to hearing your thoughts. Thank you for your time.

Juliana (Shado's mom)

Dear Juliana,

Welcome to you and Shado! Unfortunately I have only a few minutes available right now, but I’ll definitely come back later today or tomorrow to add a more extensive reply. But I didn’t want to waste any time in welcoming you girls, and to let you know that your registration has just now been fully approved. If you receive an automated email request for registration confirmation, you can ignore it at this point.

I want you to know how sorry I am about your recent loss of Saber. I can surely understand why Shado’s illness now is especially stressful and painful to deal with. Sometimes life can just be so hard. But we’re really glad you’ve found us, and we’ll do our very best to support you in your diagnostic journey.

So as I say, I’ll be back again soon. And in the meantime, welcome!
Marianne

Hello & welcome!

My condolences for Saber's passing!
Nothing i can say can soften the pain, just know we all understand & share the same pain.

Now, for Shado...
Correct diagnosis is E-V-E-R-Y-T-H-I-N-G in my experience.
Do all the tests you can afford, for whatever you suspect, and then some.

Trust me, that will save you trouble, time, money, guilt, anger and grief in the long run.
Nothing worse than giving the wrong medication due to misdiagnosis or undiagnosed issues & chasing/treating symptoms caused by wrong medication or even adverse effects of some incredibly strong drugs given for tumors/Cushings.

What i would do?
Let's go 1 by 1
First off, CBD oil is weird and in my experience does nothing. (edit: At least not unless you find the correct dosage, which is guesswork really - it doesn't depend on weight but how the Endocanabinoid system responds).
Looking up the other medications you mentioned, they kinda scared me.

I would deffinitely not rule out the surgery since that could be the only cure.
Assuming your dog has a chance of surviving it of course.
(...)
Everything else is symptom or hospice/paliative treatment really.
And between these too, i'd take hospice/paliative treatment & good quality of life for ex.6 months any day, over treatment with heavy drugs and constantly having adverse effects and giving X drug to treat the adverse effects of Y drug and then Z drug to treat the adverse effects of X drug and so on for 1-2 years...

So, if i were you, i'd do these 4-5 things right away to strenghten his organism (in case of surgery) & in any case give a good quality of life with little to no adverse effects:
1. Change the diet. No kibble.
Some rice with chicken broth mixed with chicken meat or beef or sardines etc. is much more digestion-friendly (& tastes much better).
You don't need to go overboard with weird recipes on YT. Just boil and mix them. It takes no more than 15mins to make it.
2. Give Animastrath as a good vitamin supplement.
Google it. It's a quality Swiss product for animals and not expensive.
3. Hepatiale Forte Advanced for the liver.
Excess cortisol due to Cushings & many drugs damage the liver so you want to protect it as much as possible (food i suggested before is also ''lighter'' on the liver too).
4. Anti-inflammatories for the arthritis, liver and tumor.
a. Omega-3s
Here's the dosing chart from Colorado State Veterinary University. (Read the description of course - i gave 80% of maximum dose with no issues)
https://vetmedbiosci.colostate.edu/v...sh-oil-dosing/
Mollers has a quality liquid product (get the non-flavored one).
b. 95% Curcumin
Health Aid has a good product.
1/2 or 1 capsule per day (depending on your dog's weight) is fine.
Don't give this if there are bladder stones.

I don't know prices in the US, but i guess these will cost you no more than $150-200 per month.
If that seems expensive, trust me, constant vet visits and test and prescribed drugs are much more expensive.
And more importantly, the biggest benefit is you'll get to focus on quality of life & spend time with him instead of ''it's 1am i have to give him X drug'' and/or '' i missed the dose at 14pm...'' and/or constant vet visits and chasing after adverse effects with ever increasing prescriptioned drugs...

p.s. Do these work?
Well, anecdotal evidence, but i've personaly taken prednisone/dexamehasone countless times due to my bad allergies, even been hospitalised with IV prednisone/dexamethasone due to allergy-shock.
I know first hand its adverse effects.
It's been 10 years since i've needed the damn thing, just by taking 1-3 omega-3 capsules and/or 1 95% curcumin whenever i recognise symptoms appearing.
(...)
Plus, 3 years ago i had a bad case of knee tenonditis (edit:it really was like a knife being stabbed in my knee - incredible pain) , for which i was given an NSAID (Arcoxia). All it did was cause a bad case of black stool diarhea and severely upset stomach and nausea.
I stopped it after a week against the doctors ''advise'' and started 5-6 omega-3 capsules per day. Tenonditis pain went away withing a week.
Just my 2 cents.

btw, Polyuria/polydipsia would be the least of my worries.
Damage to the liver & cachexia/lean muscle mass loss are the real offenders of Cushings.

Hello again! I’ve finally made it back and am so glad to see that Iraklis has had the chance to greet you, as well. Like him, once again I want to tell you how sorry I am about your loss of Saber. You’ve been through a lot of stress over these past few months, especially now while dealing with the uncertainty about Shado.

I’ll first jump to the “bottom line” and then add some additional thoughts. And to me, the bottom line is that your future treatment decisions will indeed be tied to the rate of growth and the actual type of adrenal mass that is present. You’ve probably been doing a lot of reading yourself, but I’ll go ahead and add a link to a scholarly summary of the different types of adrenal masses that dogs can have. The article dates back to 2006, but I’m guessing that the information remains largely accurate. It contains a lot of technical jargon, but I hope it may still seem helpful.

https://www.vin.com/apputil/content/...457&id=3858997

There are a couple major points to be made. First, different types of adrenal masses can produce elevations in different types of hormones. Cortisol is not always involved, and that could explain why Shado’s LDDS was within normal range. Elevations in other hormones might be contributing to her symptoms, though. And you wouldn’t know this because typically those other hormones aren’t included in blood testing profiles. I see no reason not to proceed with an ACTH in order to gather another piece of information about her cortisol production but that test may well be negative, too, if her tumor is not one that overproduces cortisol.

If it does turn out that cortisol is not an issue, then I’m not sure whether any medication will offer the possibility of symptom relief. For sure, I hope you can find an endocrinologist who can guide you in that regard. Sadly, it’s been quite a while now since we’ve had many discussions here about current medical treatment for adrenal tumors (a lot of folks have migrated to Facebook groups). So I’m afraid I’m not up-to-date on any new thoughts about medication treatment for non-cortisol producing adrenal tumors. But I’m guessing — especially from what you’ve written — that surgery remains the only road to a total cure. As you already know, though, adrenal surgery carries significant risks as well as significant expense. So given Shado’s age and depending on the overall assessment of her candidacy for surgery, it may or may not be a treatment you want to pursue. So overall, I think further assessment of the type of tumor and the rate of growth will factor highly in your decision. And if you do end up considering surgery, we do have a recent member here whose dog underwent successful surgery. Here’s a link to her thread if you want to read about her dog’s experience:

https://www.k9cushings.com/forum/sho...tomy-coming-up

In the meantime, it sounds as though gabapentin is a good choice for her pain relief since it seems to have lower systemic risks than NSAIDS. I don’t think there’s any problem with also giving her CBD, although like Iraklis, I’m not sure how much pain relief it truly offers. My last pup was a non-Cushing’s Lab who suffered from a lot of orthopedic pain in her last years, and I scoured the CBD research at the time. I did give it to her with no ill effect, but I also wasn’t sure how much if really helped. But I don’t see any harm in continuing with it as long as your vets agree.

OK, I’ll go ahead and stop for now. Please do feel free to ask any additional questions, and I’ll also add any new thoughts that come to my mind.

Marianne

Hi Marianne,

Thank you so much for approving our registration, and I look forward to all the guidance and advice.

Thank you, Marianne and Iraklis, for all the detailed information.

I'm currently waiting for an appointment with the internal medicine specialist. Unfortunately, we don’t have access to an endocrinologist here in Canada ☹. During the referral conversation between my vet and the internist, a Metyrapone test was mentioned as part of the plan. At this point, I’m open to whatever needs to be done—even surgery if it comes to that.

Iraklis: Saber and Shado have always been fed home-cooked meals, along with supplements, since they were young. Even their treats are homemade dehydrated chicken. That’s why this has all been so shocking—despite my extreme care. I’m currently following Forever Dog recipes and adding quail eggs. She’s ravenous lately. I’ll also look for the other supplements you mentioned and start adding them in. She’s already on Omega and Kelp.

Right now, all I can do is wait...

Is there a way I can upload her ultrasound and full bloodwork here? Maybe you’ll notice something that stands out.

I think you press ''go advanced'' (next to ''post reply'') to have the option to upload.

Unfortunately I am very technologically impaired and don’t really understand the software that runs this site very well. But I *think* the best way for us to view the results would be for you to upload photos of them. I see that you’ve already created an album, so that’s the first step. If you have problems getting the photos uploaded due to size, etc., you can send them to our forum gmail account. One of the other Administrators who’s more talented than I am can then help to get them uploaded. Here’s our address: k9cushings@gmail.com.

For site security reasons, I don’t believe members have the ability to upload attachments other than photos. And if for some reason the photo route turns out to be a problem, you can always just type in any abnormal lab results in a reply, along with the expected range. We really only need to see anything that’s flagged as being outside of normal range.

You’ve mentioned a Metyrapone test, and I’m honestly not familiar with that. You’ve encouraged me to do some research on it, myself! So I’ll plan to do that and we can talk it over some more. Aside from that, it sounds as though you’re doing everything just right in terms of helping your girl. Good job, Mom! I know it’s hard having to wait on the additional professional guidance, but we’ll get there.

Best wishes again,
Marianne