Lost about Cushings

[Kathystewart]

The center of our life, Jessie a Bernese Mountain Dog, has been through so much this year. It started with arthritis in all four legs. One leg has gotten progressively worse during the year despite everything we have tried. She is completely lame on her front right leg and severe arthritis is the other three legs. After trying everything we had to cave in and put her on steroids. This was the beginning of her internal problems. In July she threw up a pool of blood so we were told to get her off the steroids and we turned to acupuncture and massage. We were in the process of weening her off steroids and using acupuncture. It worked great for a while and then stopped. She was not weened of steroids yet. I began to notice the bloating belly and hair not growing back so had blood work done. She also had X-rays and a ultra sound. She was diagnosed with Cushings, something I'd never heard of. Our acupuncturist told us it was secondary to the issues with her legs so it has not been treated. Her rear legs are getting so weak that it is difficult to watch. She is drifting from us. The story is longer but right now I'm at a cross roads as to whT to so with her. Even though several people have suggested putting her down we are not ready to give up the battle. They don't come home to the wagging tail and the happiness to see us. Any input would be greatly appreciated.

[labblab]

Hello Kathy! Welcome to you and Jessie, although I am so sorry about sweet Jessie's problems right now. I guess the most important question I can think of to ask is whether Jessie is still on the steroids, or if not, how recently she stopped them. There is a form of Cushing's that is caused solely by longterm steroid use, so it is possible that the steroid has been the source of the problem. If so, the Cushing's syndrome can be reversed by stopping the steroids. But the weaning process is tricky, because her own adrenal function may have become reliant upon the steroid and therefore is not yet producing sufficient cortisol all on its own.

I think your accupunturist is right, though, in that you are facing a dilemma in terms of balancing the need to facilitate Jessie's arthritic comfort and mobility vs. the harm produced by the steroid use. And if Jessie suffers from natural Cushing's (overproduction of cortisol by the body itself), treatment to lower the cortisol would also have to be balanced by her mobility needs.

I am afraid I have no easy answer for you up-front, but we are most certainly here to help you work through the options. So first things first, and I'll return to my original question. Is Jessie still taking the steroid?

Marianne

[Renee]

I would suspect she does not have cushings, especially having been on the steroids for an extended amount of time. Have you ruled out any other causes of her lameness in all her legs? I had a rescue pug that suffered from tetraparesis, which caused weakness in all four extremities. It was not arthritis.

Have you tried other medications to help with the arthritis? Are you still doing acupuncture? How about laser therapy? Water therapy? Have you given thought to getting her a cart?

Sorry for so many questions up front.

[jas77450]

Hi Kathy and welcome to you and Jessie. You have come to the right place, lots of knowledgable and caring folks here. Don't have much advice but will agree steroids can cause Cushing symptoms and can be reversed. Glad you found us.

[Squirt's Mom]

Hi Kathy,

Glad to see you here! I hope you will get some ideas beyond what you and I have already talked about that may provide some relief for your sweet girl. I do know you will get unbeatable support here. ;)

My brother has a dog, Moe, he was told was a Bermese but he's a Swiss Mtn Dog instead and the sweetest thing...IF he likes you that is. :D

For several years, I was told I should put my baby down because she was old and had health issues. But like you, I saw she wasn't ready, I saw things in her no one else could because they were not in tune with her like I was. When she was ready, she told me...so listen to your heart and to Jessie only. They will guide you all the way. And we will be here right by your side.

Glad to have you and Jessie here!
Hugs,
Leslie and the gang

[pansywags]

Kathy, you are no longer lost - you have found the people who can help you work through this with the best possible outcome for Jessie. We all look forward to getting to know you and your pup.

[molly muffin]

Kathy, welcome to the forum.

It is so hard when you are balancing each thing separately, but a couple things the others mentioned I would second. Is she still on steroids, as there is a type of cushings that is caused by steroid use and once weaned off those symptoms should go away, but her own adrenals have to be functioning.
And since it is all 4 legs, then I would want a definite confirmation that it is cushings and not another joint issue.
I'd try some other things to see if any of those helped her instead of the steroids if at all possible.
It really can be such a difficult balancing act and you just want her to be as comfortable and happy as possible.
Bernese Mountain Dogs are so loyal and friendly, just really beautiful.

Welcome again

[Dixie'sMom]

Hi Kathy! I also wanted to welcome you and Jessie and although I am new to having a Cushing's pup myself, I am happy to stand in your corner. Folks who have never loved a pet as a family member can be so discouraging. You will find a group of folks here who are medically knowledgeable from their own experience and research, who have a wealth of real life experience and who are understanding of the love you have for Jessie and the joy she brings to your life. Hopefully we can help you navigate thru the confusing mess of tests and vets and medicines get to the bottom of what is causing Jessie's problems. Any other information that you can provide with regard to testing will be of great benefit. Have they done any blood work on her? And what was the results of the x-rays and ultrasound. Anything other than just arthritis?

I look forward to getting to know you and your sweet baby. Hang in there! Help has arrived!

[Kathystewart]

Thank you everyone for your comments and support. It's an amazing feeling that so many people truly care. We have decide to ween Jessie off the steroids over the next several weeks. My prayers are that this is the answers we've been looking for. How does one know if the adrenals are works again? She has so many of Cushing symptoms that I had no idea that steroids could mimic Cushing. She has the boney head, muscle loss in rear quarters, restless at night, thinning hair and no hair regrowth in areas that have been shaved. The bloating belly seems to have reduced but she has also had diarrhea for two weeks another side effect of steroids. We will have to contact the vet tomorrow to see if something more concerning is going on. Prior to reducing the steroids she was on one pill in the morning and half at night. We started by reducing to half in the morning and half in the evening and will reduce by 1/4th once per week. In the mean time I will contact her acupuncturist who is also a vet and make sure we are reducing at a safe level.
Thanks again to everyone for your very valuable support

[Squirt's Mom]

Let us know how she is doing as the pred is reduced. I hope the acupuncturist has something to offer in place of the steroids. You're a good mom, Kathy, and Jessie is lucky to have you on her team.

Hugs,
Leslie and the gang

[labblab]

Back when Jessie was originally diagnosed with Cushing's, do you know whether a diagnostic ACTH stimulation test was performed? This is a two-hour blood test that can be used to distinguish between naturally-occuring Cushing's vs. symptomology produced by supplemental steroids. It is not a cheap test, but I am thinking it might be of value to you in the event you really do not want to discontinue the steroids unless you have to. In other words, if this test indicates that Jessie's "Cushing's" issues are not the result of either the prednisone or the naturally-occuring disease, this may alter your treatment approach.


[ACTH is the] Best test to diagnose iatrogenic hyperadrenocorticism in dogs. If the dog has clinical and laboratory features consistent with Cushing’s syndrome (e.g., polyuria, polydipsia, polyphagia, pot-belly, truncal hair loss, high serum alkaline phosphatase) but has a recent history of glucocorticoid use, this is the test of choice. If the cortisol response to ACTH stimulation is low-normal or blunted in this dog, the diagnosis would be iatrogenic Cushing’s, rather than the naturally occurring disease.
This same test is also used to diagnose Addisonian conditions whereby not enough cortisol is being produced by the adrenals naturally. So if you do proceed with the weaning and Jessie still seems unwell, this would also be the test to perform in order to see whether her natural adrenal function has rebounded sufficiently to satisfy her needs.

http://endocrinevet.blogspot.com/2011/02/diagnosing-canine-cushings-disease.html

Marianne