Questions about Cushings - Charlotte has crossed the Bridge

My name is Laurie, I am new here and have some questions about Cushings symptoms and diagnosis. My Boxer Charlotte is approximately 7-8 years old (we don't know for sure since she was a rescue). We have had her for 2 1/2 years and she has always been healthy up until recently. Over the past few months her water intake has increased and for the past month it has been excessive. She is very lethargic and no longer acting like herself. She also trembles a lot and has a hard time staying warm even with her sweater on, which has always been enough when she is in the house. Her breathing is more labored but she isn't panting and she is ravenous all the time. She has always been a "chow hound" but lately it's been even worse. She has gotten into the trash and taken food off the counter when we aren't home. She also has eaten a roll of toilet paper. We have also noticed a little hair loss in areas where her hair has always been sparse. Other than that her hair coat looks pretty healthy.

A couple of weeks ago we had her blood work done along with a urine test and everything looked fairly normal. Urine was dilute but that was to be expected due to the large amounts of water she is drinking. We have seen 2 vets and both have said there are no indicators in the blood work that suggest Cushings (or diabetes which was another thought with her symptoms). She is getting worse and we have been made to feel like we are imagining it. The first vet took xrays of her abdomen and found some air/gas pockets and has put her on metoclopramide to clear it out. He thought maybe she was in pain due to gulping air when she eats. She has been on that drug for 2 days now and is about the same so far, except she seems to be trembling more.

My question to all of you is should we have her blood work and urine tests run again? Should we have a cortisol/creatinine test? How about an abdominal ultrasound? This is horrible timing for us as my husband is currently unemployed so money is tight. We will do what we have to do, Charlotte is a family member, but I hate to keep spending money and not figuring out what is wrong. I'm posting here only because her symptoms seem so much like cushings to me and I know Boxers are on the list of breeds that are higher risk for the disease. Any suggestions on how we should proceed will be greatly appreciated!

Hi and welcome to you and Charlotte!

I apologize, I'm at work and only have a moment to post :eek: It would help us if you could get copies of all the test that were done on Charlotte and post the results. I assume that an UTI or issue with the thyroid has been ruled out?

I have to run but I will try to make it back later, I am sure the others will be by to offer their support and advice. ;)

Hugs, Lori

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Originally Posted by Harley PoMMom

Hi and welcome to you and Charlotte!

I apologize, I'm at work and only have a moment to post :eek: It would help us if you could get copies of all the test that were done on Charlotte and post the results. I assume that an UTI or issue with the thyroid has been ruled out?

I have to run but I will try to make it back later, I am sure the others will be by to offer their support and advice. ;)

Hugs, Lori

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Thanks Lori! I'm not sure how to put a picture or document in this post as it asks for a URL rather than to browse an image already in my computer. When my husband come home I'll see if he knows how.

Hi and welcome to you and Charlotte! :)

On the test results, we only need to see the abnormal results from the test that shows things like BUN, CHOL, ALP, T4, and so on. Some call that a wellness check, some a Chem test, but you will know by the values reported like the ones I just mentioned. So the best way is to simply type in the abnormal values along with the little letters and ranges that follow. For example -

ALP 323 85 - 115 ug/dl (EXAMPLE)

While some of the signs you posted are typical of Cushing's some are not - like the inability to stay warm. Cush pups are generally just the opposite and have trouble dealing with heat, seeking cool places to lay year round. And Cushing's usually comes on very slowly, over years, not a few months time. BUT it is a disease with very few hard, set rules and we have seen many oddities thru the years. ;) So those test results will help us a great deal in helping you sort this out.

So for right now, lets get those test results then we can start giving you some more meaningful feedback. Call and get the copies, post the results, and love on your sweet girl as much as you can. Ya'll are now part of our family here at K9C and we will be with you all the way regardless.

Hugs,
Leslie and the gang

Thanks Leslie, I would love to post the results here but I have no idea how to post pics to this forum. My images are on my computer, not on a website. When I click to post a pic it asks for a URL rather than to browse for a photo. If someone can advise me I will post the image of the test results.

One way in which to do this is to set up a personal photo album, and then you can directly upload any images from your computer. Once you've logged in to the forum, click on the "User CP" tab at the upper left-hand side of any page. Once there, select "Pictures and Albums" from the left-hand menu bar, and off you'll go.

In honesty, though, we are really only interested in knowing about any abnormal lab values, along with the reference range. So if you want to just list them within the body of your reply here, that will be great and will save us from needing to search through multiple pages of labs in order to find the abnormals.

Marianne

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Originally Posted by labblab

One way in which to do this is to set up a personal photo album, and then you can directly upload any images from your computer. Once you've logged in to the forum, click on the "User CP" tab at the upper left-hand side of any page. Once there, select "Pictures and Albums" from the left-hand menu bar, and off you'll go.

In honesty, though, we are really only interested in knowing about any abnormal lab values, along with the reference range. So if you want to just list them within the body of your reply here, that will be great and will save us from needing to search through multiple pages of labs in order to find the abnormals.

Marianne

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Thanks Marianne but I'm also unable to upload any pictures to the photo album either so I'm going to have my husband take a look at my computer because this must be a problem on my end. I'm going to attempt to post her report now from a photo on Photobucket...

Hopefully this works...Here is a photo of her blood and urine test results:

http://i1376.photobucket.com/albums/...ps7pfuwhz8.jpg

It looks like the only thing out of range at all on the blood work is EOS and LYS (?) is low. Everything else is perfect. Not what we normally see with cushings.

The urine concentration is 1.015, yellow clear and it does say WBC occ and cellular debris. Drinking water, etc, did they rule out Urinary Tract Infection?

I don't see anything about a thyroid test on this. So I would want that checked out next, as this can have many of the same symptoms as cushings. Diabetes is ruled out based on this, kidneys and liver are good, so over all she looks to be a healthy dog, just have to figure out what is causing these symptoms.
I'd do a thyroid panel.

and hello and welcome to the forum

Definitely doesn't look like a Cushpup's bloodwork.

Maybe this can help someone in the know:

LYM—immune cell highly responsive to “stress” and potentially increased during chronic infection.

EOS—inflammatory cell associated with parasitic disease, hypersensitivity and allergy

http://www.animalmedicalcenterofchic...ostic-test.pdf

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Originally Posted by molly muffin

It looks like the only thing out of range at all on the blood work is EOS and LYS (?) is low. Everything else is perfect. Not what we normally see with cushings.

The urine concentration is 1.015, yellow clear and it does say WBC occ and cellular debris. Drinking water, etc, did they rule out Urinary Tract Infection?

I don't see anything about a thyroid test on this. So I would want that checked out next, as this can have many of the same symptoms as cushings. Diabetes is ruled out based on this, kidneys and liver are good, so over all she looks to be a healthy dog, just have to figure out what is causing these symptoms.
I'd do a thyroid panel.

and hello and welcome to the forum

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They said no UTI. And yes she looks healthy according to this. I think the vets thought we were doggie hypochondriacs! But there is definitely something going on. I asked about thyroid but the 2nd vet said she didn't feel anything when she palpated that area. I know sometimes they can feel swelling but I know that's often not the case in humans so I will ask for them to test for that next. Thanks!

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Originally Posted by dsbailey

Definitely doesn't look like a Cushpup's bloodwork.

Maybe this can help someone in the know:

LYM—immune cell highly responsive to “stress” and potentially increased during chronic infection.

EOS—inflammatory cell associated with parasitic disease, hypersensitivity and allergy

http://www.animalmedicalcenterofchic...ostic-test.pdf

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Thanks! Both vets told me there was no indicator of cushings from this bloodwork but she had so many symptoms I wondered if something went wrong with the test. But thyroid problems have some similar symptoms so maybe that's what we are dealing with. That will be next to test for.

Thanks so much to all of you for your input and I will keep you posted.

Update on Charlotte... We saw a new vet and had a senior CBC done as well as some abdominal xrays. We are still waiting on the Thyroid test results but her liver enzymes are up and the xrays showed an enlarged liver and a huge bladder. Although they do ultrasound there they don't have a radiologist on staff so they suggested we take her somewhere else for that. This vet felt like Cushings could definitely be a possibility after examining her so I thought about contacting UC Davis (we live about an hour away) to see if they are still conducting the study there. It sounds like if they accept her it could save us a lot of money. We have already spent $1000 and have no answers. She continues to drink a ton of water, she is trembling all the time and very lethargic. We are running low on money to spend on tests so I need to pick and choose carefully. I will post the CBC here tomorrow when I get it in case anyone might have some suggestions.

I've been reading posts on here frantically, trying to learn more and make decisions for my girl Charlotte (7-8 year old Boxer, 75 pounds). We have already spent $1000 on tests and still don't feel like we know much. I have another thread I started a few days ago but wanted to ask about my dog's specific symptoms. Here is what we are witnessing:

Excessive water intake with frequent urination
Lethargy
Lack of interest in exercise/playing with our other dog
Trembling/shaking
Ravenous appetite
Slight pot belly
Loss of muscle

In the past week she has been panting and not wanting to wear her sweater even though it's cold but this is something new (she normally ran cold in the winter). I've also noticed her gait has changed, something seems wrong in her hind end. She almost squats and then turns to look at her as if there may be pain. A couple of times it almost looked like she was constipated (which she hasn't been) because she was squatting and walking strangely. She is reluctant to wag her tail which she always has done in the past. She also stretches her back legs a lot which seems odd but there is obviously something going on back there, not sure if that would have anything to do with cushings.

We were not at all confident in the first vet we saw (I posted the bloodwork in my other thread) so I found another vet I feel good about who did a senior CBC, urinalysis and abdominal xrays. I will post results tomorrow as we didn't have all the results tonight but we do know that the xray showed an enlarged liver and the bloodwork showed elevated liver enzymes. We are waiting on urine culture to rule out UTI and also thyroid levels to rule out hypo or hyperthyroidism. We ruled out diabetes. This new vet said she thinks cushings is a possibility but there may be other things going on as well.

I'm just sick because Charlotte is trembling all the time now. We have given her tramadol the past couple of days in case she is having pain but it doesn't seem to stop the shivering/trembling. Is this something you see in cushings dogs?

Hi and welcome! I only have a minute but wanted to share some quick thoughts with you. I will do a search for your other thread later today and take a look at the blood work you mentioned.

Shaking/trembling is not a recognized symptom of Cushing's in my textbook. However, I have heard many pet owners describe this as a symptom. The symptoms you did list are all very common signs that point to Cushing's.

I'm happy to hear diabetes has been ruled out. Keep in mind with the thyroid test that cushingoid dogs can sometimes have a transient low T4 result. Here is a general explanation of what that means:

"Sometimes a Cushing's dog may be truly hypothyroid and need to be taking medication for that condition along with the Cushing's medication they are prescribed. But there is also a form of hypothyroidism called "Sick Euthyroid Syndrome" or "non-thyroidal illness" which may actually only be secondary to (caused by) another condition such as Cushings, and this type of hypothyroid condition will often resolve without need for medication once the excessively high cortisol production caused by the Cushing's is lowered and brought under good control." You can read more about it here http://www.k9cushings.com/forum/showthread.php?t=191

It broke my heart when you mentioned she was reluctant to wag her tail. I will never forget seeing my dog wag his tail for the first time in almost a year. This was after a month of being treated with vetoryl. I felt so horrible because I had dismissed this as a sign of him just getting older (he was 15!).

I hope the tests come back negative. I will check back later today or tomorrow.

~Kat

Hello, and here's an overdue welcome from me! You'll see that I've merged your new thread into your original thread so that we can keep Charlotte's medical history and related information all in one place. This way, we won't be repeating ourselves or, even worse, overlooking important info.

I am so sorry that Charlotte is doing so poorly and looking increasingly ill. From the list of symptoms and the new elevations in liver enzymes, I am betting that Cushing's is a very strong possibility and I'll be keeping my fingers crossed that Charlotte makes it into the Davis research study. She really sounds like a perfect candidate to me.

Even if her thyroid testing turns out to be low, this does not mean that Cushing's is not actually the underlying issue. Kat has already explained this well. So regardless of the outcome of the thyroid test, I would additionally want her worked up for Cushing's, and Davis will do a great job of that if she's accepted into their study. It's a pain that it's a holiday week, because that may slow down the communication. But again, I think she sounds like a perfect candidate and I hope you'll hear back quickly. If she's not accepted, though, then we can help you sort through the most efficient testing protocol with your new vet.

I can really sympathize with your worry, though. We were really slow in arriving at a diagnosis for my own Cushpup, even though in retrospect, it seemed clear he'd been advancing with the disease for quite a long time. By the time we determined he did have Cushing's, he looked really, really bad (and also had trembling episodes). I truly thought we were going to lose him, and I could not get that first capsule of medication in his mouth quickly enough! But we did see some rapid improvement right away once treatment was begun.

So please try not to feel too downhearted, and do let us know just as soon as you hear back from Davis.

Marianne

Thank you Kat for the good explanation of the thyroid condition and thanks Marianne for merging my two threads so all the info is in one place. This forum is so helpful and although my heart breaks for all the people and their pups that are going through this, it's so great to be able to get help and support from all of you.

I will post the additional results here later today when I get them. my vet suggested we start her on an antioxidant that will support her liver (similar to milk thistle) along with Ursodoil and Baytril. She does not have a fever and her white cell count is good but the vet still thought there could be a minor infection of the liver or gall bladder, or possibly gallstones, causing the liver problems. Thoughts on these medications would be greatly appreciated. I don't know how long it will take to get her into the UC Davis program, if she is even accepted, and I feel like I should be doing something for her in the meantime but don't want to put her on something that could cause more problems.

She slept in bed with me last night because my husband is out of town and she trembled non-stop, I hardly slept. My heart is breaking for her because I don't know if she is in pain and I feel like I should be doing more to help her. I will be taking her to work with me today because she stresses so badly when she is left home alone. She still enjoys socializing with people so maybe this will be good for her.

Your welcome. You are doing everything humanly possible to make her feel better. I know what you mean though. My boy used to stare at me as if he was asking me to help him but I didn't know how. Those were the worst times. It gets better. You'll see.

~Kat

I didn't get by to pick up a copy of the bloodwork today but I did get an appointment for an exam at UC Davis to see if she will be acceptable for the study. Unfortunately the first available appointment wasn't until December 12th. I hate to wait! So here is my question to all of you who are so knowledgeable about this...

My vet thinks we should go ahead and put her on the Baytril antibiotic along with Ursodoil and the antioxidant to support her liver. Is there any reason I shouldn't go forward with these meds? I'm very cautious about unnecessary meds but then if I can be helping her while we wait to see the vet at Davis I sure want to do anything I can.

Did she have sludge in her gallbladder? If so starting on Ursodoil would be helpful. I've seen vet prescribe antibiotic before if they think there is an underlying infection and to be on the precautionary side. So it might be worth a shot since you can't get into UDavis till mid December.

Poor baby. I hope this helps her to feel better. If it were me, I'd probably give it a try.

Yes, I believe I'd give the meds a try, too. I know it's hard to wait, but I'm really hoping the appointment with Davis will turn out to be well worth it!

Marianne

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Originally Posted by molly muffin

Did she have sludge in her gallbladder? If so starting on Ursodoil would be helpful. I've seen vet prescribe antibiotic before if they think there is an underlying infection and to be on the precautionary side. So it might be worth a shot since you can't get into UDavis till mid December.

Poor baby. I hope this helps her to feel better. If it were me, I'd probably give it a try.

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Since we haven't done an ultrasound (waiting to do that at Davis if we are accepted) my vet was unable to tell if there was sludge or stones in the gallbladder. I think she was just guessing it may be a possible problem and figured it might be something helpful we could be doing in the meantime. I want to do everything possible to help her but don't want to do anything that could make her worse.

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Originally Posted by labblab

Yes, I believe I'd give the meds a try, too. I know it's hard to wait, but I'm really hoping the appointment with Davis will turn out to be well worth it!

Marianne

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Thanks Marianne, it seems like it won't hurt to try these meds and they should be out of her system by the time we get to our appt at Davis on the 12th.

I also agree that you should go ahead with the meds. The 12th will be here before you know it.

Charlotte has been on the meds (Baytril, Ursodoil & Denamarin) for 4 full days now and so far seems to be about the same. The trembling has gotten worse though and it's so hard to watch! She is with someone all the time, if my husband isn't home she goes to work with me. I just pray she isn't in pain. I've given her Tramadol and it doesn't seem to help so I'm hoping its an involuntary reaction to whatever is wrong and she's not trembling because of pain. I hate giving Tramadol since we know she has liver issues but then I don't want her hurting either. I wish these babies could talk!

We went on a short walk today and she really perked up while we were out. She doesn't tremble when she is moving around, only when she is at rest. Has anyone experienced this with their cushings pup?

I'm going to post her most recent labs in a few minutes. Counting down to our appt at UC Davis on the 12th!

Here is page one of Charlotte's labs from last week:

http://i1376.photobucket.com/albums/...psv5j26gdt.jpg

Here is page 2:

http://i1376.photobucket.com/albums/...psa2vparxu.jpg

Hi again, Laurie! I just have a moment free to post right now, but I noticed your question about Charlotte's trembling and wanted to paste in a copy of a reply that I'd previously given to another member.

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Hello and welcome from me, too! I just want to "second" what Lori has said above: through the years, we have had other members who have worried over unexplained tremoring episodes. My own Cushpup, a Lab, suffered from intermittent involuntary tremoring episodes across his shoulder blades that made him look as though he was shivering. For him, the episodes happened most often when he was sitting down or at rest -- even when he was sleeping. Sometimes he would jerk himself awake, they were that severe. But just as is true for your boy, he would usually just stretch afterwards and never seemed to be in any particular pain or discomfort. The tremors began before he started trilostane treatment, worsened significantly when he first started the drug, and then ended up stopping entirely a few months down the road.

We never did figure out what caused them. Through the years, other members here have reported similar issues with their dogs under a variety of circumstances: some using trilostane, some using Lysodren (another medication), and also dogs not yet being treated at all. For this reason, it has been hard to point to a single "trigger." It is true that tremors are now listed as a possible side effect of trilostane. But I've always wondered whether such tremors more often just somehow relate to rapidly changing cortisol levels. But the good news is that they didn't really seem to bother my dog at all -- it was ME who was going crazy trying to figure them out!

Marianne

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I'm anxiously awaiting the 12th right alongside you!!
Marianne

Thanks so much Marianne! It makes me feel better to hear other pups have had the same thing with the tremors. You described Charlotte's situation exactly in that post. I hope once we get her on meds it will stop. I'm feeling in my gut that this is cushings but we will have to wait for the official diagnosis.

Thanks so much to everyone who has chimed in and been so incredibly caring and helpful! This forum has been such a blessing! I will keep you posted!

It seems that her liver values are now elevated, ALT, AST, GGT and PSL, indicative of pancreatis? I believe that is what i am looking at and wondering if that isn't the cause of the excess shaking, tremors (pain)

It looks like the labs in October where maybe an in house test? and the labs were more normal.

It does make me wonder if the shaking isn't a result of the pancreatis and that is also causing the liver enzymes to be elevated.

Are you seeing any change on the meds?

Im not noticing any difference on the meds after a week. Would the antibiotic, Baytril, target pancreatitis? Its been many years but i had a lab who suffered with pancreatitis and symptoms included vomiting and loss of appetite. Charlotte still has her usual "piggy" appetite and she has not had any vomiting or diarhea. She has not had a fever either.

And yes the first bloodwork was done in-house and the second was a more indepth senior workup. I wasnt impressed with the first vet we saw, the second was much more thorough and seemed to feel that cushings was a real possibility. It scares me that she could be in pain and we might not be doing everything we could be doing but Marianne described, in her above post, exactly what happens to Charlotte when she trembles so evidently this is something that happens to some dogs with cushings. But of course i want to look at every possibility so is there a specific test that is done to diagnose pancreatitis? I remember it was easily diagnosed when my lab had it so i assumed it was ruled out in Charlottes case. Any advice would be appreciated.

I believe it's the elevated PSL reading on the second page of Charlotte's bloodwork that especially raises the question of pancreatitis. I'm really glad Sharlene noticed this. Here's a link that describes the interpretation of this test:

http://precisionpsl.com/faq.html

As you'll see, the diagnosis of pancreatitis is made from a combination of factors including this test result, imaging, and a dog's behavior. If a dog is behaving totally normally, then an elevated test result would be less worrisome. The fact that Charlotte retains her appetite and is not experiencing any vomiting, diarrhea, or fever is good. However, in reading back in your thread, I see that about ten days ago you noticed some odd squatting behavior, etc. that made you wonder whether she's in pain in the rear half of her body. Hunching the back and a tender abdomen are often listed as symptoms of pancreatitis, so that does make me wonder whether Sharlene is on to something.

Has the odd squatting behavior continued? Especially if so, I would call the vet and report it along with asking her about the elevated PSL reading. I know you'd hate to get involved with a bunch more diagnostics right now prior to your Davis consultation. But just on the basis of that test result and symptoms alone, your vet may advise you to temprarily switch Charlotte's diet to several small bland meals each day such as white rice and chicken. Since she is not acutely ill with vomiting or diarrhea, simply altering her meals may be the best therapy if chronic pancreatitis is suspected. Anyway, since you are still ten days out from the Davis visit, I'd want to let your vet know if Charlotte indeed seems to be exhibiting behavior that could signal an inflamed pancreas.

Marianne

Thanks so much for all the info and insight Sharlene and Marianne! I have put a call into Charlotte's vet but in the meantime I have made her up a big batch of chicken and rice and will keep her on a bland, low fat diet, feeding small amounts numerous times a day, for awhile and see if I can see a difference. I think the purpose of putting her on the Baytril and Ursodiol was to address any underlying infection that hadn't been detected. I've read that both drugs should address pancreatitis but I also know that diet needs to be changed so at this point I think she is being treated accordingly if the pancreas is involved.

Thanks again and I'll keep you posted!!!

Only a couple more days until our appt at UC Davis. The Baytril and Ursidiol didnt seem didnt seem to make a difference and she continues to tremble over her shoulders almost all day long, but especially when she is at rest. Im hoping we are accepted to the study but im a little concerned because she has lost some weight and im not seeing the typical pot belly of a cushings dog. Ive tried to be conservative with the tramadol but i worry she is in pain and she has continued to circle and squat and look back at her hind end about twice a day and always immediately after eating. Other times she seems almost normal, although she doesnt have the energy she would normally have. She definitely has lost a lot of muscle in her hind end and can no longer jump up on the bed. Its so sad, she isnt the same dog she was 6 months ago. My heart breaks for her.

Sorry, i know im rambling and just repeating what ive already posted. Somehow it makes me feel better to get it out in writing. Im just very scared and nervous, trying not to freak out. I dont have kids, my dogs are my babies, just so hard to watch her go though this.

Laurie

Dear Laurie,

There's no such thing as rambling here ;), and we totally understand your worry. It always helps me, too, to write things out amidst our family here. I remain so glad that Charlotte will be seen there at Davis. Even if she is not a candidate for the study for some reason, I remain hopeful that they will have some helpful feedback or suggestions to guide the path forward. Hang in there -- just a couple more days, now!

Marianne

See our motto at the top of the page and that first promise - "support"? We are here to listen anytime you need to talk, to scream, to laugh, to cry, whatever....we are here. Never worry about rambling, honey...besides you are talking to a champ rambler and you have a LONG way to go to catch up to me. :D So "ramble" away anytime!
Hugs,
Leslie and the gang

Charlotte was accepted to the Cushings study! Im here at UC Davis waiting on more tests. The vet thinks she also has a heart condition so we will also be seeing a cardiologist.

Ill keep you all posted, thanks again for all your support and kind words!

Oh Laurie, I'm so glad to hear that Davis will be following her!! That is really, really great news!! We'll be anxiously awaiting any and all info.

Marianne

Good news, Laurie!

Charlotte Update...

She was officially diagnosed with Cushings, the pituitary type. The Davis vet put her on Trilostane, 30 mg twice a day, although he had me start with 30mg only once a day for the first few days. We are scheduled for another ACTH stim test in 2 weeks. Although I sure didn't want her to be diagnosed with Cushings, I'm relieved we now know what is wrong with her and can start treatment. What we thought could be another issue, a possible mass of some sort in her abdomen, turned out to be nothing. They did detect some heart issues but they think it may be Cushings related so we will just keep an eye on the situation and see if it improves.

My question to all of you is what should I be looking for as far as symptoms of her not handling the meds? The vet said this was actually a low dose in comparison to what the manufacturer recommends but yet it's what Davis considers to be their high dose for her size (70 pounds) because her symptoms are so severe. I'm hoping she won't have any negative reactions to the Trilostane but I want to be prepared. The vet mentioned vomiting, diarrhea and severe lethargy as symptoms to watch out for. Anything else I should be watching for?

Laurie