Balance and mobility issue

[Sav625]

Hello, and thanks for the add to the group.

My furbaby is an almost 8-year-old Shorkie who has (after countless tests) been diagnosed with the pituitary form of Cushings.

My best (human) friend had a dog with Cushings, so while I am not completely ignorant of the disease and its effects, I still have a lot of questions.

The most important one is this: When they cite 'muscle weakness' as a symptom of Cushings, does this mean total loss of muscular control? My Ladybug is very suddenly having trouble staying on her feet - staggering sideways and falling over - for short periods of time. Both times it happened was just after she had run to the door to greet guests, and the episodes lasted maybe ten minutes.

Any help or advice is greatly appreciated.

[labblab]

Hello and welcome, although I'm very sorry for the problem that has brought you to us. To cut to the chase, what you are describing is not a typical effect of Cushing's. Muscle weakness does often accompany the syndrome, but this typically manifests in a loss of muscle mass and a general weakening of the hind end which results in difficulty with things like jumping into a car or up on a bed, or negotiating stairs, etc. Additionally, there is a very rare condition named "Pseudomyotonia" that afflicts less than 1% of Cushpups, and can result in virtual hind end paralysis. I'll give you a link that explains this disorder, but neither it nor a general weakening sound like the discrete ten-minute episodes you are describing.

http://www.vmsg.com/wp-content/uploa...domyotonia.pdf

Can you give us more details about exactly what happens to Ladybug? You say the episodes have lasted around ten minutes -- what is she doing during that time? Does she seem to be disoriented at all? I am wondering whether she may be experiencing some type of mini-seizure.

Backing up a bit, can you tell us more about Ladybug's overall health history, as well as the symptoms and diagnostics that led to the Cushing's diagnosis? Have you started any treatment yet?

Sorry for all these questions, but your answers will help guide the path forward. And once again, welcome to you both!

Marianne

[Sav625]

Hi Marianne, and thanks for the quick reply.

The latest occurrence of this, I had taken Bug out for her evening piddle, and she seemed fine. Out the door, down the stairs, did her business and came back up the stairs and into the house with no obvious problems. Halfway through the house she just stopped and sat down, and when she tried to stand back up it seemed like her back legs didn't want to support her. She took a couple of wobbly steps sideways and I gently urged her to just lie down. She didn't seem disoriented so much as... confused as to what was happening? That's about the best way I can describe the way she was looking at me. I sat down on the floor with her and just talked to her and patted her for a few minutes until she decided it was time to try it again. She got to her feet slowly, but walked to the kitchen to demand her bedtime cookie (which is really just one large kibble of food that helps keep her teeth in good shape, but she doesn't know that), and she walked to the bedroom where I put her on the bed for the night.

Around 4:00 this morning, she woke up out of a sound sleep and 'shrieked' as if she was in pain, then she panted and her breathing was odd for little while before she went back to sleep.

We got up, went outside (I carried her down and up the stairs just to be safe), then she lay in her kitchen bed while I fixed her breakfast, and lay there and stared at it for a few minutes before she ate. This is a first, normally she natters at me the whole time I get her food ready and wolfs it down like she's starving.

She doesn't pant or present any obvious signs of a seizure, she just can't get her legs to cooperate.

As far as the diagnosis, it's been a long road. Now that we know what it is, she definitely has some of the symptoms... pot belly, thirst, lots of trips outside, thinning fur, skin problems and the like. She has been treated for a nasty bout of crystals in her urine. A couple of ear infections, a scratch from a tree branch that got infected but was taken care of with antibiotics, nothing really outside the norm for a small dog.

We have had several trips to the vet over the past couple of years, and some unfortunately expensive and (in retrospect) unnecessary tests. Poor baby. She developed dry, itchy skin and she eventually managed to rub her poor tummy raw trying to scratch it on the rug. This still hasn't healed, and since I cannot be home 24/7 for her, I finally resorted to putting her into a baby onesie (with the legs of the thing kind of wrapped around her and snapped together on her back so her rear legs and tail are free). She doesn't seem to mind it, and she knows she gets to be naked when Mommy comes home. Bloodwork, more tests, urinology, more tests, even a punch biopsy that really only told us what she DOESN'T have.

All this led to some interesting conclusions, including something about the overall health of a dog whose fur drastically changes color from puppy to adulthood. Ladybug was true Yorkie colors when she was a baby, all dark and tricolor and absolutely gorgeous. After the first haircut, only the tips retained the Yorkie coloring, and now she is still faintly tri, but generally what I have to term a "greige" color - some beige, some tan, some grey. That sounds awful, I know. She may not have the prettiest coloring, but she has the sweetest, most loving disposition.

Our vet, who has apparently never seen a case of Cushings before, finally determined through research and collaboration that she has Pituitary Dependent Hypercortisolism. (We live in a small town, which sort of explains why our vet doesn't have much experience with it).

Overall she has been a happy, healthy, playful girl who loves to go for walks and play. My little Football Dog, she's also perfectly happy to sit on the couch with me and watch football for hours on end.

I haven't started treatment yet, partially because the treatment sounds more like torture, and partially because the friend I mentioned had considerable success and less nasty side-effects with a holistic treatment regime, and I want to look into that more. I don't know how many years we have left together, but I want her to be happy and as healthy as I can make her. I have seen firsthand some of the effects drugs like Prednisone can have on humans, and I can't imagine putting my girl through that.

Lorena.

[Joan2517]

Hi and welcome from me as well. It would be helpful to post any blood work, highs and lows only, with the reference ranges.

And what diagnostic test did your vet do to test for Cushing's? The results of that would help the members more knowledgeable than I am, assist you with your questions.

She sounds like a little doll. We look forward to learning more about her.

[labblab]

Hi again, Lorena. Thanks so much for this additional info! I'm really glad that Joan has asked about specific test results, though, because I do have some questions about the basis for the Cushing's diagnosis.

Our vet, who has apparently never seen a case of Cushings before, finally determined through research and collaboration that she has Pituitary Dependent Hypercortisolism. (We live in a small town, which sort of explains why our vet doesn't have much experience with it).

There are some specific blood tests that are used to diagnose Cushing's, and Cushpups also tend to exhibit some common abnormalities on general blood and urine panels. So I am wondering whether your vet has actually tested for Cushing's, or is somehow just concluding that it must be the problem. For instance, without performing a LDDS test (low dose dexamethasone suppression test) and perhaps also an abdominal ultrasound, there's no way to conclude that a pituitary tumor (as opposed to an adrenal tumor) is the basis for Cushing's in a dog who truly has the disease.

So right now, I'm a bit concerned about the basis for the diagnosis. Also, in terms of treatment, I'm wondering what you may have read that makes you worry that it is torture . It is true that monitoring blood testing is required, and the medications can carry side effects. But it sounds as though you have some extreme fears about these meds, so please feel free to talk to us about your specific concerns. Also, just to clarify, prednisone is used to treat low cortisol as opposed to high cortisol. So that would be one worry that you can set aside.

Marianne

[molly muffin]

Hello and welcome from me too.

I'm wondering actually about a spinal issue. We had a dog on here recently that they thought had cushings, and it turned out that she had a spine problem I think it was and her body was compensating by producing high levels of cortisol to mitigate the pain. Once that issue was addressed, the cortisol went down naturally and cushing symptoms disappeared. If I remember correctly it took several different vets and a specialist to determine what the problem actually was.
So that might be worth looking into.

[Sav625]

Wow, so much helpful information, I am so happy I found you guys!

Specific tests included bloodwork showing low white cell count. She has had urinary infections in the past that she has been treated for. She has crystals in her urine and I believe her uterus, for which she has been given specific food to combat. When we have had to test urine, results have generally shown blood and crystals.

After the punch biopsy on the skin irregularities on her tummy came back negative, they did an ultrasound scan that found a benign pituitary tumor. The most recent test they did was to inject her with... have to look that one up... adrenaline maybe? and tested her blood every four hours for the next 12 afterwards.

Our vet consulted colleagues with our girl's medical history, and this was what they came up with. He also had indicated some worry that we seemed to be bringing the Bug in every couple of weeks with a new problem... I'm sure he thought us quite crazy at one point.

Something else I have noticed, although I thought it was just the cut of her fur at first, is that she seems to be more and more pigeon-toed in the front legs. She is stocky, with quite a potbelly on her (we think she may be more Bichon than Shih-tzu, or a mixture, hard to tell. The people we got her from had three dogs and they were not entirely certain who the father actually was). She also seems to have episodic breathing oddities, and she seems to have less and less energy all the time.

I have a call-in with my vet tomorrow about the odd falling-over and wobbly issue, and I will ask about the pigeon-toed walking. I hope the poor thing hasn't had some kind of heart or brain event on top of everything else. Since the episodes yesterday she just has no energy at all.

Did I mention she's almost 8? And these symptoms have been ongoing for nearly two years now. Her tummy patches started off red and sore looking, and now have mostly darkened to almost black and the skin seems quite loose and wrinkly. The rest of her body tends towards dry skin.

Sorry if I'm jumping all over the board with this, I haven't slept for a couple of nights worrying and I'm trying to get all the details I can remember down here.

Lorena.

[labblab]

OK then , that day-long test you're describing is most likely the LDDS. The injection agent is dexamethasone, and depending upon the test results, a pituitary tumor can be deemed most likely alongside results that are consistent with Cushing's, generally. I'm still somewhat confused by the imaging results, though, because the only way in which a pituitary tumor can be directly seen is via either a CT or MRI of the head. Both of these diagnostics are very, very expensive, require specialized equipment, and are not regularly performed. So I am guessing that Ladybug instead had the much more common abdominal ultrasound, and perhaps a mass was seen on some other internal organ?

It will help us a lot if you can get actual copies of the written ultrasound report, the skin biopsy, and the blood and urine tests. For instance, I'm wondering whether her thyroid level (T4) was within normal range, since low thyroid can cause a host of problems including skin issues. Obviously your vet has made a lot of effort in arriving at this diagnosis, but it will still help us to have the chance to see the actual results -- especially since Bug's sudden acute downturn is not really consistent with Cushing's alone. I surely hope she starts to bounce back for you!

Marianne