Our 12 Year Old Boxer Mila's Cushing Diagnosis

[MilaMooski]

We have the most amazing boxers Mila and Joey. Mila turns 12 next month and Joey will be 10 this July. Both were rescued as puppies.

Aside from some allergy issues as pups (that was treated with sulphur and apis through a holistic vet) we've been blessed with two of the happiest, healthiest, trouble-free boxer babies since day one.

Last December, Mila started tripping when getting out of our RV (we travel full time). Aside from taking quite the tumble down the steps, we didn't think much of it at the time. (She gets up and shakes it off.) From January through March, her joints began to get extremely rigid and she began having more issues walking. We were still going on short walks and hikes but they have decreased more and more each week.

As luck would have it, Joey recently had a few days of vomiting after eating. Something that is very rare for him. So after a couple of days we decided to take him to the vet just to get him checked out. (He did check out a-ok and hasn't had a problem keeping his food down since that day.)

We started talking about Mila's stiffening joints and the vet suggested that it didn't sound like "old age" and that he would be happy to take a look at her. We bring Mila in and after a few minutes he tells me this doesn't look normal. Suggests a blood test to see if anything shows up.

I am grateful that something came up with Joey that got us to the vet talking about Mila.

First blood test only reveals slightly low Thyriod levels.

We did a round of x-rays - she looks perfect.

He recommends a Neuroligst in a nearby town.

Neurologist is stumped by her stiffness. Suggests the local vet run a cushings test.

Consult Notes from Neurologist:

Patient: Mila, 11 yr FS Boxer
History: Signs began Fall 2017. Dragging paws front and rear. Problem is progressive. Tendency to have extensor rigidity of limbs; fore in particular. Owner perceives some pain associated with these signs although can’t really localize source. She has been knuckling pelvic paws. No other signs of systemic illness. No known chronic illness. Travel in the last 3 years has included most of the West (including Phoenix) but all over country.

Current Medications: Thyroid supplement
Lab results: Radiographs spine, thorax, abdomen, pelvis unremarkable. Blood tests done recently and only abnormal was slight low T4 per owner (not available for my review).

Physical Exam findings: BW= 24 kg T=101.3 mm, eent, pln, h&l, abd, m/s, integ (haircoat in general is thin and she is losing hair, two raised alopecic erythematous plaques central thorax) all WNL unless otherwise listed in parentheses.
Neuro exam findings:
1) Mentation-QAR, appropriate
Posture and gait- ambulatory with difficulty. All 4 limbs are extensor rigid and stiff impeding normal gait. She walks without obvious proprioceptive ataxia and does not have abnormal nail wear pelvic limbs
Postural Reactions- difficult to assess because of stiff limbs, but static CP and hopping appear within normal limits
Cranial nerves- normal
LMN/segmental reflexes- Excessive extensor tone all limbs. Difficult to bend limbs even with force .

Neuroanatomic localization: Suspect peripheral myopathy
Differential diagnoses: Cushing’s myopathy, polymyositis, atypical tetanus, other…

Recommendations:
Attempt to definitively exclude Hyperadrenocorticism (low dose Dex suppression, ultrasound of adrenal glands, etc). If this is diagnosed, secondary myopathy could be presumed
If CK was not measured on the routine labwork, I also recommend submitting serum for CK levels. This could be done at time of Cushing’s testing
Alternatively, we could do muscle biopsy here locally which would tell us both about Cushing’s and other possible myopathies
Non invasive but diagnostic testing for Cushing’s myopathy can be achieved with electromyography with a neurologist on the front range who has this equipment.

If this is Cushing’s myopathy, there is no known proven effective therapy. Effectively managing the cushings may help, but significant improvements are not likely.


We did the Cushings test. It came back positive. I don't have the results for that one.

Last Thursday we did the High Dose Dexametasone Supression Test

Here are the results.

Pre-Dex: 3.6
Post 4 HR: 3.5
Post 8 HR: 2.8

Apparently these results don't tell us whether it is a pitutary or an adrenal cushings. So our next step is to go for an ultrasound.

We have reached out to our holistic vet and she can do a phone consult (we're hundreds of miles away)

We have also scheduled an appointment with a certified accupuncture / chinese medicine vet next week.

She pants a lot, drinks a lot, is hungry all of the time, but no weight gain.

And her hair has definitely started thinning and skin is becoming scaly with a few small scabs.

She was running like a pup less than 6 months ago and we will do whatever we can to make her remaining time with us as enjoyable as possible.

So I guess I'm wondering if anyone has had any experience with the stiffness and if anyone has had luck with eastern medicine vs western medicine. We're open to trying anything to help her feel better.

Are there any specialists anyone would recommend in Utah or Colorado?

Sorry for the long post and thank you in advance for reading this...

Michelle

[labblab]

Hello, and welcome to you and your sweet boxer kids. I am so sorry for Mila’s problems. Unfortunately, I think the neurologist is pretty spot-on in terms of his assessment. Although a very rare consequence of Cushing’s, “pseudomyotonia” can be a very debilitating problem when it occurs. Over the years, we’ve seen a few dogs here with that issue. Sadly, Cushing’s treatment will likely not cure the problem. But if there is hope for any improvement at all, cortisol levels will likely need to come down. You’ve also noted a skin issue with Mila. This may be another symptom that warrants aggressive Cushing’s treatment. There is a particular skin disorder called Calcinosis Cutis that can develop in Cushpups. For some reason, we see an especially high incidence of this abnormality in boxers and bulldogs. Large, weeping/bloody plaques can develop and spread in conjunction with the eruption of calcium deposits. The condition can be diagnosed via skin biopsy. But if it exists, it can become another huge quality of life issue in addition to the myotonia.

I say all this to prepare you for the likely need to institute traditional western treatment for the Cushing’s. I am not aware of any studies that establish the ability of herbal preparations to effectively and consistently lower cortisol levels. As you likely already know, surgery may offer a complete cure for adrenal Cushing’s. However, the surgery is risky and quite expensive. Effective treatment of pituitary Cushing’s involves medical management using one of two prescription medications, and these meds can also be used to lower cortisol in adrenal cases where surgery is not feasible.

So, in summary, step one does likely involve an ultrasound. It sounds as though you may be on the western slope right now, but if you’re willing to travel, I feel certain there are specialists in the Denver/Boulder area. Another great resource on the Front Range is the vet school at Colorado State in Ft. Collins. If I were you, I’d be inclined to head there. Just from a financial standpoint, vet schools can be less expensive than private specialty practices. But more importantly, you’d have every research specialty represented at their clinic. Since neurology, dermatology, surgery and internal medicine may all be areas in which you’d welcone help, I believe CSU is where I’d head.

FYI, here’s an article that discusses Cushing’s pseudomyotonia in greater detail:

https://endocrinevet.blogspot.com/20...-cushings.html

Do take a look, and please let us know of additional questions.

Marianne