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Thread: Inca's Journey

  1. #1

    Default Inca's Journey

    Hi everyone! My girl, Inca, is a 10 year old spayed Miniature Schnauzer. Most of her life has been uneventful in terms of veterinary procedures (other than calcium oxylate bladder stones in 2019 and her spaying at the age of 4 years). We live on the west coast of Canada.

    This is going to be a long story (sorry) -

    In mid-December 2020, Inca was not herself. Not excited for meals (although there was no problem with her appetite) and standing with a hunched back and her nub of a tail tucked in. I took her to the vet, who ran bloodwork, checked her over physically and thought she might be experiencing some arthritis. The bloodwork was concerning – high total protein, globulin, ALT and ALP. Luckily, the mobile ultrasound vet was coming in for another client that day so we booked an ultrasound for Inca which showed that she had what appeared to be a biliary mucocele forming. We did more bloodwork the next day which showed that her platelets were low. The vet who saw her said we could wait and do another ultrasound in a month (and not knowing how quickly they can grow, I agreed) – no medication prescribed other than Gabapentin for the “arthritis” pain and instructions to go to the Emergency Vet/Surgical Specialists if she got sicker. (This is the one vet at the clinic who I can not relate to and I have asked not to have my dogs seen by her unless it is an emergency and she is the only person available).

    The Gabapentin caused Inca to be really confused. We saw her staring at walls like she wanted a door to open. I stopped it after 3 doses as I did not like the effect on her. After Christmas, we noticed she was walking into the other dogs and objects which were in the way when moving around the house and she seemed to be extremely hungry. In the beginning of January, I made an appointment with a different vet at my clinic and she determined that Inca has lost most of her vision. This was sudden and, after eliminating most causes, we thought it fit the signs of Sudden Acquired Retinal Degeneration (but we have to travel to another area of the province to have the diagnosis confirmed and that’s not possible at the moment). Her blood pressure was checked and was good as was the eye pressure. A week later, we retested the eye pressure and it was still good. Her eyes were goopy so a tear production test was done and a diagnosis of keratoconjunctivitis sicca (dry eye) that I am treating with a prescription of Cyclosporin Oil 2% and Optix Eye Health ointment.

    The following week, Inca had the follow up ultrasound; the mucocele had grown a lot and they referred me to the Veterinary Surgeon at the Emergency Clinic. Gallbladder Resection surgery was booked for a week later. The surgery went well, the blood work not so well. Still really low platelets and Plateletcrit, high ALT, ALP, low Total Red Blood Cells, Haematocrit and Hemoglobin. She was in the hospital for 2 nights and then sent home with antibiotics and pain control. A liver biopsy was done during the surgery and the microbiology report was good with the culture showing no growth but the pathology report showed “an unexpected lesion which was diffuse severe hepatocellular vacuolation in a pattern strongly suggestive of increased glycogen deposition and therefore suggestive of steroid hepatopathy” and suggesting that the vet might want to follow up with further investigation for Cushings Disease.

    Inca had follow up blood work a week after discharge (done at my local vet). She wasn’t her normal self at the appointment – quite lethargic and disinterested (she usually loves the vet and the girls at reception). Her temperature was low. The blood work came back with low Eosinophils and Platelets and High Neutrophils and Basophils. I was advised that she could be very ill and that they had called the Emergency Clinic with the information and I was urged to take her there immediately. She was admitted overnight for observation after a 4 hour investigation. They redid the blood work at the Emergency Clinic and noted that her liver enzymes (ALT, ALP and GGT) were still elevated and that her platelets were almost non-existent but the ones that were there were large so a slide was sent out for a pathologist to review. While there, she had an abdominal ultrasound which showed no free fluid or peritonitis and she was examined by the Internal Medicine Vet. She was sent home at noon with 2 antibiotics (Amoxicillin/Clavulinic Acid and Enrofloxacin) as well as Ursodiol and Cerenia (for nausea). She was also to start on Prednisone (3.75 mg) 2 weeks post surgery so she had 7 of those before we did the next blood work and started tapering her off (due to the suspicion of Cushings) after the results of the Feb 16 test

    Chest x-ray was done on February 8 and read by radiologist – all normal. Follow up bloodwork and urinalysis done on February 16. Platelets have improved to just below the low end of the range, Red Blood Cell Count, Eosinophils still low, TT4 low. ALT, ALP, GGT, Cholesterol and Lipase all High, SDMA slightly elevated. The urinalysis showed that the urine is not concentrating well and there was a small amount of protein.

    Inca has had loose stool for 4 days this week – had an appointment for Friday afternoon about it and started to clear up. I was giving her Aventi GI and we switched her food to Royal Canin Gastrointestinal Low Fat kibble (she usually eats the same thing in loaf form).

    Inca is much more hesitant on our walks and she does not like being in large open spaces (tried walking across a ball field and she froze). I think some of it is her blindness but wind and noises seem to confuse her as well (didn’t before). She gets around well in the house (at least most of the time) and has started managing the 4 steps up/down to the backyard.

    She has not gained weight (may have lost weight), she acts like she is starving at meal times (we are feeding her at breakfast and dinner times with snacks at noon and mid-evening), she is drinking a lot but no accidents in the house.

    At present, she is getting Ursodiol (250 mg once a day) and Aventi Liver Complete (3/4 tablet a day). I will be trying not to change her food as it is difficult because Inca needs something that will not cause bladder stones and something that does not contain egg (I am anaphylactic and can’t tolerate anything that contains egg even on my skin so I would have to stay away from my dog if she ate them).

    We have a Low Dose Dexamethasone Suppression test and Free T4 test scheduled for Thursday, March 4 (a week after the last prednisone).

    Hope that wasn’t too much information – I have copies of most of the testing.

  2. #2
    Join Date
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    Default Re: Inca's Journey

    Hi and welcome to you and Inca!

    I am so sorry that you and your sweet girl are going through so much, OMG what a journey you both are having. I apologize in advance as my post will be short, but I do want to thank you for all the information you provided about your precious Inca. A couple notes from me: Dogs with Cushing's, at least the majority of the time, have increased platelet level counts, so that has me stumped. Also, the Low Dose Dexamethasone Suppression test should not be performed on a dog that is unwell as it may yield a false positive result, the ACTH stimulation test is preferred when a dog has a non-adrenal illness.

    Could you do us a favor and type in her test results, we need only see those levels that are marked abnormal with the reference ranges and units of measurement...thanks!! Is she still taking the Cyclosporin? And exactly what symptoms is Inca displaying?

    Again, I sorry my post is so short, but please know we will help in any way we can so do not hesitate to ask all the questions you want.

    Hugs, Lori

  3. #3

    Default Re: Inca's Journey

    Hi - Inca's symptoms are excessive water drinking and peeing (but no accidents in the house and she sleeps through the night) and a hugely increased appetite - we have started feeding her snacks at noon and mid-evening but still keeping within her normal food requirements. She has not gained weight, I don't notice any hair loss and I don't think she has a pot-belly (but it's hard to tell after the surgical haircut she got ) The testing is mostly because of the abnormal test results from the blood work and the comments about the liver biopsy.

    I do a lot of research and don't have too many questions (yet) but I know the breeder I got Inca from (who still grooms my dogs and we count as a friend) is against using drugs for Cushings but I suspect the stories she has heard have been from people who did not have a good rapport with their vets and the stories may have been exaggerated. That said, I am all about educating myself on the pros and cons of drug therapy (if it is indicated).

    Inca's blood test results from February 16.

    RBC LOW 5.69 (5.83 - 9.01)
    MCHC HIGH 38.9 (30.9 - 38.6)
    EOS LOW 0.04 (0.10 - 1.49)
    PLT LOW 163 (175-500) previous result 12 days earlier was 53
    SDMA HIGH 15 (0-14)
    GLOB HIGH 53 (25-45)
    ALT HIGH 531 (10-125) previous result 12 days earlier was 251
    ALP HIGH over 2000 (23-212) previous result 12 days earlier was 1354
    GGTHIGH 27 (0-11) previous result 12 days earlier was 5
    CHOL HIGH 9.78 (2.84-8.26) previous result 12 days earlier was 7.01
    LIPA HIGH 2456 (200-1800) previous result 12 days earlier was 1427
    TT4 LOW Less than 6 (13-51)

  4. #4
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    Default Re: Inca's Journey

    The majority of Inca's abnormal blood work results could be attributed to pancreatitis, also Miniature Schnauzers are more prone to getting pancreatitis than other dog breeds. Another thing, her standing with a hunched back is a huge indicator of a dog having a pancreatic attack. If this were me, I would have Spec cPl or PrecisionPSL test performed, these tests are usually the ones recommended in diagnosing pancreatitis.

    Like I've mentioned before, in the ten years I've been on this forum I do not ever remember seeing a dog with Cushing's having a low platelet count. Dog's with Cushing's have an elevated cortisol level which causes the platelet counts to increase. Has the vet mentioned that pancreatitis could be the cause of Inca's abnormal blood work results?

  5. #5

    Default Re: Inca's Journey

    Thanks for your reply.

    Yes, my dogs have had pancreatic attacks for years. Inca has been better than the other 2 though. We are very careful with what they eat and can usually control the pancreatitis but I will get the vet to check again. I think the hunched back was from the gallbladder mucocele - it seems to have stopped now.

    The vet is also investigating Hypothyroidism as her thyroid levels are very low.

    The fact that Inca had all these issues at the same time - abnormal blood work, gallbladder surgery and sudden blindness makes it difficult to know what is causing things. She is still very hesitant with her blindness so it is hard to tell if she isn't feeling good or if she is just nervous.

  6. #6
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    Default Re: Inca's Journey

    Hi Team,

    Welcome to you and Inca!

    I have a little something to add to what Lori has shared and that is a condition called SARDS (Sudden Acquired Retinal Degeneration) that has been misdiagnosed as Cushing's more than once. In the beginning this condition causes the same signs as Cushing's and can cause false positives on the cush tests. As time passes the cush signs usually disappear and the cortisol levels return to more normal levels without treatment. Here is a link on SARDS:

    https://vcahospitals.com/know-your-p...syndrome-sards

    Glad to have you and Inca part of our little family!
    Hugs,
    Leslie
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  7. #7

    Default Re: Inca's Journey

    Thank you Leslie - I have done research about SARDS as the consensus seems to be that is why she lost her sight. Unfortunately, the only veterinary opthamalogists are a 2 hour ferry ride away but, as my husband and I are in the high-risk category if we get Covid, we won't be making that trip. We used to have a travelling opthamalogist who would come to one of the vet clinics and do her examinations - I miss her.

    With the information that SARDS can cause false positives on the Cushings tests, I wonder if I should postpone the test or, if I go ahead with it, wait on medicating for a few months to see what happens. I have been reading about hypothyroidism and she seems to fit those signs and symptoms too - really wish she could tell us what is bothering her

  8. #8
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    Default Re: Inca's Journey

    I believe postponing the Low Dose Dexamethasone Suppression (LDDS) test, or for that matter, any Cushing's test shouldn't be performed right now. The LDDS test can yeild a false positive result when any non-adrenal illness is present, even stress can alter the LDDS test.

    The goal of treatment for Cushing's is to control those bothersome symptoms while bringing that elevated cortisol down within therapeutic ranges, I suspect with Inca that her cortisol is not that elevated for the main reason that her platelet count is low. I'm not a vet, so these are just my opinions.

    Hugs, Lori

  9. #9
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    Apr 2009
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    Default Re: Inca's Journey

    Hello from me, too. Gosh, it sounds like Inca (and you!) have been through an awful lot during these past couple of months — I’m so sorry about that. Her case is definitely perplexing, with so many variables in play. I’m so glad Lori mentioned pancreatitis, because that’s one of the first things I thought of, too, especially with that elevated lipase result on the February 16 testing. I also agree with Lori that the low platelet count is very unusual in terms of Cushing’s. On the flip side, the gallbladder mucocele, some other blood counts and chemistries (high liver enzymes, “stress leukogram” in terms of white blood counts), and the appearance of the liver on ultrasound can all be linked with Cushing’s. Low T4 is also often secondary to Cushing’s. Very dilute urine with protein loss can also be caused by Cushing’s. And throwing possible SARDS into the mix is also a big question mark. As Leslie has noted, SARDS can be associated with Cushing’s-like symptoms that end up normalizing again over time. But dogs can also be afflicted with both illnesses. The relationship between the two illnesses has yet to be unraveled.

    Inca’s case is complicated enough that I fear that it will take a specialized clinician to sort out all the puzzle pieces. However, in terms of immediate testing, I totally agree with Lori that I’d be very fearful that a LDDS performed at this time would likely be untrustworthy. Inca simply has so many physical stressors at play right now that I’d honestly be surprised if her cortisol *wasn’t” elevated right now, regardless of whether or not Cushing’s is genuinely present. I’d hold off on the LDDS testing for the time being. Instead, I’d consider submitting her blood sample for a full thyroid panel, which would encompass more than just a free T4. This more involved analysis may already be what you have in mind. But a full panel could help shed light on whether a low T4 reading is a primary problem in it’s own right, or whether it’s more likely secondary to another systemic illness such as Cushing’s. Distinguishing between the two situations could guide thyroid supplementation treatment decisions, and could also lend more or less support to the possibility of Cushing’s.

    Also, one other quick question: did her abdominal ultrasound note any abnormalities in the appearance of her adrenal glands? If not — if they were normal — that would tend to make Cushing’s less likely.

    Marianne
    Last edited by labblab; 03-02-2021 at 10:51 AM. Reason: To add.

  10. #10

    Default Re: Inca's Journey

    Thanks Marianne. We are going to do a full thyroid panel and she has been seen once by a Vet Internal Specialist when she was readmitted to the Emergency Hospital. I had already been thinking that a consult with her would be a good idea.

    The ultrasound from December stated "No masses or cysts were noted. The left adrenal gland measured 0.45 cm high at the caudal pole and the right adrenal gland measured 0.48 cm high at the caudal pole.

    My dogs like to be enigmas, I think. Nothing straight forward for them

    Thanks for your help.

    Chris

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