Hera - 11 years old (Cushings & Diabetes insipidus)

[Amelia_]

Hi All,

I would like first to thank you for creating this forum, I got a lot of help/advice/support while trying to handle and come up against all these symptoms. My snowball Hera, she is now 11,5 and 20kg, Samoyed mix. She was diagnosed with cushings 2 years ago and after a long trip of tests with no luck with vetoryl we tried desmopressin to check if the symptoms of polyuria-polydipsia will reduce. And luckily it was.

Long story short...symptoms had started from end of 2018 and we changed 3-4 vets and all said it was UTI and suggested treatment with antibiotics. Drama

Just note that she was very sensitive to UTIs all of her life and she had a lot of phycological issues every time she had her period (last stopped after sterilisation at 5y) - I don't know if long time anxiety finally causes autoimmune disease and in our case came with these.

Have a look on the LDDS tests

TSH. . 0.10 ng / mL 0.01 - 0.41: 13/08/2019
ENHANCED CHEMICAL LIGHTING METHOD

Cortisol (1st Sample) 3.36 μg / dL 2.00 - 8.00: 13/08/2019
ENHANCED CHEMICAL LIGHTING METHOD

Cortisol (2nd Sample) 2.66 μg / dL: 13/08/2019
ENHANCED CHEMICAL LIGHTING METHOD

Cortisol (3rd Sample) 3.00 μg / dL: 13/08/2019
ENHANCED CHEMICAL LIGHTING METHOD

(FT4) 0.59 ng / dL 0.80 - 2.90: 13/08/2019
METHOD OF ENHANCED CHEMICAL LIGHTING


Cholesterol 470 mg/dL
ALP 159 IU/L
SGPT 209.1 IU/L

The vet we were visiting that period insisted to vetoryl of 60mg twice/day. First 3-4 weeks and no results. She was drinking daily 6lts of water and peed 200 times day/night and had increased apetite, wanted to eat everything by all meaning.

We managed to speak with the vet we have for serious cases (very difficult to find him either on the phone or with appointment) and finaly he advised to stop vetoryl and start with a dose of desmopressin. He did not want to battle with cushings due to no other symptoms (pot belly, skin problems, reduced activity, excessive panting etc). And YES we had good results from fisrt day. From then she takes injections of desmopressin twice a day and she is fine 2years now plus cibacen 10mg/day to support kidneys.

Urine tests 2020:
urine gravity: 1004
Proteins Heller: +4

Urine tests 2021:
urine gravity: 1032
Proteins Heller: +2

Of course we have noticed more symptoms of cushings over time such as muscle weakness on back legs and very slow of growing hair back from shaving due to ultrasounds. Our vet still insists no treatment of cushings.

Her last check up was a month ago and the bad results are as folows:

SGPT-ALT 180 25 - 93 IU/L
(BUN) 33,64 9 - 24 mg/dl
Glucose 57 67 - 109 mg/dl
SAP 544 18 - 110 IU/L

Ultrasound showed enlaged liver, enlarged adrenal glands and polyps in the bile.

She was given supplment support for liver (Hepatiale Forte Advanced) for 10days and Ursofalk half of a capsule once/daily with dinner.

We had a bit difficult month as suddenly she had issues. Lethargy, weakness, loss appetite / very picky, diarrhea, but fortunately she was drinking water. I started to cook for her chicken/rice and to not push her for walks as she was struggling to walk further from a house square (lucky us we have a yard). This situation was for almost 10 days and we are back to normal with eating normally (still cooking and mix with dry food), no lethargy, no diarrhea. I am on her all the time to check for any changes as I was very worried I was going to lose her last week and our favorite vet was closed for summer. BTW I stopped her from Ursofalk as maybe this was her problem. We have an appointment to the vet next week for a check up before leaving for our vacation - all together of course (my buddy, Hera and Petra - my old lady a chihuahua).

For the moment all is going well.

I am in a research of a dry food for Hera. I'd like to ask if any of you may know if dry food with high protein (more than 26%) may adversely affect the problem.

Well thank you for being here - really!

Best
Amelia

[labblab]

Hello Amelia, and welcome to you and Hera. We're very glad to hear that we've already been of help to you, and we're so glad you've now officially joined us so that we can talk to you directly! First of all, I see you're in Greece and I hope that you've not been threatened by any of the horrible wildfires that we've seen burning. The TV footage has been so frightening, just like all the wildfires here in the western part of the U.S. Anyway, we hope you are staying safe!

Turning to Hera, you've done a wonderful job of telling us about her history and past test results. There's so much helpful information here that I want to be able to take some more time to really look through all the information carefully before I try to offer out some thoughts. So I apologize for making you wait a bit longer before I'm able to write a more complete reply. But as I say, I want to be able to review all the information you've already given us.

In the meantime, once again I want to welcome you both. And I'll definitely return again later today or tomorrow.

Until then, best wishes.
Marianne

[Amelia_]

Marianne thanks very much for your reply. Our house is not very close to these area that were burnt but there were days the atmosphere was very bad and couldn't go outside because of the smoke, however we have some friends who were there and trying to save their home... huge disaster here for some areas as Greece was not ready to face such situations.

Concerning Hera's history I tried to give you the most important of her past test results - hope will help and just food for thought for some dog owners who don't see results with vetoryl on cushing dogs regarding symptoms of polydipsia/polyuria to check also for diabetes insipidus.

Thanks again.

Best
Amelia

[labblab]

Hello again, Amelia! I’m so glad to know you’ve not been hit directly by the fires, but I know the smoke can drift a very long way and create breathing problems for a lot of people. My family has a vacation cabin in the western part of the U.S. where wildfires have become more and more common. We were at the cabin a few years ago when a massive forest fire came very, very close and the air was filled with harsh smoke for days and days. It was awful! Anyway, I’m so glad you’ve stayed safe.

Turning to Hera, your information about her experience with desmopressin (DDVAP) is very helpful and very timely! We have another new member who is considering giving it a try with her dog, and I’ve encouraged her to come and read what you’ve written here, since it may be worth it for her to give it a try with her own dog.

After reading back through your thread once again, I’m very relieved to hear that Hera has regained her appetite. Also, I do understand why your vet was not originally anxious to continue with the Vetoryl once the desmopressin eased her most troublesome symptom. One reason, though, why you might want to revisit Vetoryl in the future, at least in a small dose, is due to the protein in her urine and the elevated BUN. Untreated Cushing’s can cause kidney changes that result in protein being spilled into the urine. This, in turn, can cause kidney damage over time. So in the face of persistent proteinuria or kidney issues, you may want to reconsider lowering her cortisol level through direct Cushing’s treatment. This is not something you’d likely want to explore right before beginning your vacation. But perhaps something to discuss with your vet in greater detail when you return.

As far as her food, my understanding is that you want to exercise moderate dietary protein restriction with a dog who is spilling protein into their urine. A high protein diet can increase the amount of protein that is being passed into the urine. So I wouldn’t think you’d want to exceed 26% protein in her diet right now, and perhaps even aim for a bit less than that. But you may want to launch an internet search for more specific info about current dietary recommendations for dogs suffering from proteinuria.

In the meantime, I hope you all have a great vacation!
Marianne

[Amelia_]

Marianne, I am glad you are safe too - it's horrible to live such an experience!

I found and read Jennifer’s post and maybe I will write to her later as I am really busy at work and with dogs. Fortunately I am working remotely last months and I can be with them all the time.

In general I feel really uncomfortable when thinking we may restart vetoryl as I keep reading others members posts and listening to the vet who says every time that we may cross the limits and cause Addisson disease and to battle with that is much more difficult so not an option for the moment. I really trust this vet as he is always to the point and really honest and has been in help a lot of times.

Another thing to mention after reading Jennifer's post and I haven't mentioned is that Hera has also many of these fatty lumps, or “lipomas,” but they do not bother her at all so we leave them alone. Once, the vet just made a puncture to them to check if there is something bad, nothing worried came up, some of them pop in the bath but again no pain or bother her.

Regarding her food, I made my research and found some medical articles and sites which say that high protein is good for senior dogs as they need more protein for their muscle support and that the high levels of phosphorus is this that cause more damage to kidneys. Of course this is for the healthy dogs I guess. Anyway in 2019 and 2020 I was in a research again for dry food and found the Forza10 immuno and renal as well and Hera went well with these two. After 2 years feeding these, we turned to same brand series "depura" and then again renal until she had her loss of appetite and started cooking. As she is now very picky with the kibbles I found an "oven baked" one which of course she became crazy with.

Anyway, today we had our appointment to the vet for the monthly check up for liver levels after giving the relevant supplements as well as for the polyps in the bile and here is the important and bad news…

SGPT-ALT 159 (25 - 93 IU/L)
BUN 38,18 (9 - 24 mg/dl)
γ-GT 265,0 (0 - 13 IU/L)
SAP 618 (18 - 110 IU/L)
PROTEIN TOTAL, SERUM 7,7 (5.5 - 7.6 g/dl)
GLOBULINS, SERUM 5,1 (3.4 - 4.1 g/dl)

Ultrasound showed a tumor in the liver and the vet asked for a computed tomography so to check if it is metastatic. He said he would like to arrange for a surgery because of Hera’s good clinical behavior/appearance as long as we have the results from the CT. I am desperate….
The polyp in the bile is gone btw.

I will check tomorrow morning availability for the scan.

That’s all for now.

Best
A

[labblab]

Dear Amelia,

I’m so sorry to learn about this possibility of a malignant tumor, but I’m hoping that you may soon find out (or already know) that it is not cancerous and that surgical removal is a reasonable option for Hera. I know that a decision about the tumor takes top priority right now, so I am sending you my high hopes that treatment will be available. Please do let us know once you learn more. We’ll be thinking about both you girls and surely hoping for the best.

Marianne

[jenner1026]

Hi Amelia - just wanted to pop on and thank you for all of the information you posted. Wishing the best for you and your pup. This is all so difficult to manage.

I will take a better read through regarding the injections and come back with questions if you don't mind. So interesting you posted about them.

[Amelia_]

Hi all and thanks very much for your support and your replies.

Unfortunately we do not have good news. The results from the CT scan are very disappointing. There are tumors everywhere spread in the whole body. Some small tumors in the lungs, a large one in the left adrenal gland, some small and one larger in the liver, one huge in the left kidney.

I spoke with our vet and he needs some more clarifications regarding some of these tumors in the liver and the lungs so that we can discuss further and I expect he will call back as soon as he speaks with the vet who performed the CT. He said that in case liver and lungs could withstand a surgery we could remove completely the left kidney and a part from the adrenal gland (if understood correctly).

My thoughts are that if we did not have made that much research on her along with all these exams and results we couldn’t be in knowledge for all these, as Hera is acting like a pup most of the days. She seems happy, she is playful and looks like a healthy dog. I am so confused and afraid to proceed with a surgery if that’s an option.

Jennifer thanks very much for your post and of course I am here to help you with any queries you may have regarding the injections of DDAVP. We are on this med 2 years + with injections twice a day. The effect of it is for 12 hours and usually the dose depends on the weight. I believe this is the reason of the good quality of life she has until now as our main symptoms were urination (lots of accidents day and night – literally our home was like urinal area with lakes everywhere and I was like the whole day with a mop, papers and in the end I had covered the floor with diapers) and tons of water she needed (6lt plus). I measure the water she drinks, using a big bottle of 1,5lt so to be sure.

Blessings to everyone.

Best

Amelia

[labblab]

Oh my, that CT report is definitely not what we were hoping for :-((((. I have to agree with you — it’s puzzling that Hera outwardly seems to be doing very well in the midst of so many different tumors. It does make us wonder whether at least some of them might just be relatively harmless benign growths of some sort. I know you’ll be anxiously awaiting further word from your vet, as will we. I know how hard it must be to await the clarification! In the meantime, though, we’re waiting right here alongside you and Hera.

Continuing healing wishes,
Marianne

[Kevin]

Amelia,

I've read some of Dr Dresslers work on Cancer care for Dogs. There is a sea of information out there on Cancer care for Dogs and holisitics and he helps navigate thru alot of the stuff.

Two supplements that do have some promise are Apocaps and Mushroom based supplements (see the Univ of Penn study on extended time for dogs with Hemangiosarcoma). I'll keep it at that as I know holistics can be really controversial and frankly, I'm skeptical of everything. You can be the judge if its a road you want to go down. But the two I mentioned do seem to show some promise and you can take it from there.

Praying for you. We're going thru something similar.