Cushings Disease

[Kate]

Hello Everyone, I don't come here very often but I need some advice.  My about to be 12 year old spayed brindle little girl has cushings.  In the last month to six weeks she has had damage to her knee and multiple visits to both the animal hospital and her regular vet.  Her personality has changed drastically.  She has her tail between her legs almost all the time, won't go outside with me and is just laying around and I'm afraid she is in pain.  She was always full of energy and followed me everywhere.   She just lays at the slider when I go out.  I even leave the door open for her.  She does go potty when  she has to but I've been carrying her up and down our steps (only 3) when I can tell she doesn't want to tackle them.  The vet wants to take more texts amounting to a lot of  money.  She displays all the symptoms of Cushings and I don't want to put her thru more than I have too.  She is now on a supplement for 6 weeks and then I take her back for more bloodwork.  Has anyone experienced this and can anyone give me some advice.  I will not let her suffer but I'm not ready to let her go.  Thanks for "listening".

 

[pkcrossley]

my dog suffered from cushings, though in his case it was hard to diagnose. i'm not sure what you mean by a "supplement" --a medicine? if she has been on the med 6 weeks without improvement, the vets should try a different med. did the vets say why they want to do more tests? are they trying to determine whether she really has cushings?

cushings is caused by a benign tumor on the pituitary gland. there is no positive proof that can be found in the blood, so additional tests might be helpful. the blood will show elevated readings of some hormones (particularly cortisol) or waste products. there are patterns that are consistent with cushings but nothing that is direct proof. if the vets want to do more tests, it sounds like they are not sure about her diagnosis. 

if the vets are very confident that she has cushings, then blood tests will show how quickly the disease is progressing. this is variable with every dog. some can be stabilized for long periods of time on the correct meds, some will respond less well. 

cushings can be definitively diagnosed with an MRI, which is a lot of money. vets may suggest ultrasound, which is a bit of money but much less than MRI, but ultrasound will not be very useful in diagnosing cushings or assessing response to the meds. an MRI can show whether the tumor is present (that is, whether it is cushings) and the size of the tumor. very small tumors can very effectively controlled by radiation. larger tumors are less likely to respond to radiation. cairns are too small to be operated on to remove the tumor (large breeds can be operated on). MRIs and radiation are very expensive, since one can lead to the other. if you do not see yourself going for MRI/radiation, then blood tests will be an important tool for understanding how to adjust meds and see how they are doing. 

[Kate]

Thank you so much.  The supplement is Sam-e I believe it is called.  My vet did suggest an ultrasound.  I have read about cushings and she shows about every symptom except hair loss and skin problems.   Unfortunately we are retired and don't have the funds to put a lot of money into this.  I love her so much I would go to extremes but I know that isn't feasible.  Her blood work showed elevated liver enzymes.  The thing that is the most worrisome is that she just isn't herself and doesn't seem to be getting much better.  I just don't want her to suffer.  She acts like she is starving all of the time and drinks a lot of water.  Looking back this has been going on for some time but you know how hind sight is.

 

 

[pkcrossley]

i see. sam-e is indeed a supplement, a rather strong one. if she truly has cushings, there are meds that can help to control it. sam-e is not cheap and the meds might not cost a great deal more. i suspect there is some reason your vets are not using this medication. it is worth asking them how confident they are that she has cushings. if they are confident about it, it seems like they would try meds and not sam-e.

ultrasound might be used to diagnose another kind of problem --for instance, liver problems-- but cannot do much to confirm a cushings diagnosis. the symptoms you describe seem consistent with cushings, but also with other diseases. liver and/or kidney problems can often be managed with diet and perhaps meds, but first have to be diagnosed. if you are reluctant to go for ultrasound, you can have a frank talk with the doctors and ask them to assess the probability of cushings, diabetes, liver problem or kidney problem on the basis of blood and urine tests. they can also test their hypothesis by prescribing the meds that correspond to each condition --if she responds, that could make the diagnosis more probable. 

[Sam I Am]

.  Jock was on Same-e for his liver disease, and of course other meds. I know in horses when diagnosed with Cushings  they actually give human meds for Parkinson's disease....don't know if the same goes for dogs? I know it can be tricky to diagnose Cushings . I know Addisons is another disease that vets seem to not test for....not sure why, but when diagnosed is managed with meds. And of course there is the dreaded C word none of us want to hear , however an ultrasound would certainly help in diagnosing a tumour. Ultra sounds like PK mentioned aure a lot cheaper than an MRI (at least up hear in Alberta.)

[kjwarnold]

I'm sorry your girl feels so bad.  It just pulls at your heartstrings when you know they don't feel good and you can't help.  Our Kirby was diagnosed with Addison's last fall but it took a week of hospital, tests, and research to figure it out.  During it all, Kirby was obviously very sick and some symptoms were similar to what you're seeing.  Addison's is the opposite of Cushings; Kirby now does very well with a monthly shot of Percorten-V and daily Prednisone to replace the cortisol that his body doesn't produce.  

Yes, it's expensive to diagnose these things but once they know for sure, hopefully you'll have good news on how they can successfully manage it.  By the way, liver enzymes can be elevated for a lot of reasons.  Our Packy had elevated liver enzymes just from a stomach upset, so don't get upset about that right away.

Good luck to you...

[Kate]

Thanks everyone for the replies.   Actually she is feeling a little better today.  She is even following me around a little bit.  She was always right by my side until lately.  I am going to check with my vet on the next visit and see about the possibility of an MRI as that should be able to really let us know what is happening.  I'm hoping it isn't too expensive.  Just a ballpark figure; do you think it will be hundreds or thousands.  That will determine if we have it done or not.

One other thing, does the Sam e work in making them feel better or just a supplement like taking a vitamin.  Since she has started taking it she does seem better, but maybe it is just me being overly hopeful.

 

[Idaho Cairns]

Our first Cairn was diagnosed with Cushing's or "probable" Cushing's and she was quite active for six or seven years following the diagnoses.  Now our second rescue " ... acts like she is starving all of the time and drinks a lot of water." and she had diabetes--which made for an inexpensive and quite effective treatment--a daily insulin shot which really made an enormous positive difference in her personality and her lifestyle.
Perhaps your vet has already done the test on diabetes and ruled it out but if not, you might want to see if your girl is diabetic because in our experience--once dosage is determined, insulin injections can make a real positive difference in the dog's behavior.

 
"

[pkcrossley]

an MRI will, most likely, between 1500 and 2000. many vets will allow you to finance it over a period of time, and there are often third-party financing options. and if you follow it up with treatment, as with radiation, some veterinary hospitals will knock something off the MRI or the treatment --a package, to bring down the expense of each a bit. if it is something you want to do, be frank with the vet or hospital about your situation and ask about financing options. once you really know all the possibilities, you can make a decision that you will know later was the best or only one.

if they say they want to check liver/kidney, ultrasound can be useful as it will show the size and shape --that would be only a few hundred dollars, but for cushings it is not useful. but a lot can be suggested by blood and urine tests, at intervals, unless you feel that there is some reason she needs urgent intervention. 

sam-e has mood benefits, but it can also have medical benefits for liver disease or arthritis. it is not necessarily just about making her feel better. it sounds like you need to get a very specific idea of where the vets are on this. have they made up their minds on cushings? are they giving her the cushings meds? or, are they still unsure? did they prescribe the sam-e? if so, they may be thinking along the lines of liver. if she improves on sam-e, they may begin to feel that the liver is involved. or they may have other ideas.

some things can be suggested if not confirmed by more blood and urine tests. liver, kidney diseases, lymphoma or some cancers can be found with ultrasound. cushings can only be confirmed and treatment (if possible) determined with an MRI.

these situations are very confusing, frustrating and frightening. we have all been there. try to get the vets to be as specific as possible, and be as direct with them as you about what you can or cannot do. in the meantime i hope she continues to improve. that is what is important. 

 

--adding this: idaho's comments are important: if blood and urine tests suggest cushings, they can treat her as if she has cushings and see if she improves (that would not be sam-e). if you are willing do deal with some uncertainty, you do not need an MRI to see if she improves on the meds. 

Edited May 3, 2016 by pkcrossley

[Hillscreek]

My vet offers financing help through this plan http://www.carecredit.com/vetmed/  

Brad: if this is advertising feel free to take down.

I don't have experience with Cushings or Addisons but join with others in suggest more detailed talks with your vet. Maybe also a second opinion. It's so tough to pin things down some times. Wishing you the best outcome.

 

 

 

[hheldorfer]

I have no direct experience with Cushings but it was once suggested as a possible diagnosis for my non-Cairn, Ziggy.  (Ziggy's liver was enlarged on an ultrasound.)  We talked it over with the vet and decided not to pursue it further, based on a combination of information from the vet and from our own research on the internet.  Ziggy is still happy and mostly healthy (other than arthritis).   If he does have Cushings (which is incurable, though treatable) we don't want to give him the (apparently) toxic meds that are used in treatment and don't want to put him through the constant blood tests that are necessary to monitor drug levels and adjust dosages.  Obviously if Ziggy was in pain we would do anything on earth to make him feel better, but I think he'd rather be his happy-go-lucky self and live life normally for as long as he can.

I strongly suggest you read multiple articles/fact sheets regarding Cushings to familiarize yourself with terminology, diagnostic procedures and the drugs used for treatment.  This will make it easier to discuss your girl's treatment options with the vet.  Write a list of questions for your vet and don't be shy about asking for pricing information and whether discounts are available.

I hope you'll have plenty more time with your girl.  Good luck!

[sanford]

Dear Kate, Having no experience with Cushings, I have nothing concrete to offer you except to say I'm so sorry and send you my hopes for a good outcome.

[Nitabonn]

Hello, so sorry to hear about your pet's Cushing disease.  I just lost my Australian Terrier to Cushing's.  What was most noticeable in the earlier stages was the extreme change in her behavior.  Sluggishness and strangely not coming to the door when I came home. and loss of interest in going out or getting  a treat or playing.    We also had three steps she had to take to pee outside but it became more difficult for her to get up the stairs.    (Cushing causes weakness on the rear extremities.) Complicating her disease was having a chronic bladder infection.  Strong antibiotics were hard on her little body and probably did not help her comfort level.  Eventually she appeared to not know where she was or what she was doing.  As you probably know there are two causes of Cushings; adrenal and pituitary.  My Vet did not think she was in too much pain since she did not wince or moan when her body was manipulated.  My opinion was she just felt poorly and had very little energy and lost her joy.  That was what was hardest for us to take, she just did not appear to enjoy anything anymore.  I sympathize with you, although some dogs can improve, that was not my experience.  My best to you and your pet.

[Dempsy's Mom]

Sorry Kate.  I to have no experience to offer but want to say I am sorry that you and your little girl have to go through this.