Hi all,

This post may be a bit premature but I am looking for as much factual information on Cushings disease as I can find please.

I posted on here recently regarding Orthostatic Tremour. To cut a very long story short my 6yr old Briard has been having muscle leg tremours for a while and having seen several different Vets and been given different ideas/treatment on it, he was finally referred to Glasgow University Vet Hospital by my Vet to see a Neurologist, who decided that we needed to have muscle and nerve biopsies done. These were then posted to the USA for analysis and we were waiting for the results.

I had a conversation with the Neurologist last night and she has had the results back but she's not happy as some are too inconclusive and she has asked that they elaborate for her. Having given his case a lot of thought and spoken to several specialists she is now not so sure that we are dealing with Orthostatic Tremour as was first thought. Taking into account all of his symptoms she is now leaning more towards Cushings disease. She has requested that we have a final blood test done immediately so that we can confirm or rule it out. The blood test is not something that all Vets can do as it is quite complicated. He has to have several tests taken over the course of the day and comparisons will be made.

My initial research on this disease, plus the very basic information that she has given me doesn't answer enough of my questions. Understandably she doesn't want to go into too many details until we know exactly what we are dealing with but I am very concerned and worried. I can see why she is leaning towards him having this disease as a lot of his symptoms tie up with it.

I am trying to be optimistic about it and hope that he proves negative for it but also I have to be realistic and arm myself with as much information that I can find. Also, anybody else who has dealt with it on a practical level, I would be very appreciative of any advice/experience.

Thank you,

Jo

Hi Jo

I have only dealt with drug induced Cushings caused by excessive prednisolone use.  But this link may explain it in layman's terms.

http://www.canine-cushings.co.uk/

Hope this helps a little.

Steph

Thank you Steph, very useful ;-)

I have briefly scanned the site and will read it thoroughly later on. It looks informative and should answer many of my questions.

At the moment I am researching pituitary and adrenal as we aren't yet sure what category he will fall into should he have it, in saying that, from the information I have read so far it seems likely that he will have the pituitary condition. :-(

Thanks again,

Jo

http://www.vetrica.com/care/dog/cushings.shtml

http://www.penstone-vets.co.uk/cushings.htm

http://www.biltonvets.co.uk/Client%20Care%20Sheets/Cushing's%20Disease%20CCS.pdf

http://www.vetstreamcanis.com/ACI/February08/VMD2/FactSheet052.asp

Any of these helpful? :-)

Hairypooch, have your dogs ever been treated with steroids from their vet?

If the tests are not showing definitively the dog has cushings then keep questioning it. 

Hi,

No, neither of my dogs have ever been treated with steroids. I wouldn't have allowed it unless in absolute extreme circumstances. I try to treat  all my animals as naturally as possible, where possible but obviously conventional medicine is sometimes necessary. But I don't vaccinate or knowingly use chemicals in any form and up until now they have been the healthiest dogs I've ever owned ;-)

I have finally found a Vet who I have a good relationship with, we both understand and respect each others POV and he is currently questioning Glasgow as to where the foundations lay for a possible diagnosis. He is insisting that we get a full set of thyroid function tests done instead of the T4 and T5 tests that have already been done. But we are waiting for an appointment so that we can go ahead and get the ACTH stimulation bloods done so that we can establish exactly what is going on. There is definitely something very wrong and I need to get to the bottom of it quickly, one way or the other - just so I can sleep at night if nothing else ;-) my Vet and I are in agreement that Murfee statistically doesn't fit the stereotype of having Cushings disease , but then dogs are a law unto themselves!

Jo

Thank you munrogirl :-)

The more information I can gather, the better.

Jo

> insisting that we get a full set of thyroid function tests done

Jean Dodds in the USA is fab for thyroid function tests - got inconclusive stuff on my dog from UK labs and a definite yes from her - she is an expert in the field and very helpful.

http://www.hemopet.org/services.html

Hi,

All of Murfs biopsies and the two thyroid function tests were sent to the USA for analysis, hence the long wait. The Neurologist is not particularly happy with the results as they were not elaborate enough and she is currently asking them for more information. He had various haematology tests, Biochemistry, serology including toxoplasma and neospora and urinalysis. They also did thoracic X-rays  and EMG both of which were 'unremarkable' - I hate that expression as it tells you nothing.

I don't know where my Vet is getting the next lot of thyroid tests analysed but I will ask him ;-) And add into this lot of problems, Murf had an ear infection, as it was so gunky it was flushed out (they ruptured his ear drum whilst doing it) and treated with AB's, this has still not cleared up and having done a culture swab on it last week it has now come back as Malassezia (fungus) because of the high dosage of AB's they have destroyed his good bacteria, despite me pumping loads of pre and pro-biotics into him. So my poor big boy has to go back to the Vets yet again to have his ear flushed and have fungal ear drops. He really is in the wars at the moment, he's gone from a dog that was happy and healthy to a shadow of his former self in a matter of months :-(

I hope that your dog is well, why did you have to have thyroid tests done?

Jo

My dog had thyroid tests because of poor healing after an orthopaedic op and when he (repeatedly) cut himself - I presume from leaping in ditches where lovely (not!) people had dumped broken glass. He healed much more quickly once he was on the soloxine. :-)

Hope your poor lad is diagnosed and treated effectively soon.

It's good that you managed to identify the problem and treat it :-)

I despair of the GP who have no thought whatsoever for animals and just leave what they like, where they like, it makes me so angry!

Thanks for your kind wishes, he is booked in for a chat with my Vet on Monday <that's me chatting to the Vet - not him!>so we can plan the tests for next week. It turns out that my Vet will be able to do the ACTH stimulation bloods at the surgery because he is going to get a piece of equipment in specially :-) And his thyroid function tests will be sent to the US as a matter of urgency.

Fingers crossed for you today. :-)

Thank you :-)

We've had one lot of bloods done on Monday and another load were done today - at this rate he won't have much left - I should get the results in about a week. Breathe held and fingers crossed until then ;-)

Let us know what they find - hope results are the best they can be. :-)

Results are back - good news and bad news really.

Murfs tests for Hyperthyroidism came back clear last week and I've just had the stim tests back for Cushings and Addisons, these are also clear. I haven't got the exact numbers yet I will get them when I go back to Glasgow. The Vet said that he was on the good end of normal though.

Hmmm, what to do now. I have spoken briefly with the Neurologist in Glasgow and she has put several ideas forward for further testing but as his symptoms are currently idiopathic they are all a bit lost as to what it could be.

So we are no further forward, typical Murf, he has me worried witless and all the medics scratching their heads. The trouble is, if they don't find what is going on and his symptoms deteriorate as they inevitably will, my biggest fear is that they won't know what to treat him for. The general concensus of opinion now is that it may be something neuropathic.

Jo

Hi Hairypooch

What are his specific symptoms?  Sorry if there is another thread I should have looked at :-)

Hi ;-)

http://www.champdogsforum.co.uk/cgi-bin/board/topic_show.pl?pid=1047048;hl=orthostatic%20tremour#pid1047048

These are his symptoms. The only difference is that our Neurologist has now come to the conclusion that he doesn't have Orthostatic Tremour but something along the same lines that she believes has not ever been identified before. ie, his symptoms are similar but display in a different way - no, it doesn't make sense to me at the moment either <very confused> 

Jo

Have they definitely ruled out a trapped nerve?  Does he show signs of pain, like when you look in his eyes can you see his discomfort?  And is it actually getting worse or are you just looking for more?  Sorry if that came out the wrong way, you mention it is distressing to watch.  It's very puzzling I must say - as much as my mum's dogs cushings-which-wasn't lol.  We narrowed it down to phsycological stress - ever since my mum moved out of Glasgow to be closer to me (for various reasons, she was living and working in a highly stressed environment) the symptoms have virtually gone, the dogs have physically and emotionally relaxed as has my mum.  If it had been cushings he would have been dead by now I'm sure - it was text book cushings symptoms and I stressed myself out for weeks online trying to find something else it could be, just to give it a name.  He was subjected to hundreds of pounds worth of testing which all came back as fine.  You say Murfee is ok outside, it's just inside he seems to have this problem?  Is there anything in the house that could stress him out?  I'm sorry if you've asked yourself these questions already, I know how hard it is truly I do.

Hi :-)

When Murf had his Acupuncture the Vet who carried it out is also a Pain Management Specialist and she took a very long and detailed history and also did a thorough physical examination, she ruled out just about everything 'obvious' to quote her.

He isn't in what I would call pain, it is more like aching and just feeling bleurgh - very hard to describe - some days are better than others. Some days I am convinced that he is getting slightly worse and other days he doesn't seem as troubled by it. Sorry to be so vague but unless you are actually watching him it is very difficult to describe. He definitely gets worse when he is under pressure, he trembles like a jelly and virtually cannot sit down at all when we are at the Vet's yet doesn't ever get this bad at home.

We are now up to £3,500 in exploration Vet fees and like your Mums dog, we haven't got a conclusion. It's so frustrating. I almost feel as an owner that I must be suspected of Münchhausen's by Proxy!

I've looked very closely at his life and routine and honestly, if I ever came back as a dog I would want to come back as him :-P Watching dog behaviour has always been one of my interests and I have often picked up on things with all of my dogs, past and present that have been bothering them, the only difference this time is that I cannot find a physical or psychological reason for his problem. You are spot on with the questions that you are asking and it's good because coming at it from another angle often helps ;-)

I'm glad the tests are clear - sort of - because in a way it would be better if they had found something so you know what you are dealing with, as otherwise you just keep worrying. :-(

I don't want to panic you - and sorry it's quite a scientific article - but have they tested for this?

http://www.addl.purdue.edu/newsletters/2007/Spring/CP.htm

I know it's a really non specific sort of illness, so difficult to diagnose. I can't remember if you said whether he's had an abdominal scan including his adrenal glands?

Thank you for the link, it makes interesting reading.

He hasn't had an abdominal scan. They were going to MRI him but decided that it was unnecessary.

I am waiting to get an appointment in Glasgow so I will have to be patient and take it from there. I will print out the article and take it with me.

Thanks :-)

Jo

You're welcome - again, I hope it isn't - and I doubt it is the sort of thing that would have gone on that long without getting worse - but they have ruled out so many things now, it is worth thinking of other possibilities yourself that you can discuss with them, as well as whether the MRI scan is worth doing now the other tests have come back negative. They can see so much more in terms of disc damage/ pressing on nerves with that than with an Xray. My GSP boy has lumbosacral spondylosis - which was obvious on Xray - but when MRI'd the specialist could see that the LS disc had been damaged too, and the disc material was - well is - pressing on the nerve roots as they exit that particular bit of the spinal canal. :-( He is getting gradually more trembly in his back legs - especially the right one, as it is worse on the right - and losing muscle, especially from that side. His problems started - or I first noticed them - in October 2006, when the spondylosis wasn't obvious at all (he had Xrays for his bladder then which included that area) - but it was extremely bad on the Xrays taken just over a year ago, and the MRI was done a year ago.

Has your boy had his back Xrayed? Sorry, can't remember if you said.

Yes, they X-Rayed his spine in January and said that all the discs and vertebrae looked good. Because he has a constant hump on his back, it was originally thought that he had a vertebrae or spinal problem. But having got a lot further down the line with it, the roaching is a secondary symptom and clearly not the main problem.

Sorry to hear about your boy. What treatment are you giving him for his condition and what will the outcome eventually be?

I am going to suggest that we have an MRI, even if it shows nothing and just ticks yet another box. They are still working on the assumption that it is a neuro problem and that the messages being sent from brain to nerve are getting confused. The day to day problems that we have, apart from the leg tremours, is that he leaks urine whenever he wakes or gets up. It distresses him and you can see that he doesn't understand why and is constantly licking himself. His walking when out on the lead is getting worse, he 'crabs' , his head points towards me whilst his body is pointing away and he bunny hops. He carried that on for nearly half a mile the other day and really cannot help himself. This in turn seems to exhaust him and neither of us are enjoying our walks any more :-(

I really don't know where this will end.

> I am going to suggest that we have an MRI, even if it shows nothing and just ticks yet another box.

I think I'd be suggesting that too if he was mine - I know he's not a typical breed for it, but looking at this http://www.veterinary-neurologist.co.uk/part2.htm#20 syringomyelia can cause symptoms like that, though pain is usually the main thing and you haven't mentioned that as far as I've seen - but even if it's a condition of a similar variety/ in a similar area, presumably MRI would be the best/only test to show it up. Again fingers well and truly crossed that it isn't that, but that they can find something on a test that hasn't yet been done, that can be treated successfully.

What's his name, by the way? You've probably mentioned before and I haven't noticed. *blush*

> Sorry to hear about your boy. What treatment are you giving him for his condition and what will the outcome eventually be?

Thanks. If it had been a disc they could have accessed easily, they would have considered decompressing it, and removing the disc material that was pressing on the nerves. Unfortunately the only way to reach the lumbosacral disc is by breaking the pelvis in several places for access, then plating and repairing the pelvis to heal as well - and there are I think only a couple of people in the country who do that sort of surgery. The ortho specialist said post op they would only expect the level of function my boy already has - as a good outcome. I also know there is no way I would put him through an operation like that - I just feel it wouldn't be fair on him, or right. So the main thing is to manage his pain. Tramadol was suggested, but it had no effect - well it made him sick, no effect on the pain, so he has gone onto PLT, which is fairly potent and I didn't really want to give him, but it does help. He has lost muscle because of it - above his tail, and in his back legs - I think I said the right is worse, and you can actually see the dint where the muscle has atrophied just above his knee when he brings his leg forward. I have seen that getting slowly worse, and the tablets having less effect. However he still enjoys his walks - he can run - though he has a slight limp all the time on his right, doesn't look so bad at the trot, and bunny hops when he runs. But he still enjoys hour long walks (technically little and often probably better, but doesn't work for us!). And long term it's just going to depend how quickly/ how much goes - it's the dreaded wait and see game. If he gets to a point where he is in pain that is causing him distress and can't be managed that will be it. If his muscles progressively waste and weaken till he struggles to walk/run, that will be it at the point where he is no longer happy/coping with what he can do. My fingers are crossed that it will get to a point where it will sort of remain static - no better, no worse - then stay there. He's only 8 and a half, and I've TOLD him he has to get to at least 15yrs!! LOL.

Oh, and he was also on anti-oxidants - vit A,C,E and selenium, but where I was buying them online has stopped making them, so I have to find somewhere else - easier said than done.

When's your next appointment? Sorry again if you've said, and I've missed reading it.

Lumbosacral Spondylosis sounds horrible. I am not at all familiar with it but any debilitating disease in animals is upsetting, especially when you can find no known cause or reason for it. Long term pain relief has always worried me, as I'm sure it does everyone. You sometimes think that it won't be the desease that causes them problems futuristically but the damage from the drugs to counteract it. It really is a vicious circle. It was suggested to me that I could dose Murfee up with Metacam and other NSAIDs and he did had quite a lot of the stuff after his biopsy. It's learning how to read the signals, particularly with him. Briards generally are very stoical and do not show pain unless in immense discomfort. Mind you, somebody should tell his sister that :-D I have resisted long term pain relief at the moment as I don't feel that it is yet necessary and also, there will come a time when he needs higher doses to get the same pain relief. Obviously in your case this is completely different. I think that I mentioned that they want to try him on a month long course of steroids, but I can't see the reasoning behind this if they suspect that he has a neurological problem, so I have refused.

>He's only 8 and a half, and I've TOLD him he has to get to at least 15yrs!! LOL.<

I have had similar conversations with Murf, he is only 6 1/2 and I have told him that I am not ready or willing to let him go for at least the next 10yrs! A bit ambitious maybe but it gives him something to aim for ;-)

The eventual outcome in all diseases depends upon the individual, I am actually sick of being told this. My comments to that are let's find out what 'disease' he has first before prophesying. But in the end, as you are indicating in your case, it all comes down to 'quality of life'. My Vet has said to me that despite us not finding an answer at the moment I will know when he deteriorates and in need of pain relief and possible downgrading of exercise.

Were you buying your Anti-Oxidants from a site that sells 'human supplements' or animal ones? It's just that I give Murf high quality Glucosamine and Chondroitin, working on the assumption that it doesn't do any harm, my Vet on the other hand isn't convinced that it does any good but that is another story! I buy from a 'human' site and adjust the dosage accordingly. I'm not suggesting that you buy that but I also have a friend who treats all of her animals holistically and supplements them from various dependable suppliers. I could ask her for the names of these Companies if you want.

I am waiting for the Neurologist to get back to me as she is very, very busy and is also going on a months holiday very soon. *very inconsiderate of her* LOL.

I'm afraid that I don't know what your boys name is either.

Thank you for the link, I will have a good read of it later :-)

> especially when you can find no known cause or reason for it.

It's supposed to be more common in active large breed dogs, and there was an occasion when Dorain decided unexpectedly to try and run up a 15ft vertical bank from a stream, instead of going back up the path, almost made it, then fell back off and landed on his right hip on a rock. This is when he was about 3.5yrs old. He was on 3 legs at first and I thought he'd broken it - but then he went back to normal. But it might explain why his right is worse. :-(

> You sometimes think that it won't be the desease that causes them problems futuristically but the damage from the drugs to counteract it.

That's the problem, it's balancing out benefits versus side effects. But in Dorain's case we do know what we are dealing with, so from that point of view it makes decisions a bit easier.

> I have had similar conversations with Murf, he is only 6 1/2 and I have told him that I am not ready or willing to let him go for at least the next 10yrs! A bit ambitious maybe but it gives him something to aim for ;-)

Let's hope this is one occasion when our dogs listen to us, eh? ;-) :-)

Sorry, pressed post and hadn't finished... whoops!!

> Were you buying your Anti-Oxidants from a site that sells 'human supplements' or animal ones?

It's a site that sells both - it was an animal supplement but they have discontinued it. I think I MAY have found somewhere else - if I remembered to write the web address down. If your friend knows where I can get animal antioxidants from that would be brill though - the dose is different to humans for those. I'm using them as they are meant to help with nerve problems/ Vitamin E etc are meant to mop up free radicals - so if you don't use them it might be worth checking with your neurologist to see if you'd be OK to use those too. I don't bother with G+C as with Dorain it's not his joints - but I don't know why your vet says that, as I know they make a huge difference to some dogs - MarianneB on here had her oldie, sadly now over the Bridge, on them and said they made a big enough difference that she could stop NSAIDs with him, if I recall correctly.

> I am waiting for the Neurologist to get back to me

Hope you hear soon. The not knowing is the worst bit.