Heart Like a Dog

The Good, the Bad, and the Oh My God of living with dogs!

Cushing’s Disease in Dogs

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It seems like for the past two years, every time one of my dogs goes to the vet with a symptom, Cushing’s Disease comes out of my vet’s mouth.

Some of you may recall Sampson had a urine test about 18 months ago, because the vet suspected…Cushing’s.

When Delilah’s Urinary Tract Infections started back in December, Cushing’s was once again brought up. Since I’d already researched Cushing’s symptoms, I was adamant, “She does not have Cushing’s.”

What is Cushing’s Disease?

In a nutshell, Cushing’s Disease is an over-production of a hormone called “cortisol.” Cortisol is a hormone produced in the Adrenal Glands (two little walnut-sized glands that rest on top of the kidneys.)  These little glands are the guys that produce that “fight or flight” response when you feel threatened. They are also the little guys that give moms that super human strength to lift a car off their child. (If you want to read up on Cushing s, you can check it out HERE.) Cushing’s can result from a tumor on the Adrenal Glands, but it can also be an Endocrine-active tumor on the Pituitary Gland, which is a pea-sized gland at the base of the brain. The Pituitary Gland (as I understand it) tells the Adrenal Glands, “Get cracking, it’s time to make the Cortisol. (Similar to the guy at Dunkin Donuts, who says, it’s time to make the donuts. For the record though, donuts are far more enjoyable than a tumor.)

When a body is producing too much Cortisol, you can imagine what kind of havoc it can wreak, and how having too much Cortisol in your body can be a very bad thing.

What are the symptoms for Cushing’s?

According to PetMD, the symptoms for Cushing’s are as follows:

  • Increased thirst and urination
  • Increased hunger
  • Increased panting
  • Pot-bellied abdomen
  • Obesity
  • Fat pads on the neck and shoulders
  • Recurrent infections of skin, ears, urinary tract, etc.
  • Loss of hair
  • Lack of energy
  • Inability to sleep (insomnia)
  • Muscle weakness
  • Infertility
  • Darkening of the skin
  • Appearance of blackheads on the skin
  • Thin skin
  • Bruising
  • Hard white scaly patches on the skin, elbows, etc. (associated with the disease calcinosis cutis)
  • Neurologic abnormalities (circling, behavioral changes, seizures, etc.) Source

I get compliments about my coat ALL THE TIME. The boots? Meh, not so much.

Of the symptoms listed above, there were only two that Delilah exhibited. The first was the bout she had with UTI’s that started in December and ran through the middle of April.

The other, is her unquenchable third.  Delilah drinks an enormous amount of water. In fact, if you filled her bowl with a gallon of water, she would drink it all.

A good portion of the time, her drinking is around meal times, or just before or after her walks.

Shortly after Delilah came to her forever home, I took her into the vet to question her massive water consumption. At that time, I suspected she had Diabetes, but that was ruled out with a blood test. We did discover however, that her Thyroid levels were low. We put her on Levoxythyrine and she’s done quite okay with it.

Hubby and I theorize that Delilah’s water consumption is a learned behavior. Our theory is Delilah has learned that water helps fill her up. We believe it stems from the time she spent on her own, on the Mean Streets of Lake Charles, but that is only a guess.

To help Delilah with her water intake, we moderate the amount of water that is put into her bowl at all times; because the water bowl is like the Field of Dreams…if you fill it, she will come. And drink it all.

It sucks for poor Sampson, but we are always at the ready to jump up and give him water when he indicates he requires some.

I tipped the bowl over again, something I couldn’t do if it HAD WATER IN IT!

As I stated earlier, this ‘argument’ if you will, with my vet has been ongoing for some time now.  In my vet’s defense, Cushing’s is very common in older dogs, and it is probably one of the easiest diseases to test for.

After Delilah finished the herbs prescribed by the Holistic Vet, we had her urine checked. When our vet called, she said there was no infection, but Delilah’s urine was more diluted that she’d like. When I asked what might cause that, she said “Cushing s.”

I’d finally had enough, “Maybe we should just have her tested so I can stop having this conversation,” I said to Hubby.

How is Cushing’s Disease diagnosed?

To test for Cushing’s plan to have your dog stay at the Vet’s office for the day.  There are a number of different tests your Vet can use, but mine used Low Dose Dexamethasone Suppression (LDDS.) This is the most accurate test to diagnosis Adrenal Cushing’s. Your dog is given a shot of Dexamethasone which is a synthetic cortisol, which should stop the body’s production of Cortisol. (Source)  The Vet then draws blood at various intervals. The Cortisol levels in dogs WITHOUT Cushing’s disease will decrease over time. However, if your dog HAS Cushing’s disease the levels will remain the same, or in some instances increase.(If the Adrenals and Pituitary are healthy, the gland knows there is enough Cortisol in the body, if they aren’t doing their job, the Adrenals will continue to produce Cortisol.)

There is some controversy/confusion over fasting with this test, which is one of the biggest reasons I hesitated to put Delilah through the test. Initially, my Vet said Delilah had to fast. Now this may seem silly to some, but I promised Delilah a long time ago, that as long as I had control over it, she would never miss a meal again. Then I was chatting with my friend, she said her dog only had to fast for the first draw. Then they fed him his breakfast. So I questioned my Vet’s office and was told, “Yes, fasting is required.” Hubby and I talked, and for the sake of putting the Cushing’s diagnosis to bed, we decided to go ahead with it.

Flash forward to the day before the test, and my Vet’s Office called to confirm, and said, “No fasting required.”

Chocolate Lab counter surfs

I don’t need YOU to make me breakfast, I can help myself!

I asked her if she were sure, and she said she’d check, but if I didn’t hear from her, to fast Delilah.

I called on my way home to see what the cutoff time was for food and water, and was again told, no fasting required.

I asked her to confirm with my vet, and she put me on hold, then told me again, “No fasting required.  We want Delilah to be happy and comfortable.” (As comfortable as she can be stuck in a crate with people poking her with needles all day long.) “Delilah will be happiest if she’s had breakfast,” I assured her.

The next morning Delilah got her breakfast, and Hubby dropped her off at the Vet’s office, and picked her up when it was over.

Delilah Does NOT have Cushing’s Disease (a.k.a. I TOLD YOU SO, I TOLD YOU SO, I TOLD YOU SO!)

The next night my Vet called with the results of Delilah’s test. “As you suspected, Delilah does not have Cushing’s Disease” my vet said. I turned and looked at Hubby with that smug look I save for when I’m being totally vindicated (yes, apparently I am making this about me,) and I think I actually did a fist pump or thumbs up too. I couldn’t actually say, “I told you so,” to my Vet, nor could I tell her that I’m done having this conversation, but I did tell her I was glad we had ruled it out, because I knew she was concerned about it. She did go on to say that just because Delilah doesn’t have Cushing’s now, doesn’t mean she can’t get it in the future. She is concerned because Delilah’s urine is diluted and she can’t seem to concentrate it.

I explained Hubby and my theory and she said typically dogs that drink a lot have an underlying issue, she didn’t rule out a behavioral issue, but she said those are pretty rare. She also suggested adding a bit of water to Delilah’s food, to see if that makes a difference.

The discussion then became, how far do we want to dig to get to the bottom of the UTI’s and the diluted urine; and the answer is, this is far enough. If the situation changes down the road, we will cross that bridge when/if we need to.

If it’s NOT Cushing’s Disease, what could it be?

The next day I did the Google to see what could make a dog not concentrate her urine, and found there are a number of other diseases/afflictions/conditions which could be causing this.  Chemical Imbalance of the Urine (Source), Water Diabetes (Source) are two of the illnesses I found. Since both of them require additional testing, we will not pursue a diagnosis at this time.

Are some breeds more susceptible to Cushing’s Disease than others?

The answer is yes! Some dog breeds like Labradors, Beagles, Poodles, Terriers, Dachshunds and German Shepherds are more susceptible to Cushing’s Disease than others. The disease also tends to strike middle-aged to senior dogs.

Are there different tests that diagnose Cushing’s Disease?

Yes.  There is a urine test that costs around $100, and last I knew, there was only one laboratory in the US that ran the test, and that is in Wisconsin. The test will NOT tell you if your dog HAS Cushing’s disease, but it can tell you that your dog DOES NOT have Cushing’s disease.

If you are concerned about leaving your dog at the Vet’s all day, or about the cost for the Cushing’s test (Delilah’s test was $246), then you may want to speak with your Vet about the urine test that can rule out the disease.

You mean peeing in a cup was an option? I call foul on you woman.

I chose to go with the actual LDDS test because of Delilah’s urine dilution issue.

Disclaimer: I am not a Veterinarian, I don’t play one on TV, and I haven’t stayed at a Holiday Inn Express lately. What I have shared here is my experience and understanding of Cushing’s Disease in Dogs. It is not meant to be used as a diagnostic tool.  If you have concerns that your dog might have Cushing’s Disease, please consult your own Veterinarian.

 

Corneal Ulcers in Dogs

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When Delilah went to the vet’s for her annual check-up, I mentioned to Dr Soutter how I was concerned with Delilah’s inability to gain weight.

“I’m not worried about that at all!” Dr. Soutter exclaimed, “I’m more concerned with this ulcer in her eye!”

When Hubby and I looked, we were shocked to see a brown mark about 1/16th to 1/8th inch long in her right eye. While it was noticeable when pointed out to us, it wasn’t something we had noticed ourselves.

What is a Corneal Ulcer?

Think of the Cornea as a windshield for the eye.  A Corneal Ulcer is an open sore on the Cornea. Naturally we were concerned about how she got it, and how to treat it. Dr. Soutter explained the majority of these eye ulcers occur due to an injury.

Anyone who has a Labrador Retriever knows, these guys do everything enthusiastically. This dog plows through gated areas in the house, dives under counters for a flake of tuna, disregards trees and shrubs in her path to run the fence line, and rides in the car with her head out the window.

For us, there was absolutely no way of knowing how, or when this injury had occurred.

Debridement of a Corneal Ulcer

Dr. Soutter said the way to treat the injury was to numb Delilah’s eye, and then ‘slough’ off the ulcer with a Q-tip. This is also known as “Debriding.” According to Wikipedia, Debridement is the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue.” Source

I was freaked out about the idea of anything being put in her eye, but these ulcers can be painful, and we needed to begin the healing of her eye. Delilah tolerated the debridement quite well, and we were sent home with Tobramycin, an antibiotic drop that needed to be put in her eye four times a day.

FOUR TIMES A DAY.

She also needed a re-check in ten days to two weeks. I was faithful with the Tobramycin. Delilah absolutely hated it, but it had to be done. It is never fun when your dog shies away from you when you pull out that dropper.

We were also told that Delilah could be uncomfortable from the debridement, and if we noticed her rubbing the area, we would need to cone her.  But she didn’t seem bothered in the least by it.

After two full weeks of antibiotic drops, FOUR TIMES A DAY, we headed back to the vet. It was so disappointing when Dr. Soutter said it wasn’t healing as well as she’d hoped, so at this point she recommended adding a serum twice per day, along with the antibiotic.

That’s drops in her eye six times per day, yo!

What is serum a.k.a. PRP?

I had never heard of serum for the eye. This serum is made from the blood of either a horse or a dog. It is put in the centrifuge and spun down, which isolates the platelets and blood plasma to separate from other components of the blood. The plasma and platelets are then combined into platelet-rich plasma a.k.a. PRP. (Which is in fact, a treatment all its own and is in experimental treatment for soft tissue injuries.) This serum has high concentrations of natural growth factors. In traditional PRP, the animals own blood is used, but in Delilah’s case, we were using serum made from the blood of a horse. (In retrospect, I would have insisted the serum be made from her own blood, but this was totally new to us, and I had no idea.)

The serum is contained in a sterile tube, and you use a syringe to remove the serum from the tube, then you take the needle off the syringe, and using the tube portion, put one drop of serum in the eye.

Dr. Soutter said there was a trick to it, but she didn’t tell me the trick. She did say you could put more in the syringe then you needed, so I filled that sucker up. (This, as I later found out, was NOT the way to do this.) The serum needed to be refrigerated, and I kept the full syringe standing up in one of the compartments on the door.

With Hubby holding her eye open, (you try holding open the eye of a dog that is not cooperating, and then depressing a plunger,) we managed to get a drop in the first night and the next morning. The next night, I shot the serum all over her face and the floor. It was all gone. $28 on my dog’s face and my kitchen floor. That ‘trick’ sure would have come in handy, before I wasted $28.

I was pissed. I called and asked for more, and asked if it could be in a bottle (it couldn’t, due to the sterility issue.) I was asked to come in so I could be shown ‘the trick.’

Here’s the trick, just in case you ever have to do this stuff yourself.

The trick is this…once you put the serum in the syringe, draw the plunger back slightly, and remove the needle. Now, when you gently depress the plunger, only a small drop comes out.

Delilah was on the serum for two weeks, at twice per day. Along with the Tobramycin four times per day. SIX TIMES PER DAY! SIX TIMES!

The kick is this, the drops have to be at least five minutes apart, because the eye can only absorb so much liquid. Also, I work. I’m gone from the house at least 9 1/2 hours per day. So she would get one antibiotic drop first thing in the morning, the serum when we got back from our walk, and another antibiotic drop just before I left for work.  The evening schedule was one antibiotic drop as soon as I got home, the serum just before dinner, and another antibiotic drop at bedtime. It was challenging, but we made it work.

After the two weeks, Hubby and I both thought her eye looked better, and I took her back to see Dr. Soutter who said, “I think it’s time to see a ophthalmologist.” You could have knocked me over with a feather. Then she said, “Well, there’s one more thing I can try, I can take a needle and gently move the ulcer.”

I think my quick “NO” ticked her off a little, but I have a thing about eyes, and my thought was,  if someone is sticking a needle in my dog’s eye, it will be someone who specializes in eyes.

Is there more than one antibiotic that can treat a Corneal Ulcer?

Dr. Soutter recommended two different ophthalmologists, one not too far from me, and one just over an hour away. I hemmed and hawed over which one, (it literally took me at least a week to decide) reading the reviews on YELP. (Side note. Don’t read the reviews. Happy people rarely write reviews.) While I made my decision, I researched Non-Healing Corneal Ulcers, and found there was more than one antibiotic used for treatment.

I had two thoughts…one being that as Delilah is an older dog, and I have learned from Sampson that everyone heals in their own way and time, maybe she just needed more time, or a different antibiotic drop. I asked Dr. Soutter if there was something else she could try while we waited for the ophthalmology appointment.

There was, and Dr. Soutter prescribed Neomycin-Polym which is a drug used in humans, and available at my local pharmacy. We also continued her on the serum.

Getting an appointment with a Canine Ophthalmologist is hard!

Finally I made my decision to take her to the ophthalmologist who was over an hour away. I was told that my vet would need to fax over her medical records, and the Dr. would determine the urgency with which she’d be seen. They called me the next day and said they could see her the following Wednesday. I was thrilled. Then she asked if I could drop her off in the morning and pick her up in the afternoon. The Vet tech would tell me what the Dr. thought when I picked her up.

NO…no.,..no! First, this tells me that my dog will sit in a crate all day, and the Dr. will see her when she has time. Two, I don’t know you, and more importantly, my dog doesn’t know you. I’m not comfortable with that. I was told if I needed an appointment they could not see me until August.

So I called the other facility, and it was basically the same spiel. My vet had to talk to the specialist, and then we could make an appointment. When I called them back after getting the go ahead from Dr. Soutter, I got the same deal. “Can you drop her off in the morning and pick her up in the afternoon?”

They got the same answer, “NO.”

I told them I needed an appointment, and thankfully, they had one in about ten days.

Dog or horse serum, does it make a difference?

In the meantime, we ran out of serum, and the vet’s office didn’t have any available, but one of the tech’s dogs was there, so they drew blood and spun us some dog serum.

This serum was pink compared to the yellowish serum I’d been getting, and quite frankly, it made me want to vomit every time I had to put it in her eye, but we did.

The day finally came for her appointment. Hubby and I had been thinking her eye looked great, and we were right! The ulcer had healed! (Hubs and I both really feel the dog serum made the difference for Delilah, although there is no documentation to back that theory up.)

After sharing the good news with me, Dr. Greenberg asked me if I’d noticed the blueish tinge Delilah has going on in her eyes.

It’s hard to photograph her eyes, but do you notice the blueish, or hazy effect that she has going on over her pupils?

I had noticed the color change, but I thought it was part of the natural eye aging process.

I was wrong. It’s actually a symptom of a progressive corneal disease.

Delilah was diagnosed with Endothelial Decompensation.

What is Endothelial Decompensation?

The inner layers of Delilah’s corneas have stopped functioning normally.

From her take home instructions: “The function of the inner layer of the cornea is to keep fluid out of it, helping to maintain its clarity. When the endothelium degenerates, fluid fills the cornea, which gives it a blue cloudy color. This is known as corneal edema. This fluid can form littler blisters or bullae, which can rupture and cause corneal ulceration.”

This is a life-long, progressive condition of which there is no cure. The goal will be to try and prevent blisters from forming in her eyes, and turning into ulcers and to keep her eyes comfortable.

It’s very likely Delilah’s ulcer was from the disease, and not an injury as we had originally suspected.

According to the paperwork, most dogs maintain functional vision with this condition.

The eyes have it.

The best thing we can do for Delilah, is to have regular visits to the ophthalmologist, and keep looking into those beautiful eyes to make sure she doesn’t have an ulcer.

Disclaimer: I am not a vet, I do not play one of TV, nor did I stay at a Holiday Inn Express last night. Delilah’s treatment and subsequent diagnosis were arrived at by examination and consultation with a licensed and trusted veterinarian. If you suspect your dog is having problems or ulcers in her/his eyes, please consult your veterinarian. DO NOT SELF-DIAGNOSE YOUR DOG.

Is it IBD, EPI or Something Else?

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Last week, in my post about Chronic UTI’s, I mentioned another medical issue had cropped up. During one of our visits for the UTI, my Vet noted Delilah had lost about five pounds in three or four months. She suggested I try putting some weight back on Delilah.

At the time, Delilah was weighing in at about 66 pounds. I started feeding her the same portion I feed Sampson. Which is the portion size for an 85 pound dog.

Side note: Delilah was fine with the increase in food. 😉

“Don’t give me extra food,” said no Lab ever.

During one of our calls about Delilah’s UTI’s,  I mentioned her weight, and wondered if she could have a digestive disorder, like EPI.

“How are her poops, hard or soft?”

“Soft, but I just assumed it was from the constant antibiotics.”

“Are her poops smelly?”

“Yes, but she’s been on antibiotics for basically four months!”

The vet suggested a blood test.

When the test came back, her Cobalamin and Folate (B12) levels were low. For the record, the normal for Cobalamin is 284-836, hers were 222. Folate normal is 4.8 – 19.0 and hers were 4.3.
The big surprise was…her liver level that had been high for two years, was normal.

At this point, my vet said, she probably had IBD. But I wasn’t buying it.  according to PetMD, the symptoms for IBD are:

  • Diarrhea
  • Fatigue
  • Weight Loss
  • Depression
  • Chronic Intermittent Vomiting
  • Farting (Gas)
  • Abdominal Pain
  • Abdominal Sounds
  • Red Blood in Stools
  • Distressed Coat

Of the listed symptoms, she had weight loss. Nothing else, in fact, I’m complimented ALL THE TIME, about how beautiful her coat is.

And then the vet said something horrible. She recommended a Commercial Hydrolyzed diet.

To which I said, “Absolutely not. I’m not putting her on that. I’ve read the label, and there is not one discernible ingredient in it.”

My vet gave me a lengthy explanation of how the food is broken down into the tiniest possible unit, which makes the food source undetectable to the body.

Let’s say your dog is allergic to chicken. A Hydrolyzed dog food takes that chicken, and breaks it down to the smallest possible unit. Now the body cannot detect that the food it’s ingesting is chicken, thereby allowing the dog stop having the reaction to chicken. At least this is the way I understand it.

But something my vet said, triggered a number of thoughts in my brain. (At this point, my Hubby would say, “I thought I smelled something burning.”) She said that Delilah likely had inflammation in her intestines.

I’ve done some research on dogs with IBD and what’s the best diet for them, and from what I can tell, the raw diet is highly recommended for dogs with this disease. And Delilah’s been on it for seven years, so the IBD diagnosis didn’t sit well with me.

My thoughts were this:

1) Long time readers may remember a time when Delilah had a severe allergic reaction to something.  We never did figure out what it was, I suspect it was a fish oil, but have no proof.)

Hives on dogs

It looks like a crown of hives, or a bad job of corn rowing.

2) Could any of these issues stem from being on the antibiotic for so long?

3) Sometime last year I began adding a couple of different proteins into the dogs diet. Specifically Beef and Tuna.

4) I have food allergies myself, and they manifest as inflammation. (I get hives!)

I was adamantly against the company and food recommended by my vet. My decision, after discussing thoroughly with Hubby and my vet, was to eliminate beef, tuna, dairy, and grain from her diet, as well as consulting with the Holistic vet. We decided to do this, because the symptoms Delilah was having were not severe, she didn’t appear to be sick, and the levels were only slightly off.

I had my vet’s office e-mail me Delilah’s records for the past year, which I then forwarded to the Holistic Vet. You may recall from last week’s post, that he had a plan for her chronic UTI’s.

Well, he also had a plan for the weight loss/intestinal issues. We started her on a Chinese herb called, “Bu Zhong Yi Qi Tang.” Don’t ask me how to pronounce it, when I call for a refill, I ask for the Chinese brown powder. We also put the dogs on a really good Pro-biotic. (I’m a firm believer that the Gut is the Root of all evil in the body.) Throw the flora in your gut off, and it’s a crap shoot as to what can go wrong. And antibiotics can definitely throw your good bacterial levels wonky.

I also put Delilah on Cobalaquin which according to my vet, is the only Vitamin B12 that can be given orally that is actually absorbed properly.

I immediately stopped the other proteins I’d been feeding, and kept her only on chicken and turkey. These were proteins she had been having all along for the past seven years.

I’m always careful on what goes into their treats, but I really became vigilant. As I picked up poop, I noted whether it was soft, or stinky, or both. If it was either or both, I stopped feeding her that treat.

After six weeks, Delilah went in for her annual exam. I was thrilled when the bloodwork showed the Cobalamin was not a concern at that time. To be on the safe side, we kept her on the Bu Zhong Yi Qi Tang and the Hydrangea & Eupatorium tincture for another six weeks.

At this point, her weight seems to be stable, and her poops appear more like her normal poops. In my opinion, Delilah had an allergy to one of the proteins I was feeding her. I’m betting on the Tuna, but just to be safe, she’s staying off Beef for now.

IF she continues to do well, I MAY consider adding some Beef back into her diet, but it won’t be for a very long time.

MEANWHILE, during Delilah’s annual exam, our vet discovered that Delilah had a Corneal Ulcer in her right eye.

Next week, I’ll share our struggle with the ulcer, her eventual diagnosis and where we go from here.

DISCLAIMER: I am not a veterinarian, I do not play one on TV, and I did not stay at a Holiday Inn Express last night. If your dog is showing signs of intestinal discomfort, if (s)he’s vomiting or having diarrhea, or just not feeling well,  please take him/her to your veterinarian. The diagnosis we came to with Delilah is based on conversations and testing with a licensed veterinarian and is in no way intended to be a diagnosis for your dog. Please DO NOT SELF DIAGNOSE your dog.

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