Like many dogs diagnosed with Cushing’s Disease, Amber’s journey was not all that different. It started with many small observations, little changes, that slowly began to tell a story.
For Amber the very first sign was fur around the back of her neck appeared to have thinned out in a small section. It was winter and she had been wearing her little jumpers and singlets quite a bit. Assuming her fine coat must be rubbing on the fabric we took her jumpers off during the day and only popped them on during the cold nights.
Amber’s Coat Thinned Out
Amber was due for her senior full blood test. A small patch of fur on her neck was clipped and several months later the section clipped still had not fully regrow. The vet had also mentioned on several visits how her skin is so fine and fragile.
Clipped And Bruised After Bloods
During this time Amber had become very picky with her food, she would get super excited about breaky or dinner than when offered, turn her nose up and walk away. We tried everything, slow cooked beef brisket and roast chicken to entice her to eat. She started losing weight. We had regular vet checks trying to work out the source of her loss of appetite. We kept a food diary for a month to show our regular vet; Amber was now only eating around 50g of food a day! Not convinced Amber was being “picky” it was highly recommended we have her looked at by an Internal Medicine Specialist at the Animal Referral Hospital (ARH); our vet was suspicious Amber may have Cushing’s Disease.
Ambers appointment specialist appointment consisted of a thorough initial consult, examination along with some tests including bloods and ultrasound. They made an unexpected discovery, Amber was suffering from a gallbladder bile disease (we were told quite common in older dogs and often never discovered unless an ultrasound happens to be done) and although not showing all of the “classic” signs of Cushing’s Disease, the specialist too was suspicious of the condition.
First step was for Amber to undergo an ACTH Stimulation (Adrenocorticotropic Hormone) test, to see where her Cortisol levels were sitting. Blood was taken to look at her Cortisol base line; a synthetic ACTH injection given and one hour later another blood sample is taken to see if the adrenals produce enough cortisol in response to the stimulation. Insufficient response suggests Addison’s disease while a spiked response may indicate Cushing’s disease. (Note: Coincidently my previous Papillon “Corey” lived with Addison’s disease nearly his entire life. I was thinking “OK if its Addison’s again at least I know how to deal with that!”)
The results:
TIME (hours) CORTISOL (nmol/L)
0 439 (30-100)
1 806
NORMAL DOG
Post-ACTH cortisol: 200 – 380 nmol/L
DIAGNOSIS: Suggestive of Cushing’s Disease. The ACTH stimulation test result by itself should not be considered diagnostic, but must be interpreted considering history, clinical signs and other laboratory date. Sick or stressed dogs may yield a false positive.
As Amber had lost weight (she is a tiny dog even before losing some weight) it was safe to presume she was feeling nausea and stress from weight loss and the gallbladder bile. We agreed it was best to take a conservative two-pronged approach to her treatment, with both drugs to treat each condition is often not well tolerated and can cause vomiting and diarrhoea.
Step 1: Commence treatment only for the gallbladder first. Once treated for around a month we are hopeful her appetite will return and in turn her weight will increase. She should feel a bit if not a lot better. We also started Amber on a drug called “Mirtazapine”, commonly used to treat depression in humans, that just so happens to have a helpful side effect that makes you feel hungry!
Amber responded well to the medication and showed no signs of vomiting or diarrhoea. One month in and we were able to get her back to a healthy and stable weight.
Step 2. Now it was time to do the LDDS (Low-Dose Dexamethasone Suppression) test. A crucial tool that assists in confirming a true Cushing’s diagnosis. Unlike the ACTH one-hour test, this is over an eight-hour period.
TEST ONE: The first sample of blood is taken before the injection of dexamethasone.
TEST TWO: The second sample is taken four hours after the dexamethasone injection
TEST THREE: The third sample is taken eight hours after the dexamethasone injection.
To keep Amber stress levels to a minimum, rather than leaving Amber at the clinic for the day, we requested to bring her home between each test so she could relax and have a sleep.
The results:
TIME (hours) CORTISOL (nmol/L)
0 92 (30-100)
3 or 4 33
8 195
FINDINGS
4- or 8-hour post-dexamethasone cortisol:
> 28 nmol/L consistent with hyperadrenocorticism
20-28 nmol/L equivocal
Amber has Cushing’s Disease.
The treatment for Cushing’s Disease is a drug call “Trilostane”, we were already very concerned about Amber’s weight, especially if she did not tolerate this drug well. It could be a complete disaster; she could start losing weight again or even worse end up on ED with terrible vomiting and diarrhoea.
Again, under our specialist’s advice it was decided to commence treatment conservatively.
Amber’s treatment plan:
AM – Treat Cushing’s:
Amber has breakfast
Trilostane 0.2ml
PM – Treat Gallbladder:
Mirtazapine (increase appetite)
Ondansetron Odt-WGR Wafer (nausea)
1 ½ hours later – Amber has dinner
Ursodeoxycholic 0.5ml
We also have another drug on hand called “Cerenia”. This is quite useful if we suspect any nausea or diarrhoea. Amber has responded so well to all her medications we have not had to offer Cerenia very often. When we do it has been for suspected nausea alone.
Two-week Review: Amber is back to have an ACTH test to determine if the Trilostane is working to reduce her Cortisol levels.
The results:
TIME (hours) CORTISOL (nmol/L)
0 138
1 272
NORMAL DOG
Post-ACTH cortisol: 165 – 320 nmol/L
Amber’s specialist is very happy with the results so far! Before having the test, we could already see a positive change in Amber’s demeanour; we were hopeful the results would be optimistic.
My Funny Little Girl!
She IS eating (not woofing down her food, which honestly, she has never done, preferring a back massage, but I guess who wouldn’t right?). Regardless she is eating breaky and dinner (mostly) and she is happy and playful again. Which is such a positive sign and a HUGE relief.
The plan for Amber now is to continue seeing her specialist on a regular basis (monthly to start with, stretching this out depending on her progress). ACTH tests will continue to be part of her on going plan and medication tweaked, as necessary.
I will be honest with you; to say we were DEVASTATED with Ambers diagnosis of both conditions is AN UNDERSTATEMENT. It has been a stressful and costly journey thus far, though at the end of the day we would do anything for our pets, all we ever want is for them to be healthy, feel well, happy and loved.
Would you would like to read in more detail about Cushings Disease.
Ambers story is dedicated to my sisters dog “Jack”, diagnosed with Cushings & Gallbladder Disease only months before Amber. His diagnosis has helped us feel like we are not alone in treating these conditions. We are in this together xx
Author Bio: Nikki is pack leader at Pressplay Pets, a blog for the modern age pet parent interested in health & care, news, reviews & personal accounts of unconditional love & at times heartfelt pain of pet parenting. She is also proud mum to cute and cheeky Papillons ‘Amber’ and ‘Indy’!
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