My Westie, Harriet, has been on prednisone for skin problems since she was just over a year old -- she'll be eight in June. Lately, she has been very lethargic and, just in the last couple of weeks, she has begun to pee in the house during the night. She's also very thirsty all the time and, if I let her, will down most of a bowl of water all at once -- and then throw up.
I googled the symptoms and they all add up to iatrogenic Cushings syndrome -- the kind that is medication induced. I'm going to make an appointment with the vet tomorrow to have her checked out. In the meantime, I've cut back on the prednisone to a 1/2 tablet every other day (she has been taking a 1/2 tablet every day for about a year after a series of stubborn ear infections).
I know some of you have experience with Cushings but have any of you dealt with the medication-induced kind? Will it really resolve itself once she's weaned off the prednisone, as the stuff I've read on the internet seems to suggest? I'm worried that, if I take her off the prednisone, her skin condition is going to become unbearable for her and I don't think there's any alternative medicine that will work (we've tried Benadryl but it didn't help the underlying allergies that trigger her skin problems).
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Thanks, DBD, but I think it's too late to stop the test. They were going to start it tonight and hopefully have a result by morning. I do trust the vet in terms of their knowledge, but they do have a tendency to want to run a lot of expensive tests. It's kind of what I'd call a "designer vet" -- they offer everything from physio to massage therapy to stem cell therapy for arthritis, along with the regular veterinary care, so their overhead is pretty high. On the other hand, when Harriet had a stubborn ear infection, they were able to cure it when my former vet couldn't, by using a combination of antibiotics and antifungals. They're up on the latest treatments and immediately recognized the possibility of prednisone-induced Cushings. Harriet had been on the prednisone for a few years before I started taking her to this vet, but I do wish they had suggested alternatives sooner. I wasn't aware that there were as many possibilities as we discussed tonight.
Well that sucks (the possible diabetes) but I would take that over Cushing's and if they can get rid of that by taking away the pred, that's a win. The pred might also be having some impact on the insulin so it might be a good wait and see what a diet change will do. Dogs are no different than people when it comes to diabetes so if you keep Harriet off all grains and starches and sugars that will go a long way to putting her insulin in order. they never even got diabetes until we put all the fillers and sugars into their food, same as us, so it is one of those things that diet can control usually. I know that one from my own experience with it.
I have to ask... do you trust this vet? I ask because Cushing's from long term pred use is a well known side effect and I'm surprised a vet would leave a dog on that long (knowing full well what could happen), for a problem that might be helped with more holistic means (like diet). Also cushing's is one of those things that vets don't see very often so I'd want to make sure he knew what he was doing. From experience I can tell you you need someone who has seen many cases over their career and is tapped into the INternet and other sources so they know all the treatments etc.
Also, if he already thinks the pred has to stop, why test? That ACTH test costs over $200 to tell you what? That the dog has too much cortisol caused by too much pred which you are eliminating anyway? Seems like a waste of $200 to me. He may want a test to see levels so he can see whether things improve or not, but I can tell you that will be visible when the dog comes off the pred, test or no test, so again, only a nice to know. I would only do that test if the dog didn't improve within a couple of weeks of being pred free (which might mean Cushing's caused by one of the other two causes but I bet it's the pred). If you get caught in a cycle of tests you are going to be lighter by all those tests X $200+ in pretty short order.
My vet taught me this and I have found it to be true, no tests unless they will help diagnose and [I]only[/I] when they may change treatment. If treatment will be the same regardless, you are only paying for 'nice to know' info. Besides, the test takes over 6 hours. First they take a blood sample and inject some hormone then they put the dog in a kennel for 6 hours and draw blood again. The test shows if the dog is showing the extra stress hormone. Now I don't know about you, but when my dog had the test I took her home and brought her back for the draw knowing she would be more than stressed waiting around in the vets kennels for 6 hours. At some vets here they will actually charge for that kennel time so $$$ for their pockets which annoys me to know end so I'd ask about that.
You may want to call them first thing before they can start the test and really find out what he expects to find out and be really clear "how will this change how Harriet is treated for this condition she has?". If he says it won't change anything, you don' t need a test. If he gives you the gears about having more info, he's charging you for nice to know info that an experienced vet probably wouldn't need. The treatment either works or it doesn't and since the result will be visible (thirst will return to normal, peeing in house should stop, energy should return) so why the test? Call before he starts it in case you can save putting Harriet through it and lightening your wallet.
Fingers crossed for you. I have a feeling this will be okay once you get Harriet off the pred and get her diet adjusted so her skin and insulin can work normally. Here's hoping you can do it without emptying your wallet with extra vet charges though.
Awww...poor Harriet! It's so hard to go through this kind of thing.Hope that all goes ok for her. I know I just wanted to figure out what was wrong with our dog and get her the needed treatment.
You never know...Mocha's blood work came back initially with high enzymes in the liver and Vet also suggested likley Cushings. However, the ACTH tests ending up coming back negative. Guess it is a hard one to diagnose though...
Please keep us posted on results.
All fingers & paws crossed here!
Take care,
Lisa
Well, Harriet's in the vet's for the night. :( The vet ran a blood test and she had high sugar levels as well as high liver enzymes. He suspects that it is indeed Cushings. He's going to run the ACTH test and let me know the outcome tomorrow. He is convinced she needs to come off the prednisone and we will try to manage her skin condition with some combination of diet, fatty acid supplements and possibly cyclosporine. The big question now is whether she has diabetes, as well, or if the high sugar levels are the result of the high cortisol levels from the prednisone. It may not be necessary immediately, but he said he "sees insulin in her future". :( Poor puppy.
Have you had Harriet's skin scraped and tested? Any allergy tests done? I can tell you with Cockers people find all sorts of things going on with skin but #1, is take away all grains (all wheat& corn in particular) and see what that does. More often than not that helps a lot.
If you want to see if food is the cause (and often it is) you need to try an elimination diet. That means whole foods, one at a time and seeing what happens because any kibble can have other additives and if they are the culprit, you won't be able to weed it out. Once you see which foods cause what you can avoid them when looking at ingredients.
I can tell you with my dog, she isn't allergic but if she eats any grains (sometimes she'll get a biscuit) her eyes get goop within an hour or so. Their bodies just don't do grains by nature so that's why so many people just get them out of the diet because the effects can be ear/eye problems and itchy dry skin.
Thanks, Lisa, I did read your thread and it was some of the discussion on there about Mocha that made me suspect Cushings in Harriet. I hope Mocha is feeling better. It's no fun when our furry family members aren't feeling well.
Hi Looking4ideas,
I sympathasize with you...it's so hard to have a doggie that's not feeling well. Believe me, we've been through a lot with our (almost 12 yrs old) Lab since last Summer.
We also suspected Cushings-not drug induced though...
Our dog had been very ill last summer and we ended up doing x-rays, ultrasounds and various blood tests. One of those blood tests was a 'Low dose dexamethasone suppression test' to test for Cushings. This was done as some of the initial blood work showed elevated levels of creatine/cortisol ratio) and Mocha was showing some of the signs of Cushings. All came back negative.
There are some effective drugs to treat Cushings which I believe our Vet indicated would run @ $150/200/mth. I can't recall names, but know he was NOT a fan of one called Lysodren.
I don't know how to link the files, but if you want to read on some of what we went through (various tests) do a search on 'My Poor Doggie' You;ll see a thread that was started under my name.
DBD provided some great info in here too.
I hope all goes well with Harriet!! Good luck with your vet appt.
Keep us posted...
Lisa
Thanks, DBD, I will be seeing the vet tomorrow night. In the meantime, I've started weaning her off the prednisone gradually because, like you say, an abrupt stop to that medication can have pretty serious consequences.
I've tried some different diets -- everything from the most expensive to the supermarket kind. None seemed to work, but maybe we need to redouble our efforts on that front. I've heard that Tavist, another over-the-counter antihistamine might work for some allergic dogs, so I'll see what the vet thinks about that. Benadryl didn't do the trick. We have to bathe her with an oatmeal shampoo every few days to keep her skin issues in check.
Cutting her back to half a pill every other day already seems to be helping her thirst and making her less lethargic. She's always been a pretty lazy dog, LOL, but her sleepiness lately has even been excessive for her!
My last dog had Cushing's and the symptoms are the same (and hence the diagnosis) as long term pred use. As I understand it, once the dog is off the pred, the symptoms can vanish so you are lucky there. I believe you have to ween off pred or you can be in trouble, but if I were you and could find any way, I would get the dog off the pred if you can ASAP.
I hate pred after learning what it can do so I'd be looking to see if there is some other way to deal with Harriet's skin. Cushing's is a terrible thing and it will win if left to do it's thing in pretty short order. Believe me, it is not a nice way for a dog to go.
As for that skin, have you looked at various diets to see if those might help? I know with the discussions I've seen on Cocker forums, there is really a big relationship between skin issues and food (particularly grains and some additives) with that breed. Some people use elimination diets to figure out what the offenders are, some keep trying different foods, but most of the time it's the things that are not biologically appropriate that are the cause. Other common issues are sometimes specific proteins like chicken or beef.
I hope you can find some answers because without trying to scare you, those symptoms are serious and you need to stop them before they progress. Once the adrenal glands start working normally again you should have a normal dog again (well except for figuring out the skin thing but that is entirely doable).