I've learned to OPEN CUPBOARDS while mum was out!!! It wasn't STINKY, it was alll ME because I'm the GENIUS of the family!!
(mum: Ever since Jaffa's Advil incident, he has been fairly well trained when left alone. He may counter surf once in a blue moon if something really yummy (ie, dehydrated liver treats) has been left on the counter, but never would he go to the extend of causing such catastrophic scene.)
This was the first time in 10 years I've opened a cupboard!! Aren't you proud of me my fellow canines??
(mum: Sunshade has never done anything remotely close to this, not even when she was a pup. I could leave food on the coffee table and she would not touch it. Same thing with garbage left out. However, things are a little different now... I'll explain more later in this post.)
I dragged the garbage out (and devoured everything that was devourable),
Then I dragged the rice bag out. Unfortunately, the rice wasn't cooked and it wasn't too yummy.....
So I moved on to the Ziggies. These were Kong stuffings mum bought when STINKY first arrived, almost 4 years ago. (mum: I don't even want to know what the expiration date was....)
I recall mum mentioning something about how she didn't like the ingredients, so she decided to stop giving them to STINKY. Those treats were basically left forgotten inside the cupboard.
Well, in the times of economic recession, we mustn't waste any foodables,
So, am I a considerate GENIUS or what?
Now, mum is going to post something very very very long & boring below (about me being a Genius opening cupboards). So I thought I would summarize her essay in two sentences for you - Mum says that there is something a little bit wrong with me that causes my body to constantly think I'm starving. The result of that is me searching for food all the time, and begging for food all the time.
(mum: Sunshade has an endocrine disorder called Atypical Cushings Disease. Some of you might be familiar or have heard of "Cushings Disease". Both Cushings and Atypical Cushings are forms of hyperadrenalcorticism (increased activity of the adrenal cortices).
The adrenal glands, one located near each kidney are responsible for the production of the stress hormone - cortisol, as well as the production of other steroid & intermediate sex hormones. The stress hormone Cortisol is a hormone that is necessary for many body processes to occur. It is impossible to live without some form of this type of steroid, either made naturally by the body or given in the form of prescription steroids. However, too much cortisol and/or other steroid hormones circulation in the body over a prolong period of time can cause serious damage to the body and its organs. Secondary illnesses often arise as a result of uncontrolled Cushings/Atypical Cushings.
To differentiate between Cushings and Atypical Cushings:
Cushings (Typical hyperadrenalcorticism): The overproduction of the hormone cortisol from the adrenal glands.
Atypical Cushings (Atypical hyperadrenalcorticism): The overproduction of adrenal steroid hormones other than cortisol (ie, estradiol, androstenedione, progesterone, 17-hydroxyprogesterone, aldosterone).
If your dog is showing all the symptoms of having Cushings, and yet has tested negative for having Cushings, meaning the cortisol level is normal. I would strongly suggest you run a U of Tenn panel to rule out Atypical Cushings. This was the case with Sunshade. Her cortisol had been normal in all of her tests, but her intermediate sex hormones were elevated. U of Tennessee has a huge endocrinology department, and is the only place in the world that runs this particular panel for Atypical Cushings. Dogs from Australia are having their blood sent to U of Tenn!!! Please note, it is possible for a dog with Atypical Cushings to also have elevated cortisol. Right now Sunshade's cortisol level is still within the normal range, but I do see it creeping up compared to tests performed last year and the year before.
Symptoms commonly associated with Cushings/Atypical Cushings Syndrome:
- Polyphagia (increased, excessive appetite) - see photos from earlier in the post ;-)
- Pot belly or distended abdomen
- Muscle wasting resulting in hind end weakness
- Chronically elevated serum liver enzymes: ALP, ALT, AST
- Enlarged liver
- Enlarged adrenal glands
- PU/PD (excessive urinating; excessive drinking)
- Dilute urine
- Excessive panting, temperature intolerance
- Haircoat problems (baldness, hair loss, hair thinning, discoluration of coat)
- Skin biopsies that indicate presence of an endocrinopathy, such as calcinosis cutis (abnormal calcium deposits in and beneath the skin)
Both typical and atypical Cushings can be caused by either a tumor in the hypothalamic-pituitary area (85-90%) or in the adrenal glands (10-15%), or both. Typical Cushings can also be caused by cortisone medications (ie, Prednisone, Prednisolonde, Dexamethasone, etc) given in excess or over a long period of time.
Sunshade had an ultrasound in March 2009 that showed both her adrenal glands were on the small side of normal, blood panel negative, and she had none of the Cushingoid symptoms listed above at that time.
Looking back, I realized she actually started showing symptoms of having Cushings/Atypical end of last year, early this year. The excessive begging was the first sign. I ignorantly chalked it up to behaviour. She also started to gain weight, 10+ lbs to be exact (from 65 lbs to 75 lbs), and started having a pot-belly or pendulous look to her stomach. Energy decreased, was pretty lethargic most of the time. I again, thought it was due to me giving her lots of treats and table scraps whenever she begged which resulted in the weight gain, hence the lethargy. Then she had her first UTI (Urinary Track Infection) of her life, followed by another one shortly. At the same time of her UTI, she started drinking excessively (normal when having an UTI). However, after her UTI's were resolved, the excessive drinking did not go away. This was when I put 2+2 together and had my vet run an Atypical Cushings test.
After Sunshade tested positive for Atypical Cushings in June 2010, we had another ultrasound done. This time it showed both of her adrenal glands had doubled in size in just a year's time. They were still considered normal because they were small to begin with. However, this confirmed that there was increased adrenal activity, thus the clinical symptoms. Her liver enzymes have become slightly elevated for the very first time in her life as well. Her coat isn't as profuse or healthy looking as usual, and the colouring is off. I know Sunshade has never had the standard blk and tan Airedale colourings, but her coat has always looked thick, healthy to the touch, and quite a bit darker. She usually grows a full coat in 6 weeks time, now her hair is growing slower. We suspected that she was heading towards typical Cushing's with elevated cortisol as well.
Since both her adrenal glands increased in size synchronously instead of one being bigger than another, adrenal tumor is unlikely. We believe Sunshade's Cushings is either caused by a tumor in the pituitary gland like mentioned above. Most of the pituitary tumors are benign micro-tumors at less than 3mm in diameter. However, if they start to grow and becomes a macro-tumor, on top of the damage that comes with Cushings, they may also start to cause other problems (blindness, incoordination, seizures, neurological problems, etc) due to the pressure on the brain tissue.
The conventional drugs commonly used to treat Cushings are Lysodren (mitotane) and Vetroyl (Trilostane). Both are *scary* cytotoxic (kills cells) drugs, in the same family as drugs used in chemotherapy. Their function is to kill off layers of the adrenal glands to reduce their ability to produce cortisol and intermediate sex hormones. Both drugs require close monitoring via specialized blood test as well as close observation in changes in behaviour and/or clinical symptoms. When well monitored and controlled, the Cushingoid dog can live a normal life span and be symptom free. However, those cytotoxic drugs can also kill off too much adrenal tissue or even the entire gland that would in term send the Cushingoid dog into life threatening crisis called Addisonian Crisis (little or no cortisols being produced, detrimental to life). Some dogs recover, some don't and they die from not having enough cortisol.
That being said, uncontrolled Cushings/Atypical Cushings will speed up aging as well as creating other secondary illnesses (ie, Diabetes, Chronic Renal Failure, Cataracts, Hypothyroidism, just to name a few). Most dogs with uncontrolled Cushings end up dying from one or more of the secondary illnesses resulted from the Cushings.
Right now we are trying things holistically with Sunshade because both me and my vet hate the idea of giving drugs that eat away at an organ, not to mention the risks involved in using such drugs. While Sunshade does have most of the symptoms listed above, I feel like I have a little bit of time to try out different holistic approaches with her because her condition isn't severe yet. However, should the holistic approach fail, I do believe I need to go the conventional route in order to keep Sunshade comfortable and maintain quality of life.
I hope I'll never have to see those scary drugs...... Please keep Sunshade in your thoughts that the holistic approach will work.
Some links for Cushings Syndrome:
- Canine Cushings Disease
- Canine Atypical Cushings Disease
- Yahoo Canine Cushings Autoimmune Care Group (very informative & experienced group of people who are either dealing with or have dealt with Cushings/Atypical Cushings and related autoimmune illnesses)
- University of Tennessee Endocrinology Department
Lastly, a few updates on Sunshade's hearing and Vet-Stem:
Sunshade's hearing isn't back to what it was prior to the tire popping incident, and I doubt it ever will. She still has discomfort in her left ear whenever our vet tries to have a look at the ear drum. The ear drum according to our vet should long be healed. She has no discomfort in the right ear. She can definitely hear, but sometimes not very well. She still seems to have problem locating the direction the sound is coming from. The loss in hearing however doesn't seem to be effecting her at all. In fact, it is actually easier on her during the fireworks/firecracker season. She doesn't get stressed and pant non-stop.
Vet Stem Update:
Sunshade's right elbow, the one problem that has been my biggest source of concern over the last 8 years or so has been doing FABULOUS since the Vet Stem procedure 4 months ago. Like I had mentioned before, she wasn't crippled nor was she in extreme pain in that elbow prior to the procedure. She did get stiff, and would sometimes hobble a little upon rising before walking it off. However, nowadays, she is almost never ever stiff in that elbow, not even after bunny chasing. She rises from her sleep soundly and is able to walk away normally. She has not limped since Vet Stem. She also has full range of motion in that elbow. All in all, I would give her an 11 out of 10 on the elbow.
Another one of the reasons we decided to go with Vet Stem was because Sunshade was having mild neurological problems that was causing her to stumble (hind + front) from time to time. The neurological problem was thought to stem from narrowing of the spinal canal in the Lumbar region of the spine (L4-6). We were told ahead of time by the Vet Stem representative to not hold our breath on the procedure helping neurological problems. Well, it is true, her stumbling did not go away. She is still stumbling. Sunshade's chiro vet feels that the extra weight (10 lbs) Sunshade is carrying in her pot belly due to Cushings is weighing her spine down, and therefore, exacerbating the neurological problem. I do feel like she is stumbling in the front more now, some have resulted in severe face plants. She has also skidded on her wrist a few times due to front end stumbling. Each time causing the wrist to be scrapped raw. So if Cushings is really causing her neurological problem to be worse, that's another reason why we need to get it under control ASAP.
There is another possibility that her stumbling/neuro issue isn't actually caused by the spine, but by a tumor on the pituitary gland that's causing the Cushings. In that case, it might be a growing tumor that's compressing other brain compartments, causing neuro issues at the same time. Drugs for Cushings unfortunately would not help reducing the tumor or the neuro problem. Only an MRI or cat scan will tell if there is a tumor present. I however will not put her under for an MRI/cat-scan since even if the tumor is confirmed, it won't change my course of action.
If you are still with me right now, Thank You! Please keep Sunshade in your thoughts, she has been through so much in her life, and in this past year.
Ear scratches to all the fur babies,
*UPDATE on Cushing's Disease (March, 2013):