Friday, June 15, 2012

Cushings Disease and Fooh Fooh

FoohFooh and Maxie
Yesterday, after he bit my foot, John and I took our 12 year old American Dingo (Carolina Dog), FoohFooh (for whom this blog is partly named), to the vet to see if we could find out what's wrong with him.  He's been acting weird, and we fear he is becoming a danger to ourselves and especially to house guests.  Three weeks ago he lunged at my mother's arm and broke skin, trying to get at a piece of toast she was carrying around.

His presenting symptoms have been excessive water consumption, excessive urination (including indoors), excessive begging, ravanous appetite, weight loss, dull hair, lethargy, loss of muscle tone, irritability, food guarding, eating whole toilet paper rolls, plastic bags, paper towels, mail, raiding trash cans, and growling if you try to take them away, lying in the doorways and halls then snapping at us if we try to step over or move him (why he bit me), not coming when called, reluctance to go outside.

As soon as I told the vet, she said it was almost certainly Cushings Disease, a brain tumor on the pituitary gland that causes symptoms easily confused with "old age", but treatable, and a relief to know it is not painful to the dog. 

She spent a lot of time listening to his heart.  Feces and blood work came back "normal", no diabetes, but there was blood in the urine-- a unirary tract infection.  She put him on Keflex for 2 weeks.  After that he goes back for a second evaluation and to establish a course of treatment for Cushings.

The vet said "Look Cushings up on the internet.  There is a lot to learn."  That was a first -- a medical professional advising me to research a condition myself!  So this morning I Googled "Cushings Disease Dogs" and found that it is a disease of the endocrine system (see diagram).  Here are the most suscinct summaries I pieced together from here and there.

Symptoms: Symptoms of Cushing's disease can be vague and varied and tend to appear gradually and progressively. It is thus easy to mistake Cushing's disease for normal aging. Additionally, many of the clinical symptoms are not unique to Cushing's and could reflect a number of other health concerns.

The most common symptoms include:
• increased/excessive water consumption (polydipsia)
• increased/excessive urination (polyuria)
• urinary accidents in previously housetrained dogs
• increased/excessive appetite (polyphagia)
• appearance of food stealing/guarding, begging, trash dumping, etc.
• sagging, bloated, pot-bellied appearance
• weight gain or its appearance, due to fat redistribution
• loss of muscle mass, giving the appearance of weight loss
• bony, skull-like appearance of head
• exercise intolerance, lethargy, general or hind-leg weakness
• new reluctance to jump on furniture or people
• excess panting, seeking cool surfaces to rest on
• symmetrically thinning hair or baldness (alopecia) on torso
• other coat changes like dullness, dryness
• slow regrowth of hair after clipping
• thin, wrinkled, fragile, and/or darkly pigmented skin
• easily damaged/bruised skin that heals slowly
• hard, calcified lumps in the skin (calcinosis cutis)
• susceptibility to infections (especially skin and urinary)
• diabetes, pancreatitis, seizures

There are several types of Cushings, and different treatment for each one, but they all affect the pituitary and adrenal glands.  Here's a summary of that:

In health: In order to understand Cushing's disease, one needs to understand the basics of the negative feedback loop that operates in a normal, healthy dog. The pituitary gland, located at the base of the brain, produces ACTH (adrenocorticotrophic hormone), as directed by the hypothalamus (another part of the brain). This hormone is released into the bloodstream and stimulates the body's two adrenal glands, located near the kidneys, to secrete glucocorticoid (cortisone-like or cortisol) hormones into the bloodstream. Cortisol helps the body respond to stress. It is necessary for life and impacts a wide variety of bodily functions including blood sugar levels, fat metabolism, skeletal muscles, kidney function, nervous system, cardiovascular system, and immune response. ACTH/cortisol secretion is increased due to stress, including infection, pain, surgery, trauma, cold temperatures. When the blood cortisol levels are high enough, the pituitary stops secreting ACTH. When the blood cortisol levels dip low enough, the pituitary secretes more ACTH. The adrenals respond by secreting glucocorticoid hormones in response to the pituitary, just as the pituitary responds by secreting ACTH in response to the adrenals. The net effect is that a mildly fluctuating balance is achieved. This is an oversimplified picture of cortisol homeostasis in the healthy dog.

In Cushing's Disease: The feedback loop has gone awry for one of three reasons: a pituitary tumor, an adrenal tumor, or veterinary interference. The result is a chronic excess of blood cortisol. In effect, the dog is being poisoned with too much cortisol and cannot rely on its own feedback mechanism to regulate the blood cortisol level.
Cortisol increases appetite and thirst, so owners may notice that they are filling their dog’s food and water bowls much more often than usual, and in fact may report that their pet’s appetite is ravenous. Likewise, they often report abnormal hair loss that is symmetrical on both sides of their dog’s body, along with loss of muscle mass especially in the legs. Muscle atrophy and corresponding redistribution of weight often give dogs with this disease a “pot-bellied” look. They also commonly have poor wound healing. Dogs with hyperadrenocorticism are predisposed to developing other problems, including heart failure, diabetes mellitus, infections and high blood pressure. Typically, several of these signs appear at or around the same time. As the disease progresses, affected dogs’ signs typically worsen and increase in number. However, because Cushing’s is largely treatable, possibly curable and usually manageable, it is important for dog owners to become familiar with the signs of this disease.

Prevention:   Unfortunately, other than managing the medical use of corticosteroids, there is no way to prevent hyperadrenocorticism in dogs. Functional tumors of the pituitary and/or adrenal glands occur for unknown reasons, and until the cause of those tumors is discovered, prevention of Cushing’s disease is not realistic.

Bottom line: Cushing's disease is a common condition in older dogs and is often mistaken for signs of normal aging. Although most dogs with Cushing's disease cannot be cured, their quality of life (as well as the owner's quality of life) can be improved, and their lives may be extended with early intervention. It is often possible to successfully manage this disease for years. It thus behooves the pet owner to become familiar with the typical signs of Cushing's and the treatments available.

Fooh Fooh blocks the gate and won't move.
So, it looks like I'm on another voyage of discovery.  SIGH!  I always question the concept that there is no cure for things, and will commence exploring whether there are homeopathic remedies. There are so many other things I'd prefer to be doing but it's hard to ignore a 40 lb. dog that growls and snaps and limits my freedom of movement in my own home.  And I love my FoohFooh, though I must admit, my fond feelings for him diminish in proportion to his increased and unpredictable aggressiveness, as well as ruined carpets.  If anyone out there has experience with this disease, or with these feelings, please offer me your advice.

Upwards and onward, I guess . . . . .


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Jacque Ptak said...

I have a Carolina Dog that was just diagnoised with Cushings. I was wondering how your treatment was going.