I'm a GENIUS!! + Health Updates

LOOK EVERYBUDDY!!

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.

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(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
• Lethargy
• 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:

Hearing Update:

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,
Sunshade's mum)

*UPDATE on Cushing's Disease (March, 2013):

Please note, the above post was written in June 2010, before anything had happened, before cancer hit. 

Sunshade was dx with Cushings in June 2010 (about 10.5 yrs old), but looking back, she had been Cushingnoid for a good 5-6 months prior. She went untreated for almost a year because I was too afraid of the potential deadly side effects from the drugs commonly used to treat Cushings. Then she got diagnosed with cancer in November 2010. We didn't start treating until December 2010. It has been two years since we have been treating Sunshade with Trilostane. I can honestly say looking back at the huge difference it has made in Sunshade's overall wellbeing as well as quality of life that I would NEVER allow Cushing's to go untreated for so long. 

Sunshade went from having mild Cushingnoid symptoms to full blown Cushingnoid symptoms. All her personality (what you see now) was GONE towards the end of that untreated year! She was a "Sunshade shell" that wanted food and that was it. Everything that made her "Sunshade" was no longer there anymore. I would take her to her favourite park, and she would just stand there and refuse to walk. A squirrel would run by, no reaction. A dog would jump on me, or try to get attention from me with her standing right next to me, no reaction. She is normally quite possessive/protective of me, and  would growl her way to keep the dogs away from me. People running towards me at night, no reaction (would normally run up to block them from coming straight towards me). She didn't care for unneutered boy dogs, and NO HUMPING horsie/fat rat (*gasp* can you believe it!!). The Sunshade sparkle was gone. Light was out from those beautiful eyes. It broke my heart. That was when I realized I needed to take the plunge and start her on meds because I was losing my girl already. Two weeks after I finally decided to start treatment, she was diagnosed with cancer (November 2010), so we had to deal with that first. When cancer came, there was no other choice but to treat Cushings if we wanted to win the cancer battle. Prolonged steroid exposure to the body greatly compromises the immune system. Lots of things can go wrong when the immune system is compromised, including cancer. 

This was Sunshade at the peak of her untreated Cushing's. I took her to a place she had never been before, and she did this. The normal Sunshade would have loved to explore new places being the curious girl that has always been, and is today. Notice the muscle loss, pot belly, thinned out coat (and she has a sheepcoat!!)

Once treatment started, I began to see little glimpses of my girl returning. It took quite a few months to get to the correct dosage. When she was fully controlled, my bossy, flirty, protective, loyal girl was back!! Now at 13.5, she is just as bossy as she was in her prime, still keeping the pups in check anytime  and every time. Pictures below were taken in November 2012, on her 13th birthday. Notice the thick coat, dark colouring, well muscled, svelte waisted, happy girl with light and mischief in her eyes? She has also lost over 10 lbs, and is back to her optimum weight of 62 lbs. 

Cushing's Diseases causes elevation in liver enzymes due to the prolong "steroid" exposure. Sunshade's liver enzymes were off the charts, as in, in the thousands when I left it untreated for a year. As soon as we got control, the liver enzymes came all the way down. Cushing's Disease also digests muscle mass, so it makes the dog lose muscle tone, which in turn exacerbates existing orthopedic problems and/or make the dog look a lot older than he/she is. 

One thing I have to mention is that once we were beginning to get control of Cushing's, Sunshade's arthritis pain became more noticeable. This meant we had to up her supplements, more frequent acupuncture/laser treatments, etc. Some dogs may even need to go on opiate pain control meds or NSAID's. 

There are a few different forms of Cushings disease. Pituitary dependent Cushing's, adrenal dependent Cushing's, and iatrogenic Cushing's. Iatrogenic Cushing's is usually caused by steroid use, so by removing the steroid agent, the Cushing's should resolve. 

Usually with Cushing's, you need two positive tests to confirm it. The cheapest, easiest test I think is the Urine Cortisol to Creatinine ratio test. If that's positive, you can either run a LDDS (Low Dose Dexamethesone Stimulation) or ACTH Stimulation test. The LDDS will most likely be able to tell you whether the Cushing's is pituitary dependent or adrenal dependent (two different types, different treatment plans). ACTH tells you whether there is an increase in adrenal activity. If both of those tests come out negative, you can then test for Atypical Cushing's. Sunshade was Atypical for a year before she turned typical. 

Good luck to everyone embarking on this journey. Yes, it can be frustrating, yes it can be overwhelming, yes it can be scary for some, but I do believe there will be light at the end of the tunnel. Sunshade is a living proof. Please don't hesitate to contact me via e-mail below if you have any questions. 

Sendittoelaineplease@gmail.com

Cheers,

Sunshade's mum