Tara the elephant and Bella the dog are inseparable.

An unlikely pair who can teach  us something special.  Enjoy!

Early Detection of Symptoms of Cushings Disease

I know I am guilty of hoping a symptom will go away on its own, and sometimes wait too long until the problem becomes difficult to treat.  Dr. Becker recommends proactive action to keep the symptoms of Cushings disease to a minimum....

Needless to say, identifying pre-Cushing’s syndrome early – or at least ensuring that your pet has a reduced likelihood of acquiring Cushing’s disease – is, hands down, the best approach.

My recommendation is for you to be proactive and check your pet’s ALP on an annual basis. Address it if you notice that the ALP is climbing. Do a screening test, a UCC, or CIALP to determine if your pet is indeed overproducing cortisol. Through this, you’re better able to manage the condition before your pet has fully developed Cushing’s disease, which is pretty difficult to manage.

Always remember that you shouldn’t ignore symptoms. If your dogs have consistent (even minor) symptoms, then it’s absolutely worth investigating endocrine or adrenal disease as a contributing factor to why your pet has symptoms that are concerning for you.

Blood testing is important to identify Cushings disease

In a continuation about Cushings disease; Dr. Becker explains the importance of blood testing to determine what is going on in your dog.  It is a difficult disease to identify.  

The Importance of Blood Testing

I think it’s important for you to ask for a copy when you have annual blood work done on your dog. I would show the blood work to the pet owners and say, “Look, your dog has had ALP elevation for two or three years,” and their answer would be, “Why didn’t my veterinarian tell me?”

Unfortunately, many reactive veterinarians simply won’t address Cushing’s disease until all of the symptoms are there, or until you begin telling him or her about the symptoms: “My dog’s peeing in the house,” “My dog’s hair is falling out,” or “My dog’s incontinent at night in bed.”

Oftentimes once you start complaining, your veterinarian starts digging. But if you want to be proactive in preventing this disease from occurring, you need to be asking for copies of blood work and why every single blood work value is not balanced or correct.

Your veterinarian needs to partner with you to be able to identify if your dog is at risk of having pre-Cushing’s symptoms, or indeed already cushingoid. So if the ALP value is already elevated in your dog’s blood work, you need to ask your veterinarian if this could be the start of Cushing’s disease.

The diagnosis of Cushing’s disease is difficult. Typically it’s with the blood test. There are two blood tests that many veterinarians will do.

An ACTH stem test is a two-part blood draw that veterinarians will do to diagnose Cushing’s disease, along with a low-dose dexamethasone suppression test. Both of those are two-part – sometimes three-part – blood draws that compare the cortisol levels in your pets’ bodies to be able to make a consistent diagnosis of Cushing’s disease.

After Cushing’s disease has been diagnosed, your veterinarian will want to determine if it’s indeed adrenal or pituitary dependent. In my opinion, the best way to rule out an adrenal tumor is non-invasive ultrasound. Some veterinarians prefer to do a secondary blood test called a high-dose dexamethasone suppression test.

It is important to have a definitive diagnosis of Cushing’s and what type, either adrenal or pituitary dependent. This way, your vet will be able to offer you treatment options to the best of his or her ability.

symptoms of Cushings disease

Your pet may have some or many of the symptoms of Cushings disease because the way cortisol affects the body is diverse.  It is best to get to a vet early for an assessment.  Read on to get informed about a disease that is often not identified.  The post comes from Dr. Mercola's pet section of his health website which is lead by Dr. Becker:

Because cortisol is such a diverse hormone, there’s a whole host of diverse symptoms. Not all dogs that acquire Cushing’s disease have all symptoms. Honestly, unless you or vet have waited to the bitter end to make the diagnosis, most dogs have only two or three in the long list of symptoms.

The symptoms we see commonly with dogs that are beginning the Cushing’s process is that they tend to drink more, urinate more (can include incontinence in the house), pant more, and gain weight. Even if you reduce calories in their food, they tend to have a potbellied appearance, a big, swollen abdomen. You can see thinning skin, hair loss and, in many cases, change in the pigment of the skin. If your dog used to have a pink belly, she now has a gray one or even black skin.

Oftentimes, your dog can become irritable or restless. We’ve seen some animals develop bruising. There are some rare symptoms like rear limb weakness, as well as blood clots that can be associated with Cushing’s disease.

But because the syndrome is so diverse -- every part of your pet’s body literally has a cortisol receptor -- sometimes the immunosuppressive aspect of Cushing’s disease is what ultimately brings you to the veterinarian.

So if your pet has a recurrent urinary tract infection that he or she can’t get rid of – along with one or two of the other symptoms like thin skin or failing to gain weight – you have to think about asking your veterinarian about Cushing’s disease.In my practice, the number one reason I see Cushing’s patients being referred in is for misdiagnosis of liver disease. Because the liver has to process all this extra cortisol circulating in your pet’s body, your pet’s liver enzymes tend to increase – not only the liver’s specific enzyme ALT, but a secondary induced liver enzyme called alkaline phosphatase (ALP) tends to elevate when animals begin developing Cushing’s disease.

The long term effects of stress on our canine friends

We know a little about the effects of chronic stress on humans.  We really underestimate that, I think.  We often don't  relate a symptom with the true cause, so we treat the symptoms without changing the cause.  That is reactive instead of proactive.  Dr. Becker at Mercola.com further explains the effects of stress on our canine friends.

The Effects of Chronic Stress

Chronic stress – and therefore chronic cortisol release – ultimately results in elevated blood sugar in the long term, which can lead to diabetes. It results in elevated blood pressure, which can be negative for your pet’s cardiovascular system.

There’s also extreme hunger; when your pet’s burning that much blood glucose, then he or she ends up being much hungrier than the average pet. Increased thirst and urination also come about when there’s extra cortisol in your pet’s system.

There’s an accumulation of fat in the abdominal area, as well as thinning skin, poor, thin hair coat, a change in the pigment in the color of your pet’s skin, decreased muscle and bone mass, and increased risk of infection. That infection can come about anywhere, so pets that have chronic cortisol release, and we refer to them as immuno-suppressed, tend to be more exposed to oral, eye, gum, ear, and urinary tract infections. Infection can come about wherever your pet’s body’s weak link is, so it isn’t just in one area.

For animals that have recurring infections – or those that just lag on and on and pets have a hard time getting rid of – you need to think about cortisol influencing your pet’s ability to fight infection.

Types of Cushing’s Disease

There are several forms of Cushing’s disease, and they can become confusing for clients. So I’m going to try spell it out in an easy-to-understand format today. If you have a pet that’s dealing with Cushing’s disease, it’s important for you to know exactly what’s going on. If your pet is currently healthy, I want to help you prevent Cushing’s disease from occurring in your pet.

There are different types of Cushing’s disease because there are several layers of your pet’s adrenal glands. Depending on what layer of your pet’s adrenal gland is overproducing hormone is the type of Cushing’s disease your pet has.Traditionally speaking, the middle layer of your pet’s adrenal gland for typical Cushing’s disease begins overproducing glucocorticoids. The zona fasciculata is the middle layer of your pet’s adrenal glands. When that particular layer of your pet’s adrenal glands overproduces glucocorticoids (which can also be called steroids, cortisol, cortisone, or the synthetic version that veterinarians can give orally, prednisone), it’s called typical Cushing’s disease.

Sometimes veterinarians unknowingly induce Cushing’s disease by giving too-high doses or too long administration courses of oral prednisone therapy. If your pet is on prednisone, that predisposes your pet to acquire Cushing’s disease.

Typical Cushing’s disease is too much cortisol. Atypical Cushing’s disease comes about when the outer layer of the adrenal gland overproduces electrolyte-balancing hormones called aldosterone, or when the inner layer of the adrenal gland begins overproducing sex hormones.

Atypical Cushing’s disease comes about from the outer or inner layer overproducing mineralocorticoids called aldosterone, or sex hormones like estrogen, progesterone and testosterone precursors.

So it’s all very confusing. Traditional or typical Cushing’s disease (too much cortisol in the system) also has two types. There’s adrenal dependent, and there’s pituitary dependent. Hands down, the most common form of Cushing’s disease in pets is the pituitary dependent form. About 85% of dogs that acquire Cushing’s disease acquire the pituitary dependent form.

This means that the pituitary gland – the master gland in the brain – is sending too much stimulating hormones to the adrenal gland, and the adrenal gland is simply responding to the stimulus to produce more cortisol.

In rare or about 15% of cases, the adrenal glands acquire a tumor, and that causes the up- regulation of cortisol production in the body.

Breed Predisposition among Dogs

It’s very rare for cats to acquire Cushing’s disease, which is much more common in dog breeds.

There’s also breed predisposition. The terriers, unfortunately, are predisposed. These include silky terriers, Yorkies, bull terriers, and Boston terriers, as well as poodles, doxies, and the American Eskimo dog, also known as spitz. All these have genetic predisposition to acquire Cushing’s.

Cushings disease may be hard to identify

Sometimes a few symptoms are hard to follow to the true source of problems.  This explanation of Cushings disease is very thorough and understandable.  I hope it is helpful but not relevant to your own pet.  I found it at Dr Mercola's website: 

Hi, this is Dr. Karen Becker, and today we’re going to discuss Cushing’s disease. This is the first of a three-part series.

Cushing’s disease was originally diagnosed by Dr. Harvey Cushing in 1932, hence the name. I prefer the correct title of what’s happening to this syndrome: hyperadrenocorticism, which is a bigger much more descriptive word. It means “hyper” or too much, “adreno” referring to the adrenal gland, and “cortisol” or what exactly the syndrome dictates. It’s too much adrenal release of the hormone cortisol.

What Cortisol Does to Your Pet’s Body

Cortisol is your pet’s “fight or flight” hormone. It is designed to be released by your pet’s adrenal glands in very small amounts. When there’s an up-regulation of cortisol demand, your pet can begin producing cortisol in high amounts. This can be toxic to the body.

Cortisol is a very important hormone, it’s part of your pet’s fight-or-flight response, and cortisol is designed to be released in small amounts from the adrenal glands when the body perceives stress. Ultimately speaking, the end result of cortisol release is glucose release from the liver.

Glucose, being sugar, is what provides energy to the muscle cells so that your pet is able to escape a bear, or for a kitten to run up a tree when chased by a dog. It helps your pets ready their bodies either to address confrontation or be able to get away in a life-threatening situation. That’s the big reason why pets release cortisol.

However, cortisol influences a whole host of other biochemical parameters. It influences the body in a whole host of negative ways. Cortisol is also linked to regulation of blood pressure. It can negatively influence electrolyte balance. It is immunosuppressive, so it can negatively impact your pet’s immune system in the long term. It has a negative interaction between bone and fat metabolism.

Needless to say, we’re thankful that cortisol is in our pets’ bodies in small amounts. The goal is to help your pets not over secrete cortisol, which becomes a toxic situation.

Chronic cortisol release translates to chronic signs of stress in your pet. Keep in mind there’s no such thing as good or bad stress for your pet. It’s all stress, so your pet is having the samephysiologic response whether you’re dropping them off at the groomer, they’ve been hit by a truck, they’re all excited that your serving them steak for your birthday dinner, there’s divorce or a new dog in the family, they have a large wound, or they’re dealing with the inflammation of cancer or allergic response. Those are all the same stress.

If you’re thinking, “My pet doesn’t really have stress. I’m moving from place to place, and he travels with me all the time in a brand-new environment,” then that’s still considered a type of stress on your pet’s body.