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Reference - Cushings Disease - case history.
pinta - 6/26/2004, 3:55 am
Case history of a pig with Cushings Disease.
This case history is compiled of postings to a medical list and personal emails.
08 Jan 2000 (posted to a med list)
We are currently treating a 3-year-old sow for Cushings Disease with L-deprenyl. We just had a urine analysis done and our vet needs to know if anyone knows the normal range of BLOCD, Urine cortisol, and Urine Creatinine for guinea pigs. (We initially thought she had cysts, but an ultrasound revealed enlarged adrenal glands. We took another pig to the ultrasound for comparison.)
(If some of the letters seem wrong, it's because I'm copying off a low quality fax.)
Urine cortisol >1380 nmol/l
Urine Creatinine 20.0 mg/dl
WBC, RBC, EPITH, HYAL CAST, GRAN CAST, RBC CAST, BACTERIA, MUCUS,: All Neg
Crystals: Other types AMOUNT: Many
Calcium carbonate crystals present
Many oil droplets present
Amorphous debris present
This ratio can not be determined as there is a large amount of cortisol in urine and although this could be normal for this species, the dilution of the test and repeating the test would not help as we have no reference values for this species
10 Jan 2000 (in response to a post on the med list)
The only conclusive diagnostic tool (so says my vet) for Cushings is an ultrasound. Take along another pig for comparison. The adrenal glands are too small to show up in an xray. Our symptoms were uneven hair loss over the back and flanks. Tiramissou has not been drinking excessively, but a past pig with Cushings did(edit note - I can't remember what pig this might have been). She initially had an eye infection that we treated for 2 months. After it had cleared up, we noticed that she was still very gradually losing weight and her coat was thinning in a "chunky" way. We dosed her with Ivermectin. No change. Then we suspected that ovarian cysts were screwing up her hormones. We took her and a comparison pig for an ultrasound. Bilaterally enlarged adrenal glands. (Interestingly, the comparison pig has several surface cysts all over her body. No sign of cysts inside her.) The standard symptoms for Cushings in dogs and cats are excessive water drinking and hair loss from the flanks.
She is on L-deprenyl. Her weight has leveled out. Her coat is worse, especially over the flanks. She is very bright and active. The ultrasound technician has offered to slip her in for a free recheck at the beginning of February.
With the Cushings Disease, we're just making it up as we go along based on existing protocol for dogs and cats. If anyone has any info, please email me.
11 Jan 2000 (This was in response to the list owner saying that the description said cystic ovaries, not adrenal problems and also her comment that that we were making up as we went along because this was not a known problem in guinea pigs.)
There were absolutely no cysts evident in the ultrasound and there was no sign of cysts during palpation. The ultrasound was done at a critical care clinic which demands referrals from the vet. The technician is a specialist and also a DVM. He has not done a lot of guinea pigs, which is why we took a comparison pig. He has done a lot of ultrasounds as that is his speciality. Both of the adrenal glands were extremely enlarged compared to the comparison pig. Again, there was no sign of ,cysts. We had fully expected to find cysts and were surprised that they weren't there.
Being in Canada, I suspect there might be logistic problems of sending a blood sample to Missouri (List owner commented the only *conclusive* diagnostic tool for adrenal disease was to send blood to the University of Missouri.)
Since she's been on the L-deprenyl, she has been improving except for her coat, which has gotten worse. She is livelier, participates more and has stopped losing weight. She is very slowly starting to gain weight.
The same DVM diagnosed heart disease in another of our pigs by ultrasound. He was correct. We kept her going on Lasix for another year.
16 Feb 2000
Tiramissou had her second ultrasound to check on her adrenal glands. After 2 months of L-deprenyl, one gland is smaller and the other could possibly be larger or the same size. The specialist said the size "increase" could be due to the image not being viewed at exactly the same angle as before. The size of "increase" is negligible(3mm). The glands are also smoother in shape (on the first ultrasound they were "knobby"). The specialist doesn't know what this would signify in a pig.
On her first ultrasound, there were flecks on the liver. These are now gone. The specialist also noted that there was more fat on her body than before (this is good). Her coat is still very sparse but she is bright, animated and participatory. Because the vet has never dealt with Cushings in a pig, he is unsure of her progress. He does think there is an overall improvement and recommends that we continue with the L-deprenyl and have another ultrasound done in 2 months. If the one adrenal gland IS getting larger - then he feels we might want to consider removing it but hopes it won't come to that since adrenal gland removal is a high surgical risk.
On the whole, the general feeling is that the treatment is working.
14 Apr 2000
Tiramissou has had her third ultrasound. The left adrenal gland, that had previously shrunk, remained the same size, 1.1 cm (round shape). The right adrenal gland that we had been uncertain as to whether it had remained the same size or increased, has decreased in size becoming more oblong (taken from report) and measures 2.0 x 1.2cm (previous size was 2.3 x 1.2 cm). "This makes it unlikely that the changes are due to aggressive neoplasia and more likely secondary to Cushings's disease." The liver appears normal, another positive indicator.
Her weight is okay and she continues to be bright and lively. Her coat is sparser, but our vet says that the hair is the last thing to come back. We are trying low energy helium neon laser treatments to get some hair regrowth. The physical therapist has had success with this laser treatment in dogs and is of the opinion the treatments are producing results. Personally, I can't see any improvement, but maybe I don't know what to look for in this type of hair regrowth.
We will continue with the laser treatments(on the off chance that they are working) and the L-deprenyl.
The L-deprenyl will be a lifetime treatment from what I understand.
03 Aug 2000
Tiramissou has hair regrowth. A real, honest-to-God coat of hair growing in after approx. 8 months of major hair loss. The vet did say hair growth would be the last to come back, so I don't know if it is the laser treatments (approx. every 2 or 3 weeks) that did it or the L-deprenyl. But she is finally getting a new coat of hair.
Her weight remains stable and she is very active and bright.
The following entries are from personal emails:
4/8/01 - Tira has a lump that I palpated. The vet felt another one. Could be a cyst or a tumour. The vet wants her ultrasounded before she decides what to do. Tira is the Cushings pig so we need to think twice about surgery. She's on daily L-deprenyl.
4/10/01 - She has cysts. One is bigger than her kidney. She'll have them out on Monday.
She couldn't have had surgery a year ago. Would rather she didn't need surgery - but the vet doesn't want to leave them.
4/16/01 - Picking her up in 1 1/2 hours. Vet said it was a really tough spay and one cyst was huge and close to the kidney. She's sending the uterus off to the lab because it was really thick and weird looking. Described something about hydro something and the uterus retaining fluid and causing infection. Dogs and cats get this thing. Latin words that garbled once they entered my head.
She wants to find out how much the uterus stuff is related to the Cushings/adrenals.
Tira had been a bit "off" this weekend - not as lively as usual. I attributed it to her eye which has an ulceration on it and possible cyst discomfort. Hopefully she'll be okay. Sounds like it took a lot out of her.
4/17/01 12:28 am - Well, she's back and her spirit is good. She's pissed off - butted my hand. She's created acouple of poops but is refusing to eat or drink. I think she's in too much discomfort. So I called the vet and asked if I should give her some Rimadyl. I had some ground up in the fridge. Vet didn't like that air had gotten to it so she's meeting us at the clinic at 11pm to give us a couple more pills. She had to go anyway to check on a sick dog.
Took Tira with us because I wanted an injected painkiller so I wouldn't hurt her by forcing something down. I think Cartophren(a Rimadyl kind of drug) sounded like what she got. She also got some more baytril so she wouldn't have to choke down a pill and a hydration subcue. If she isn't eating by tomorrow we're to critical care her.
I'm hoping the painkiller kicks in soon so that she eats on her own. Must hurt like hell and I don't want her straining herself while being forcefed. She's obviously in pain just when she poops.
2:07 pm - The painkiller did the trick. She's eating and looks way better. She's very active and pissed that she isn't allowed to be. She needs to be very restricted in movements for 3 days to prevent adhesions from
We'll have her on Rimadyl for 3 days.
She doesn't need to see the vet today - knock wood. Looks like she's getting enough fluid on her own.
Good vets. They called at 9:30am to check on her. And asked for an update at 4pm.
I wish everyone had vets 5 minutes away who will meet you at the clinic at 11pm on Easter Monday.
She's ripping at her towel now. Really pissed off and impatient.
We lost a spay to adhesions once. Vet did some research and talked to a few other vets and got the info that they must be kept confined and limited in movement for 3 days after major surgery and then limited to no jumping or climbing for another 4 days. Adhesions happen when the wounds get reopened through straining. Scar tissue builds on scar tissue eventually creating obstructions. The pig will appear to be fine and then 10 days after surgery, bloat up.
Seems to be fairly common with pigs because they heal so damn fast.
So she's kept confined to promote slow, gradual, minimal scar tissue healing.
Very hard for a free range pig.
Lab Results: second stage Cysticmucometra. Could have developed into Pyometra which is a severe infection in dogs. First case in a pig the vet has seen although she isn't surprised it occurs.
A spay was the right thing to do. She's on Baytril twice a day for 14 days to make sure the infection is gone.
Next surgery we have done - I will request painkillers at the start. I wonder how many surgical pig patients die of shock from the post op pain. Tiramissou was definitely not doing well - rapid breathing, constant searching for a comfortable position, not eating or drinking. And I got the distinct impression that the vet wasn't completely convinced she'd make it - knock wood.
Now she'd raring to go - knock wood. She's due for more painkillers at 11pm.
4/18/01- Vet called. She talked to the pathologist and the uterus was definitely on its way to pyometra. That's why she'd been a little "off" the last few days.
So we did the right thing. She would have died from it without the spay.
Vet didn't give painkillers during surgery. She didn't seem too enthused over torbitrol(sp?) Mentioned something about it being pretty mild.
4/19/01 - Not totally sure why but I suspect the vet wants to make sure they are totally out of the anaesthetic before giving painkillers. Guessing anyway. She was concerned because the surgery took way longer than it should have and she had to release Tira 2 hours sooner than she normally would have. She was awake but I guess the vet wants to see her total reaction to coming out of the anaesthetic. I could see as the anaesthetic wore off Tira was breathing more rapidly and starting to make pain noises so I called the vet on the cell for painkiller instructions. She was just going to give me the pill but decided on an injection instead.
The narcotic Bear got did not work as well as the one Tira got. I could tell he was still in pain. The last 2 pigs we had spayed showed no sign of pain at all and were eating and drinking again really quickly. But their spays were easy compared to Tira. In fact, this is the first time I remember seeing post-op pain - except for Hazel after her caesarian.
4/21/01 - Tira has a seratoma(?). Serum leakage from the surgical site. Noticed it last night - day 2 in the condo, restricted to a single level. So she's back in confined quarters until the wound stops leaking and the fluid is absorbed by her body. Only starts leaking when she moves around. Goes back to see the vet tomorrow.
She's off pain meds. Bright and cheerful and pissed as hell. She's on baytril.
4/22/01 - It's a seroma. The vet taped a bandage to her after cutting armholes. Said she would rather see her leak for a few days and eat well than go off her feed from boredom and depression. So she's back on the confined top level. The vet also was discussing the uterus thing with another vet and thinks it would have killed Tira after 2 more cycles. Would have definitely turned into pyometra.
4/26/01 - After a couple of days of wearing a "sweater" to protect her wound - tira seemed all dried up and sick of the "sweater".
Took it off but haven't noticed her really improving. Yesterday, she was a little puffed, so I gave her some Rimadyl. Big improvement. Critical Cared her and she appeared to be eating well later on. This morning, weight loss again - she's fluctuating between 2 lb. and 2 lbs. 2 oz. Seemed unhappy. So I called the vet and suggested she go back on Baytril. The vet didn't think she needed it but agreed to a couple more days and wants to see her tomorrow.
It was a huge surgery, so she could conceivably still be in pain(does walk gingerly) but I am concerned she has an infection. She's just way too quiet and introspective. Does perk up a lot when the Rimadyl kicks in but it may be masking the reason for her "offness".
4/27/01 - Her temperature was taken and the vet concluded that she didn't have an infection but was still suffering post operative pain. Rimadyl for 3 more days and Critical Care her to keep her weight up.
5/2/01 - She's off the Rimadyl and moving from level to level in the cage. Slooooooowwwwwwllllllyyyy gaining weight. We stopped Critical Caring her as soon as she held steady. Doesn't seem to be in pain anymore but still looks a bit scrappy. She has scar tissue on one eye from an abrasion that we're still trying to get rid of. Makes her a bit squinty.
I still weigh her several times a day to monitor.
5/6/02 - Tiramissou is down in weight. I think it's due to gas as she looks and feels gassy. Giving her simethecone(sp?) twice daily and handfeeding to get the weight up. Just barely making 2 lb. Should be 2 1/4 lb.
She goes in to see vet.
I forgot that a month ago she was acting very strange and was in pain. She was walking as though trying to escape her pain. Unresponsive and not eating. Took her in and The other vet palpated a cystlike thing that suddenly disappeared. she started eating again and improved within minutes of the thing disappearing. xray at the time just showed gas. We don't know what happened - best guess was that the cyst thing was a localized gas bubble causing extreme discomfort.
She gets an xray today and maybe some new gas meds.
The vet couldn't palpate anything "off" today.
Belly is full of gas. She's not moving any food thru. This has been an ongoing problem with her.
Vet wants to try Beano. A couple of drops a day.
Gently massaging her tummy might help too.
5/10/02 - Beano seems to be working. Banned her from barley which is easy since she can't climb levels with her arthritis.
Still is gassy but she is slowly gaining weight. Not a lot but she isn't losing anymore.
Her belly is still gassy though. The only way I know it's improving is the slight weight gain. The vet said she has Ilius(??)
From Oxbow Hay Company article:
The floral imbalance can be caused by a number of factors, such as the wrong antibiotic (oral penicillins can be deadly to rabbits for this reason!) or a diet too rich in digestible carbohydrates and too low in crude fiber. Often, however, it is caused by a slowing of the normal peristaltic muscular contractions which push food and liquids through the intestines. The slowdown or cessation of peristalsis of the intestine is known as gastrointestinal (GI) stasis or ileus.
She gets Reglan, L-deprenyl for her Cushings, Meloxicam for her arthritis, Sulcrate to buffer her stomach. Plus Beano once a day. Might try twice a day.
Will give her poops too.
She just hauled her ass out across the room to beg for a healthy bit. She thinks they're as good as critter berries.
5/14/02 - She bloated again and lost weight so we upped the Beano to 4 drops a day. I did give her 2 days of poop but forgot yesterday. Will give her some today. Seems a lot better on the 4 drops beano. Got her to 2 pound 1 oz from 1 pound 14 oz. and she's willing to eat. Before, she wasn't enthusiastic about being fed. She should be 2 lb. 4 oz.
I'll try cutting her Reglan back to once a day if the trend continues.
5/15/02 - 2 lb. 2 oz. Stomach less tight, more pliable.
The only thing that is bothering me is that she is slightly puffed as though conserving heat. No symptoms of illness though. Could be her adrenals I guess.
All in all she is improving.
5/22/02 - 3 drops Beano twice a day and she is on Baytril for 10 days. Her stomach is good but she has one snotty nostril and is a bit puffed and losing weight again. Bright and active.
4 hours after her first dose she was gaining weight again.
Abby lost 4 oz. during the week and I put her on Baytril and within a day she was gaining back again. I assume they have the same infection which the vet thinks is sinus related not a URI. No lung sounds. Just weight loss and slight puffing.
I delayed Tira's baytril til the vet saw her because she is on so many drugs I wanted to make sure I didn't put her on something that would react adversely.
6/6/02 - She losts a bit of weight over 24 hours - 1 1/2 oz. She also looked off and seemed uncomfortable. Handfed her back to 2 lb. 1 1/2 oz. Palpated something weird and took her in to the vet.
She has an enlarged spleen. First time the vet has ever been able to
palpate a spleen in a pig.
The vet did 2 needle aspirations to send to the lab to check for cancer. Major surgery if it is. Because Tira has Cushings it means she has a crap immune system. The vet said there was no way she was doing that kind of surgery unless she had to.
Dogs and cats can get enlarged spleens from parasites - don't know about
6/7/02 - She died in my arms.
Riddled with liver cancer. Involved the spleen. What we thought was the spleen was a node of the liver. She wouldn't have made it thru the weekend anyway. Her daily meloxicam pain killer probably kept her going this long. Would have been 6 on Aug 15. But I knew she wouldn't make it to Aug.
6/26/02 - She was not very smart but sweet. When she wasn't crippled with arthritis she was in and out of the cage all the time. When she could still run easily, she would always take a select piece of food and trot off to a private corner to eat it even if there was a pile of the food available.
The long autopsy report had chronic bronchitis, heart disease (ventricular hypertrophy, a benign tumour in the spleen, Cushings Disease and liver cancer.
If the cancer didn't get her the heart disease would have.
Tira showed no symptoms of heart disease.
L-Deprenyl aka Selegiline aka Anipryl, concentration: 2mg/ml
Tiramissou's dose: 0.5cc once a day. Her weight: approx 1 kg.
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