Cushing's Disease Dog

[music plays] >>kelly runyon:on this episode of the paw report, we're talking about endocrinology.what's that, you ask? it's the study of hormones and how they controlour pets' different body systems. unfortunately, sometimes hormone balance goeswrong. and when that happens, disease results.with more on that, we're joined by dr. gregory

Cushing's Disease Dog, mauck from the kaskaskia valley animal hospital,next.[music plays] production of the paw report is brought toyou by... >>rameen karbassioon:dave's decorating center is a proud supporter of the paw report on weiu.dave's decorating center features the mohawk

smartstrand silk forever clean carpet.dave's decorating center, authorized mohawk color center, in charleston.okaw vet clinic in tuscola and dr. sally foote remind you to properly take care of your pets,and are happy to help support the paw report on weiu.okaw vet clinic, located at 140 west sale street, in downtown tuscola.more information available at okawvetclinic.com. >>kelly runyon: well, thank you for joiningus for this episode of the paw report. kind of a complicated topic we're talkingabout today. but that’s why we invited dr. gregory mauckwith us today to kind of sort things out. and we're talking about the endocrine system.that's a big word, and really hard to spell.

but you've been seeing some issues with thatcome through your office. so, thank you for joining us for this episode,and we're going to talk about that. so, why don't we start there?the endocrine system does play an important role, not just in human bodies, but in ourpets' bodies, too. >>dr. gregory mauck:right, and we see a lot of endocrine disease. so, the study of endocrine disease is endocrinology,so you hear that a lot. and a lot of people have their own endocrinologistthey see all the time. so, it's very common disease.we see, there's hardly a day goes by i don't deal with it.the most common things we see with that are

thyroid disease, adrenal gland disease, anddiabetes. but there’s lots of other endocrine tissuesin your body. and then, sometimes things like tumors willdevelop an endocrine component to them. like, for example, there's a common tumorwe see in dogs where they develop a tumor near the anus.it's called a perianal gland tumor. well, it will start producing hormones thatmimic parathyroid gland hormones, so, which messes up your calcium levels.so, there's lots of endocrine diseases and tissues.but the main ones we deal with are thyroid, the adrenal glands, and diabetes.and so, what endocrinology, or what the endocrine

means, glands produce substances.if the substances go outside of your body, like sweat glands or your pancreatic enzymes,which are being dumped into your intestines, those are exocrine glands.if they're being dumped back into your bloodstream directly, like insulin or thyroid hormones,cortisol, those things, things from the pituitary, those are endocrine because they're goingback into. so, that's what endocrinology is, is dealingwith those tissues. >>kelly runyon:now, you mentioned, you touched on a few, but there are lots of different diseases thatcould be spawned in our pets if that system is out of whack.>>dr. gregory mauck:

right, right.and so, like just take the thyroid, for example, dogs almost always have low thyroids.i've never seen a dog with a hyperthyroid, a high thyroid.cats basically always have high thyroids. i've had one cat in 28 years of practice whohad a low thyroid. so, they just, so we basically could haveit, we keep it in the back of our minds, but that's just probably not going to happen.so, but what happens in hyperthyroidism in cats is that they develop a little, usuallya tumor tissue. it's usually not malignant, but it can be.but that's rare. it's usually benign.but there's a little, tiny tumor in the thyroid

glands that's producing excess thyroid hormone.so, your thyroid hormone tells your body how fast to rev, so it's how much gas is on thepedal. >>kelly runyon:good way to explain it. >>dr. gregory mauck:so, yeah. so, if you've got too much, you've got toomuch pressure on the pedal and your body's going 80 miles an hour all the time, whichis very damaging. it can cause heart failure, it can...these cats come in, and they used to weigh 11, and now they weigh six pounds.so, that's hyperthyroidism. hypothyroidism, which we see in dogs, is usuallya situation where the thyroid gland basically

dies.the cells just die off, usually from an immune effect.and so, they can't produce thyroid hormone. so, in that situation, we don't have enoughgas in the tank, and these dogs gain weight, their skin looks terrible.you need thyroid hormone to turn your skin over and things.so, they just look really bad. their hair falls out.they don't produce, they rub their hair off of like their elbows or their tail, placeslike that, and it doesn't grow back. >>kelly runyon:i was just going to ask, what are some of the signs?i know, you know, when you're talking about

thyroid disease, diabetes, hypothyroidism,they're all going to have different signs probably.but you know, i have an animal that's just not acting right.what are some of the other things that i may look for, signs to know that something’sjust not right? >>dr. gregory mauck:right, well a couple things. one thing is just look at your animal.and look, you know, what doesn't look right? like, for example, there are times that iwalk into a room, and i had this happen recently, had a large retriever, and walked in the room,looked at it, and just immediately this dog's got thyroid disease.he had a tragic expression.

whenever you have low thyroid, you producethese molecules called mucopolysaccharides. they're great big sugar, mucousy molecules,and they get under your skin. and so, then your skin gets heavy, and itdrifts down, and you look like, you know, you're horribly depressed.we call this-- >>kelly runyon:you could see that in this retriever? >>dr. gregory mauck:yes, so they just wehh, they look horrible. people do that, too.you have to be pretty hypothyroid to do that, but it does occur.and so, that's a very common thing. the skin, like the skin on this dog was flakyand dry.

the hair coat was very sparse.so, the hair coat, the skin will hyper-pigment, and will get darker.>>kelly runyon: how long did that go on?did the owner-- >>dr. gregory mauck:that's probably been going on months. the thing with these, a lot of these diseasesis that they're very gradual. and so, the owners may not notice them asthey occur, because it's just very gradual along.and they don't, it's just kind of like the old thing where you put the frog in the boilingwater, and if, you know, supposedly, as they get slowly warmer you don't notice it.but when somebody else might show up that

hasn't seen the dog for two or three months,oh my gosh, what's wrong with your dog. you know, but the owners haven't noticed that.and so, that's a common thing. so, we look at the dog, and does anythingnot look right. like cushing's disease, where you have anoveractive adrenal system, they develop a pot-bellied appearance a lot of times, andthe skin gets very thin. and so, we'll have these little poodles comein, they'll have a big pot belly, and you can see the blood vessels through the skinon their abdomen because the skin's so thin. so, that's just some common, you might lookat your dog and, you know, he really doesn’t look normal.his skin just doesn't look good.

it's not, you know, shiny and nice, and youknow, he's got these worn off spots. or by golly, he does have a big pot belly.and that happens because the thyroid hormone, cortisol, weakens the muscle.and so, their abdominal muscles thin and weaken, and just the pressure from their abdominalorgans bulges out, and they develop this pot-bellied appearance.>>kelly runyon: what about eating?you know, they're lethargic, no energy? >>dr. gregory mauck:yeah, a lot of times eating, actually, most of the time with a lot of these diseases,increases. diabetes, typically you eat more, you drinkmore, you pee more.

those are kind of three biggies.cushing's disease, same thing, the appetite's increased from the cortisol.they also urinate more with that because the cortisol dilutes their urine.so, they can look, you know, we have an animal that comes, "hey, my dog's eating a lot, andhe's peeing a lot," that's the first two things we think about is diabetes, but also hypercortisol,cushing's disease. addison's disease, a low adrenal system, youdon't have enough cortisol, a lot of times those dogs' weights are dropping off rapidly,and they’re not eating because they feel so terrible.hyperthyroidism, a lot of times with cats, they're eating like crazy, and yet they'relosing weight.

so, again, that can be confused with diabetesbecause it's the same deal: eating huge amounts and losing weight.>>kelly runyon: you know, there is a laundry list, it seemslike, of all the different diseases if your endocrine system is out of whack.is one more prevalent than the other? i had a pet that was diabetic, i had to giveher insulin shots twice a day. is diabetes probably one of the more popularones? >>dr. gregory mauck:yes, yeah, we deal with lots of diabetic dogs and cats, pets in general.super common. hyperthyroidism in cats is very common.low thyroid in dogs is very common.

the adrenal ones are not as common, both thehigh and the low. but they're, we still see quite a few, butway less than the other two. >>kelly runyon:you know, as you alluded to earlier in our conversation, i'm a pet owner.and you know, you see your dog or cat every day, and you may not notice something, youknow, slowly, but over time you start to develop signs that something might be wrong.how, i mean how long can you really wait before something like this is treated, before somethingbad could happen? >>dr. gregory mauck:well, it can happen fairly quickly. and usually, when things get critical, itbecomes very obvious.

like, for example, we had a cat come in acouple weeks ago with diabetes. and it was literally filling its litter boxup. i mean, the amount of urine was just phenomenal.my mom and dad's cat, years ago when it developed diabetes, it just looked like somebody hadpoured water into the litter box, there was so much urine.dogs will start like needing to go out to the bathroom outside five, you know, to 10times a day instead of a couple or three. you know, just those types--so, it becomes really obvious. but one, and you know, weight loss can becomeso, in cats, i mean they can just literally plummet in their weight.so, things can be sneaky at first, but when

things come to a head, it usually becomespretty obvious something's going on. >>kelly runyon:you mentioned that sometimes when the endocrine system is out of whack, it can be hard todiagnose. it can be hard to, you know, see.talk about that as a vet, you know, and what you go through and what you struggle to kindof diagnose somebody's pet. >>dr. gregory mauck:yeah, because a lot of, you know, some of these are very obvious, where i do walk inand wow, that dog looks like it's got a thyroid or, you know, that dog looks like it's gotcushing's. a lot of times it's not like that.it may be more where the people come in, "you

know, my dog's been urinating more," but helooks totally normal and things. so, or we just will find stuff, you know,like we'll do general blood work or something just peaks our interest.hey, you know, it looks like maybe something's going on.because, we're in the early stages. so, we have to do blood work to diagnose allof these. but most of them, the tests are not 100%.so, we have to be very careful what we do with the numbers we get.so, now, you know, if we have a dog who we suspect with diabetes, and we've got a bloodglucose and it's 600, well, there's just really nothing else that's going to cause that.we can be pretty sure right then that this

dog's got diabetes.so, that’s a fairly easy one. if there's sugar coming out in the urine,and they've got a 600 blood glucose, that's pretty much case closed.thyroid disease is a little more difficult. so, we have a dog, well, they look like theymight be hypothyroid. or maybe we're just doing a senior panel,just a screen of blood work to see if there's anything going on.but those tests can be a little more difficult. because, let's say you're on the low sideof normal. like i had a dog the other day who looked,well, the dog i was just talking about that looked obviously hypothyroid.well, when we did his tests, normal on the

test for the thyroid hormones one to four.well, he came back 1.3. so, if you took it just right down the line,you'd say, well, he's in the normal range. one to four is normal, he's 1.3, he's normal,he doesn't have thyroid disease. well, that's not correct.one thing, your thyroid hormone is not constant in your body.so, if you measured all day long, it goes up and down all day long.little bits, not a huge amount. but we might have caught that dog on his highend, and then during the day, the rest of the day, he's down at 0.7.so, his average is below normal. so, you have to take the numbers in associationwith the clinical signs.

and cushing's disease is super important withthat. it's more maybe along the lines of 80% accurate.so, we have to look at this dog. does this dog have symptoms of cushing's,does his blood work that we're testing support that or not, and look at both of those andmake a clinical judgment. and one thing with, especially with cushing's,the treatment for it is, it's kind of dangerous, to be frank.we have to be very careful with it, so we're not just going to throw around treating cushing'sjust because the numbers are abnormal. i had a dog this week who's test for cushing's,we were looking at other issues, but his cushing's number came back elevated, the cortisol, inthe cortisol test.

and, but this dog has no symptoms of cushing'sdisease clinically. so, even though his numbers were high, we'renot going to treat that dog for cushing's. he has no symptoms of it.and that's what we're really treating. it's a touchy treatment.and you can actually cause more problems with it than you're helping, if you're not carefulwith it. so, but the tests, you have to take them witha grain of salt. you have to look at the numbers we get in,and look at the dog clinically, and then decide, you know, where we'er at with this.>>kelly runyon: kind of a two-part question.one, this sounds to me like it's not just

a, you're going to know what the diagnosisis the first time i come into your office. it sounds like the diagnosis could take sometime, number one. number two is treatment.i'm sure every single, you know, ailment that your pet is diagnosed with, it's going tobe a different treatment regime. so, i'll let you answer both of those questions.we'll start with the diagnosis. it's not some instantaneous thing you're goingto know. >>dr. gregory mauck:no, not for the most part. there are blood chemistry things, machinesthat can test for thyroid, for example, in the office.so, that's available.

it's a total thyroid, but it doesn't tellus the whole thing. most of the time, we're going to draw bloodfor thyroid, send it off to a lab, and get numbers for different things we look at.and that's going to take a few days. but these, or most of these diseases, otherthan diabetes, and addison's disease can be s critical situation, but most of them aren'tthings we have to deal with today. now, addison's disease can be critical now.it's something that, i mean, you can, i mean if we're in an addisonian crisis, you candie like now. so, that’s something we have to--and so, that's one of those things where sometimes we have to not have tests.there are certain tests we can do in the office,

like look at a potassium level.with addison's, that can shoot through the roof, and cause heart block, and they candie. and so, we can look at a potassium.but we can't do a cortisol level today, cortisol test and get the results today.that's just not going to happen. so, some of those things we have to.diabetes is the one thing we can. yes, your blood glucose is 600, your ketonesare through the roof. we need to institute therapy right now.but most of them aren't. cushing's, you know, is not something we'regoing to diagnose today. we might get an idea today, but we're notgoing to have an absolute, you know, know

what we're doing.and so, with a lot of these diseases, other than if we're in an emergency situation, wedon't want to go off until, treating them until we're absolutely sure we've got thisdisease we're going to deal with. so, that's important.but all of them, you know, obviously have different treatments.if you're low thyroid, you're going to take a thyroid supplement.if you're high thyroid, we're going to give you drugs that prevent your abnormal glandfrom continuing to produce high levels of hormones.if you've got cushing's, the next thing, you know, cushing's is a syndrome.it's not a specific disease, so there's different

things that can cause cushing's.in cushing's disease, you're producing too much cortisol from your adrenal glands.well, and there's always a tumor involved for naturally occurring cushing's.it's usually not malignant, but can be. but for the most part, you're either goingto have a tumor in your adrenal gland that's just going to produce cortisol by itself,or you're going to have a tumor in your pituitary gland that's producing too much of the hormonethat tells the adrenal glands to make the cortisol.so, you have a tumor in one of those spots. and so, we deal with those two things in twodifferent ways. >>kelly runyon:remove the tumor?

>>dr. gregory mauck:yeah, we can't get rid of the tumor. if you have a pituitary tumor in a dog, rarelya cat, that's not something we're going to be getting rid of.if you're a person, you're probably going to either having surgery, radiation, thattype of thing to destroy that tumor. but that's not really available for dogs andcats. so, if you have a pituitary tumor, it's goingto continue to produce acth, which is the hormone that tells the adrenal glands to makethe cortisol. so, we can't stop that.so, then we go to the adrenal gland and give them a drug that damages their adrenal gland,so that it doesn't continue to make the cortisol.

the acth is still going to be pouring in therefrom this pituitary tumor, but the adrenal glands are going to be damaged so that theycan't respond to it. that's the touchy part of the treatment, becauseif we damage them too much, then you can't make any cortisol.and then, this dog that was cushing's now becomes addisonian, you know, develops addison'sdisease, which is actually more dangerous than having cushing's.so, if you are a naturally occurring addison's dog, that's an immune disorder, where yourimmune system destroys your adrenal glands. and so, then you can't make cortisol.so, we have to replace that by giving oral prednisone and injections of other types ofhormones that control your sodium/potassium

levels in your body.>>kelly runyon: so, just a lot of different treatment options.>>dr. gregory mauck: yes, lots of stuff.>>kelly runyon: now, what about breeds?and what about dogs vs. cats? >>dr. gregory mauck:yeah, dogs vs. cats first. you know, i mentioned a while ago about catswith thyroid, they’re always high, dogs are always low, basically.diabetes is basically equal, i would say, in cats and dogs.we get lots of both. one thing with diabetes, it can be slightlydifferent.

cats, they say kind of have a little bit morethe type ii, like people do. we think of diabetes, it used to be type i,type ii. type i was insulin dependent, juvenile diabetes.type ii was adult onset, possibly not insulin dependent.but really, we really need to think about diabetes as insulin dependent and non-insulindependent. and dogs and cats for the most part are alwaysinsulin dependent. so, but pretty much equal in most breeds.the adrenal gland stuff, big difference. cats very, very rarely get addison's disease,which is the low problem. dogs, it's not a common disease, but they'rethe ones that get it.

high adrenal, you know, where you're producingtoo much cortisol, is again quite rare in cats.it does occasionally occur, i've seen a couple cases.but it's mainly a dog problem. so, the adrenal stuff's mostly dogs, rarelycats. you know, thyroids, cats are high, dogs arelow. and diabetes is about the same.>>kelly runyon: breeds, different breeds it's prone to?>>dr. gregory mauck: so, like dogs, for example.a lot of schnauzers get diabetes. well, i won't say lots of schnauzers get it.i wouldn't say that, but they're much more

prone to getting it than other breeds.when they get it, a lot of times it's worse. they tend to get ketosis associated with theirdiabetes, which is a problem with fat metabolism. you produce toxic metabolites from fat, andit makes things a lot worse. so, schnauzers with diabetes tend to be abigger problem than another dog. but we tend to see, diabetics tend to be smallerbreed dogs. we definitely get large breed.we've had 150-pound dogs get huge amounts of insulin.but i would say probably 70% of the dogs we deal with, with diabetes are small dog breeds.cats, you know, most of the cats we see are domestic shorthairs and things anyway, ordomestic cats.

i don't know that there's any huge differencein, but many of the cat breeds are just really not that common, that i could make a judgment.but most the cats we deal with are just plain old cats, you know, with those things.>>kelly runyon: plain old cats.>>dr. gregory mauck: yes, and then talking about the adrenal stuff,that's definitely is a difference, too, in dogs.like again, schnauzers are very prone to getting cushing's disease, compared to other dog breeds.you know, it's just one of the things they do.but a lot of these are just very mixed. in the adrenal cushing disease, where youget the adrenal tumor vs. the pituitary tumor,

tends to be, small breed dogs tend to getpituitary tumors. large breed dogs, it's maybe half and half.so, if we see an adrenal tumor, it tends to be a big dog.but i've seen adrenal tumors in little dogs, too.and i've certainly seen lots of big dogs with pituitary tumors.but the adrenal tumor definitely is more common in large breed dogs.and then, as far as thyroid problems in dogs, certain breeds like golden retrievers arekind of notorious for thyroid disease. doberman pinschers, you know, tend to getit. but you know, we see it in lots of dogs.i don't get, that's definitely more of a big

dog problem than it is little dogs.we get some little dogs with thyroid problems, certainly, but they tend to be bigger dogs.>>kelly runyon: the key is, you know, if you see somethinga little quirky with your dog or cat, just make sure you get it checked out.>>dr. gregory mauck: yeah, yeah.because, these are sneaky, sneaky diseases. >>kelly runyon:yeah, always interesting to talk to you dr. mauck.thank you for joining us on the paw report today.look forward to seeing you again sometime, with another interesting topic.and we thank you for joining us for this episode

of the paw report.we'll see you next time. production of the paw report is brought to you by...>>rameen karbassioon: okaw vet clinic in tuscola and dr. sally footeremind you to properly take care of your pets,

and are happy to help support the paw reporton weiu. okaw vet clinic, located at 140 west salestreet, in downtown tuscola. more information available at okawvetclinic.com.dave's decorating center is a proud supporter color center, in charleston.[music plays]