Sara's Story

A small swollen area under Sara's eye led to a vet visit. While the eye itself wasn't concerning, the vet noticed Sara's gum color looked off and recommended full bloodwork. Tests revealed high liver enzyme (GGT = 18.2), and ultrasound found significant gallbladder sludge. Treatment with Ursofalk was delayed over a month due to medication unavailability in Romania.

New blood tests showed that liver levels were slightly better, though this time kidneys' levels were worrying. New ultrasound showed sludge improvement. Further discussions regarding Sara's thin skin, visible blood vessels, round belly and loss of hair, alongside the previous sludge and now kidneys problems made the vet consider Cushing's disease. The 8-hour LDDS test confirmed it.

Started Vetoryl 30mg/day (15mg AM + 15mg PM). Rapid physical decline followed: extreme weakness, needed help standing, total lack of energy, and developed Calcinosis Cutis - losing hair and skin around shoulders, back, and tail. It is then when I started learning about the amount of damage high cortisol had been doing whilst being uncontrolled for so long, and why Sara was getting worse rather than better, despite treatment.

For her Calcinosis Cutis, we started weekly medicated baths with DOUXO S3 PYO, daily Baneocin powder for her elbows and back legs open sores and Camrosa Ointment. For her joints I introduced Hyaloral, and for pain CBD oil specific for dogs (we tried Gabapentin but stopped because of the side effects). Dose increased to 40mg/day after cortisol values remained out of range. Knuckling in rear feet raised suspicion of Degenerative Myelopathy. Added Vitamin B12, fish oil (later Omega 3), and collagen powder.

Gradual improvements noticed: less knuckling, reduced water intake, skin healing. Still had trouble sleeping with lots of repositioning and panting at night. Needed help getting up frequently.

After a night of elevated heart rate and extreme restlessness, Sara was taken to the vet first thing the next morning, where she experienced a sudden stroke-like neurological event - head tilt, disoriented eye movement, inability to stand or move normally. She received immediate emergency treatment (injections, IV fluids) and was hospitalized for three consecutive days. She made a positive neurological recovery. A full cardiac exam and lung X-rays were performed to assess possible causes. Both her heart and lungs were within normal limits for her age, ruling out cardiac or respiratory involvement. An MRI was considered, but not pursued due to the high anaesthesia risk associated with her age and Cushing's disease.

Mostly stable months with only two minor vet visits - one for an anal gland infection and one for an ear infection (which later became recurrent). Sara travelled through Europe, walked 3× daily (20–30 minutes each), and kept a stable weight of ~32.5 kg. She rebuilt muscle mass, her curiosity returned, and back-leg shaking was rare (only when relaxed, about twice a week, easing with massage). Her main limitation was heat intolerance above 20°C. She remained on Vetoryl 20 mg AM/PM, plus Omega-3, Vitamin B12, collagen, glucosamine, and occasional CBD oil.

5 September: A cortisol test came back low (27.85nmol/l, normal range 50-250nmol/l), so her Vetoryl dose was adjusted and later temporarily stopped for three days. 25–27 September: Sara developed severe vomiting. She was treated overnight at the vet with fluids, but her condition worsened over the following 24h - shaking and foaming at the mouth - so she was taken to emergency care. Blood tests and an ultrasound showed severe liver failure caused by a gallbladder mucocele. The situation was critical, and the vets discussed two options: risky gallbladder removal surgery or euthanasia. My own further research identified a medical approach using Ursodeoxycholic acid (Ursofalk), antibiotics, and Denamarin (SAM-e). This treatment was started immediately and led to her recovery (gallbladder was not removed, mucocele remains present, Ursodiol remains as life-long treatment alongside Trilostane and SAM-e) - clinical signs are still positive.

13 weeks after her liver crisis, Sara continues to beat the odds. Her gallbladder mucocele is stable, and her bile acids are back to normal. Remarkably, her ~4cm adrenal tumor even appears slightly smaller on her latest ultrasound. Supportive meds like Ursofalk and SAM-e are now for life, alongside her Trilostane. The Balancing Act: The Pause: We stopped Trilostane for 25 days to prioritise liver recovery. This delay proved how quickly uncontrolled cortisol acts, causing rapid muscle loss, the return of the "pot belly," hair loss, and increased panting. The Restart: We restarted conservatively at 10mg BID (twice daily) to avoid an Addisonian crash. Current Dose: Based on symptoms and her latest ACTH test, she is now at 13mg BID - currently her "sweet spot" for stability. The Outcome: Despite the "havoc" of high cortisol, a gallbladder mucocele, and a sensitive pancreas, Sara is thriving: eating well, exploring, and rolling in the grass. To her vets, her survival is a medical miracle. To me, every day is a gift I didn't think I'd still have.

A routine check-up revealed a significant pancreatitis flare (cPL 848.5, up from cPL 636 less than one month before) and hypertension (175-210 mmHg). We have introduced Lypex enzymes and started a conservative dose of Cardalis for blood pressure. Despite these clinical findings, Sara remains clinically asymptomatic - the ultimate 'War Machine' - still rolling in the grass and enjoying her meals. Together with our vet, we are doing our best to keep her stable until the Surgeon visit coming up on January 7th.