Isabella Kelly (Diabetes Mellitus & Cushing's Disease)

[chasing_bella]

Hi friends, I know some of you guys from the k9diabetes site. I decided to post because my little girl is getting tested for Cushing's today (ACTH stim test). Depending on the results (if negative), I'll be requesting blood work to be sent to UT@Knox. BTW, even if she comes up positive with the ACTH stim test, should I have the blood work sent to UT? If so, will they be able to tell me how long Bella has had Cushing's?

I had Bella tested 11 mo. ago for both diabetes & Cushing's (ACTH). At that time she came back negative. Now she's developed diabetes mellitus, along with pre existing health issues (heart murmur, enlarged heart, liver disease). Bella is 10 yrs old & is now at 25 lbs (gained 2 lbs since starting insulin.

Bella's RX schedule
17 units NPH 7am/pm
Ursodiol 9 pm (liver rx)
HeartGuard Plus (monthly)
Frontline Plus (monthly)

Food
Hilll's Prescrip. Diet W/D dry 1 1/2 cups & W/D 1/4 can 7 am/pm

Any questions I should ask my vet if she's positive?

Thank you so much for all the advice and support (from both sites!).

-Sam
(I posted some pics of Bella- album section, if anyone is interested)

[Squirt's Mom]

Hi Sam and welcome to you and Bella!:)

I can't help with the diabetes end but others here do deal with both issues plus I'm sure you get excellent support from our sister site.

The ACTH is more often used as a monitoring test VS diagnostic but some vets do approach it this way, especially if a non-adrenal illness is already present or suspected. One thing I highly recommend is that you have an abdominal ultrasound done. It will let them get a good look at not only the adrenal glands but many other organs as well. I would definitely ask for a referral to have one done on a high resolution machine if needed.

The full UTK panel includes the ACTH but you can have it done without the cortisol being checked and it should be a bit cheaper that way, too. Personally, I think this test should be included in every pup's testing for Cushing's as it can help head off issues later down the road. Plus, I'm one who likes to know everything from the beginning. ;)

As for being able to tell how long she may have had Cushing's, no they cannot answer that question and I'm not sure anyone could unfortunately. Cushing's is such an insidious and slow progressing condition that it isn't recognized until the signs start to show and even then many think it is simple aging. Sometimes you can tell whether it is in the early stages by the number and severity of the signs but not always as each pup is different. To my knowledge, this remains one of many mysteries connected to Cushing's. :rolleyes:

If the testing points to Cushing's these are the things I would ask about:
*I would want to know how many Cushing's patients they have successfully treated, and how many with both conditions.
*I would want to know which treatment the vet was most experienced with, and which one they were considering for Bella and why.
*I would also want to know whether it is adrenal or pituitary based, tho this isn't important to some, just a personal preference.

So, there's my 2-cents worth! :p

Glad you and Bella are here!
Hugs,
Leslie and the girls

PS. Bella is a doll!!!

[BestBuddy]

Hi Sam,
Buddy had been diabetic for quite some time so the specialist we saw said that the best test for him to start was the ACTH. We didn't have the option of the full UTK panel. The ACTH is more accurate in a diabetic I believe. We also did the LDDS to try and discover what type and it was pituitary.
Jenny

[Squirt's Mom]

Hi Sam,

Just wanted to clarify for you that Jenny is right - the ACTH is preferred in pups with non-adrenal illnesses. I didn't intend to make you think your vet was wrong in choosing the ACTH. One of our admins had pointed this out to me and Jenny beat me to to punch in getting that cleared up.

Hugs,
Leslie and the girls

[Harley PoMMom]

Hi Sam,

Although I have no advice to give to you but I am sure "others" will, and I see Jenny & Leslie already have, I did want to welcome you and Bella to our family.

I did see from you lovely pictures that Bella has her paws full with all of them brothers. :eek::p:D You do have a beautiful family I must say.

We're here for you and Bella, in anyway we can.

Hugs.
Lori

[chasing_bella]

Okay, test results will be back Monday. I briefly spoke with my vet. This is what he wants to do: If the ACTH test comes back negative, he wants to do the low dose dex stim test, if that comes back negative, then we send the blood work off to UT. He said if it gives me peace of mind, even if she tests positive on either test, he would send the blood work off to UT. He has done this several times for other patients, but feels that it might be an unnecessary expense (whatever :p, not like we couldn't buy a nice used car for what we've paid in vet bills for her reg. & emerg. visits in last 2 yrs).

Bella has been with this vet for several yrs. The last 2 years we've been working closely together in monitoring Bella's health. He cracked a smile when I pulled out 4 pages of notes & questions today. Of course he told me to stop panicking & wait for the test results.

Anyways, I'll update you Monday. Everything is going to be okay (so I keep telling myself).

Thanks Jenny for staying in touch (on both blogs). BTW, my mom has 2 mini white poodles that are 16 yrs old (Louie & Samson). Thank you guys for all the advise & support, Bella & I are so glad we found all of you :)

-Isabella & Samantha

[Harley PoMMom]

Hi Samantha,

I'm just being nosy here :eek::) but what symptoms does Bella show that made you want her tested for cushings? And did you have any recent CBC or a Chemistry panel done on her that, maybe, if you wouldn't mind, posting the abnormal numbers here. Debbie, one of moderators is a lab tech with over 29 years experience and I'm sure she would take a look at them numbers and see if something was "wacky."

Will be waiting with you and the others until Monday for the results of Bella's test. And yes, everything will be ok. :)

Hugs.
Lori

[AlisonandMia]

I would think that sending the blood off to UTK first off would be the way to go simply because most of the cost of the UTK panel is the cost of the ACTH stim that is necessary to run the test - the analysis by UTK is only around $135 more (last time I looked). There is probably nothing technically wrong with doing the tests in the order that your vet is advocating but doing the UTK panel with the stim initially will save you money if nothing else.

I also think that as she's previously tested negative for Cushing's over the last year (that is right isn't it?) despite showing some symptoms that this could be a good idea for that reason too. Dogs with elevations only in the sex hormones (normal cortisol) will usually test negative on the standard Cushing's tests that only look at cortisol (standard ACTH stim and LDDS) while having symptoms. If her adrenals happen to be producing abnormally high amounts of progesterone (even if her cortisol is normal) that could possibly have contributed to her developing DM and will almost certainly make it hard to get her regulated, just as high cortisol would. Cortisol and progestrone are both powerful counter-regulatory hormones which means they increase insulin resistance.

Alison

[acushdogsmom]

Just have a few minutes online tonight but I wanted to pop in and give a link to Samantha and Bella's thread over at our "sister board", k9diabetes. There is very likely info already posted there about Bella's story so far that may answer some questions that our members here may be wondering about. like some of the reasons that Bella's Vet suspects possible Cushing's.

http://www.k9diabetes.com/forum/showthread.php?t=1339

:)

[Harley PoMMom]

Hi Samantha,

First, let me thank Cushy for supplying the link to your thread at our "sister board" it did answer my questions...poor Bella and poor you.

My Harley is dx'd as PDH + Atypical cushings, as of right now we are treating the Atypical cushings only because his cortisol remains within the normal ranges.

The Atypical Cushings is much more easier and less stressful to manage than the Conventional/True Cushings.

From your thread at the our sister board I see Cushy mentioned Dr. Oliver...Oh what a saint of a human being...I have sent him many emails regarding my boy Harley and his treatment plan, and Dr Oliver always graciously responds back in a timely manner. If you want/need his email address, please let me know.

Keeping you and Bella in my thoughts and prayers.

Love and hugs.
Lori

[Squirt's Mom]

Morning Sam,

How are you and Bella this morning?

I read yours and Bella's story on the diabetes site...bless your heart! But you are in great hands for both conditions should it turn out that you are dealing with both. That would really throw me for a loop so I understand your angst! :eek: Of course, I am easily thrown! :p

My Squirt is Atypical even tho she tested positive for PDH in the beginning. It turned out she had a splenic tumor that was removed, along with part of her spleen, and her cortisol returned to normal afterward. She had tested positive for conventional Cushing's on the LDDS, HDDS, ACTH, and UTK panel, but now it appears those results were because of the tumor. However, her intermediate/sex hormones remained elevated which makes her Atypical, not conventional Cushing's (no elevation in cortisol, only in the other hormones).

Squirt had an underlying condition that caused her cortisol to rise, skewing the tests. So, your vet is right to address the diabetes first, get it under control and then look at the possibility of Cushing's. Cortisol is a normal, necessary hormone in all our bodies. It is one of the "flight or fight" hormones that come into play any time we are stressed - no matter the cause. Any illness can cause the cortisol to rise in response to the physiological stress of the body trying to deal with the illness. So, I think you and your vet are on the right track in trying to control the diabetes first.

Know we are here for you any time for any reason. If you just need to talk, voice your fears and concerns, ask questions, discuss something - anything, we are here to help if we can.

Keep your chin up! You're doing just fine!
Hugs,
Leslie and the girls

[chasing_bella]

Thanks Leslie:) We were suppose to wait a month b/f testing for Cushing, but because of the weight gain in Bella's case, the vet decided to go ahead & test for Cushing's. In most cases diabetic dogs tend to loose weight, but not my chunky monkey. She gain two whole lbs (25 from 23 lbs) since being diagnosed with diabetes mellitus on Sept 26, 09 (at the emergency vet clinic). So my vet wanted to go ahead and test for Cushing's sooner.

All the babies are struggling with their new feed schedule 7am/7pm. I decided to put everyone on Bella's feed/insulin schedule. I have to sneak milkbones to the rest of the pack while my husband is playing with Bella. They don't care so much for the fresh veggies snacks, but Bella, please, that chick will eat anything not nailed down.

Bella's hanging in there like a trooper & I'm adjusting. There's a dog named Chrissy Ann on the K9diabetes blog. She had both diseases, other complicating health problems, & lost an eye to acute glaucoma. She lived several years with all of these problems. Her mom was nice to share Chrissy's journey with me. So beyond the occasional meltdowns, I have hope for my Bella girls :)

BTW Bella's symptoms
ferocious appetite
drinks water often
thinning hair on back, but more so on her sides
dark pigmentation on back

[acushdogsmom]

There's a dog named Chrissy Ann on the K9diabetes blog. She had both diseases, other complicating health problems, & lost an eye to acute glaucoma. She lived several years with all of these problems. Her mom was nice to share Chrissy's journey with me. So beyond the occasional meltdowns, I have hope for my Bella girls :)Bonnie (aka "bgdavis", Crissy Ann's Mom) is a member here too. She used to be a very regular poster on our message board before we moved (this one is fairly new - we just moved our message board to here in May 2009). I remember Crissy's before and after Lysodren photos. There was a very dramatic improvement after Crissy was started on the Lysodren. :)

[BestBuddy]

Hi,

We all have those meltdowns at times. It will make it easier if you put all the four legged family members on the same schedule as Bella. Bella and the others might not like it at the start but it will soon be routine for them and it will make it so much easier for you.

Good luck with the testing.

Jenny

[chasing_bella]

Got the test results today.

She tested negative. I asked the vet to skip further in house testing & opted to have the blood work sent to UT. Bella goes in on the 19th Oct. for blood work & we'll know in a couple of weeks the results. My vet reminded me that both diabetes & Cushing's are so similar in symptoms that maybe I should wait to see if I have a hard time managing/regulating her diabetes (which at that time would be a very good indication to pursue UT). I agree its an expensive test, but even if it comes back negative, and all of this can be just attributed to her diabetes, I'll at least have my peace of mind. I'm holding my breath and praying my other 5 dogs stay healthy in the mean time.....

Thanks y'all for everything:) Let you know when we get the results.

Isabella & Sam

[acushdogsmom]

Did the vet check for hypothyroidism? - testing for canine hypothyroidism (ie a "thyroid panel") should definitely include a "free T4 by equilibrium dialysis" test (free T4 by EQD), a measurement of T3 and a canine TSH and there are a few other thyroid hormones that can be measured in a full thyroid panel - or did he just do an ACTH stimulation test to check for Cushing's? Because unexplained weight gain and and hyperpigmentation and thinning hair and/or hair loss, could all be due to hypothyroidism. It's not usually an in-house test (usually the blood has to be sent to the Lab) but hypothyroidism is easy to treat, by the way.

Hypothyroidism may be secondary to the diabetes or your Bella could have both diabetes and the kind of hypothyroidism that needs to be treated (usually just with a daily thyroxine supplement)

http://www.lbah.com/canine/hypot4.htm


If the thyroid test is low or low normal, then 2 main scenarios are possible:

The first scenario is called the sick thyroid syndrome or nonthyroidal illness (NTI).

In this situation the thyroid gland is normal, but there are factors that are suppressing it from secreting a normal amount of thyroxine into the bloodstream. These factors include medications like cortisone, valium, anticonvulsants, and sulfa antimicrobials. Diseases like Cushing's disease, diabetes mellitus, chronic renal failure, liver disease, and addison's disease can also cause NTI. When these factors are corrected, or these diseases are treated, the apparent hypothyroid problem corrects itself. No treatment with supplemental thyroxine is needed.

In the second scenario the thyroid gland is having a problem secreting adequate thyroxine due to one of the causes previously mentioned in the causes section. This is the hypothyroidism we need to treat with supplemental thyroxine.

How do we differentiate between a true hypothyroidism from the sick thyroid syndrome? We have another blood sample that aids us, called the free T4 test by equilibrium dialysis. If this is low, and the signalment, history, and physical exam are consistent with this disease, then a diagnosis of hypothyroidism is made.

P.S. It's true that usually it will be very difficult to get decent control of the blood glucose if a dog has Cushing's (and is untreated for the Cushing's)

[gpgscott]

Hi Sam,

I treated Moria for Atypical Cushing's (elevation of estradiol only) for over a year before we discovered that she was also hypo-thyroid. Even though there is no way to know for sure, I believe she was -T for a long time.

The thyroid supplementation has been a wonder med for us, I hope you will pursue the testing.

Welcome.

Scott

[chasing_bella]

No testing for hypothyroidism as of yet. Can the hypothyroid test wait until we get the results back from UT? Or is this some thing that has to be done right away? The only reason I ask is I can't afford to do both test right now. UT test is $299.50 (I'm not sure if that high or not for the Atlanta area), but I still have to have money in reserve just incase we have to go to the emerg. vet for whatever reason. So which is the lesser of two evils? Testing for Cushing's or hypothyroid? I'm going to go research this also while I wait for your reply. Thanks again!!!

[gpgscott]

Sam,

I would do it at the same time. A draw is a draw and there can be multiple tests done on the sample.

Scott

[chasing_bella]

The only problem Scott is that I can't afford both tests at this time:( unless I win the lotto in the next week or get a 2nd job (which I'm looking).

-Sam

[Harley PoMMom]

Hi Sam,

I really do understand the financial hardship...when I took Harley to the MJR University of Philadelphia Hospital for his ultrasound and other tests, I knew it was going to be high because I had him there before, so I applied for a Care Credit, I couldn't believe they took it, but I checked before I applied for it.

If your interested here's a link to the Resource Thread where it's located plus there are other links to assist with financial needs.

http://www.k9cushings.com/forum/showthread.php?t=212

Love and hugs.
Lori

[k9diabetes]

Check the thyroid level on the standard blood panels you have had done and see if it looks normal.

I believe the results typically show it inaccurately low if a dog has another condition - that is, the standard blood panel will show low thyroid but the more accurate test will show it in the normal range. At least that is what happened with us - Chris' thyroid results on a standard blood panel were borderline low but smack dab in the mid-range of normal on the Free T4 with ED test. I don't know if the std panel can show it normal when it's actually low.

Cushings has been a topic of discussion with the vet for a while now as I understand it - the vet believes Bella has it.

So I personally would opt for the UTK panel unless there has been some indication on the standard blood panel that thyroid levels are an issue.

I don't think the Free T4 with ED is very expensive... could very well be that UTK can test the same sample for Free T4 with ED and it won't cost a whole lot cuz it's all being done at once. Maybe check this out with the vet.

Natalie

[chasing_bella]

Just wanted to update you guys:

Results came back from UT... She doesn't have Cushing's but came back with a recommendation to test in 6 months again. Also, no thyroid problems.

So we are just dealing with the diabetes (and preexisting illnesses).

She misses her doggie biscuits but has settled for the fresh veggie snacks (especially peeled cucumbers).

All in all, Bella is doing really well :)

I just want to say thank you guys so much for all the support :)

Best wishes to all of you & all the fur babies.

God Bless,
Isabella & Samantha

[Squirt's Mom]

Hi Sam,

Good news! :D Thank you so much for coming back and sharing this with us! Do keep in touch and let us know how Bella is doing...ya'll are still family even tho she is Cushing's free. ;)

Congratulations!
Hugs,
Leslie and the girls

[Roxee's Dad]

Hi Samantha,

Great news, I am happy for both of you. Glad that Bella is doing well:)