Greyson - 4 yr old Brussels Griffon. Diabetic with possible Cushings.

[brittanyt]

Hi all. I just wanted to introduce myself and hopefully get some input on my little furbaby's situation. I'm Brittany. Greyson is a 4 yr old Brussels Griffon who was diagnosed with diabetes at age 3 1/2. I'm pretty sure it was brought on by a vetalog injection.

I post regularly at k9diabetes and Natalie told me about this forum. Greyson is still not regulated but I feel he is almost there. The reason I took him in for testing was because all of a sudden he stopped wanting to eat. He was always a fussy morning eater but never ever in the evening. Natalie suggested there may be an underlying issue so I took him in first and the vet took some blood and checked a few different things. One thing that came back very alarming was his triglycerides were through the roof at 1500 and she said they should be closer to 150. His cholesterol was high as well.

I took him a few days later and they kept him for a few hours to check for cushings and also his thyroid. I broke down yesterday to hear that he tested "borderline" for cushings and he also had thyroid issues. I got medicine for that and also filled a Lysodren prescription.

Several people at the other board read my post and told me to hold off on the lysodren until I could come post the actual numbers. I got those today and e-mailed Natalie and she read and posted on the other forum.

I am going to paste that here. Would you all mind looking at this and giving your input? I don't want to treat him with Lysodren if it was really the diabetes making it seem like he had cushings. Also, the prescription called for 1/8th of a Lysodren pill once a week. I would like to hear thoughts on that as well. I think she said she was starting him on a maintenance dose since he was only borderline.

Sorry for the novel! I really appreciate any thoughts/comments on this. I pray that he really doesn't have cushings but if he does I'll do everything I can for him. I just want to make sure that this is what this is. Posting the numbers below.

Thanks, Brittany
(and Greyson)

"Hi Brittany,

I'm going to post the test results here and then you can copy them to a post at the Cushings forum.

I cannot tell what kind of test the vet did for thyroid. It does not actually say Free T4 with ED so I'm still concerned that this test may not be accurate. Chris' thyroid levels used to come up borderline low on a standard blood panel and when checked with the Free T4 with ED they came up smack dab in the middle of the normal range because that test is not affected by concurrent illness.

ACTH Stim Test

Pre - 9.43
-- reference range given is 1.0-6.0

Post - 24.8
-- reference range given is 6-17, borderline 17-22, Cushings >22.

Thyroid

"Total T4" - 0.967 -- reference range 1.7-3.6ug/dl

The lab results are kind of a pain to read as they don't supply reference ranges or indicate clearly when things are high... I will note what seems to be marked as abnormal - only his triglycerides and cholesterol.

Amylase - 258
Glucose - 210 (Nice!)
BUN - 31
Creat - 1.55
Sodium - 144
Potassium - 4.8
Chloride - 123
CO2 - 15.3
Calcium - 10.9
Phos - 4.5
Cholesterol - 319 reference range <200 desirable
Triglycerides - 1,469 Reference range <150 desirable
Uric Acid - <0.5
TP - 7.0
Albumin - 4.1
Globulin - 2.9
A/G - 1.4
AST - 34
ALT - < 6
LDH - 1,138
AlkPhos - 82
Total Bilirubin - 1.4

Blood count all normal."

[brittanyt]

I also wanted to add that he has NONE of the listed normal symptoms for cushings. His hair is fine. No bloating or potbelly appearance and his skin is completely normal. No increase of drinking or going to the bathroom and the fact that he just turned 4 makes me question if this is really cushings. Thanks :)

[littleone1]

Welcome Brittany,

I've been treating Corky for Cushings for just about a month now. I know that there are other issues that can increase various levels. I'm sure someone with more experience will be along shortly and will be able to provide you with more information.

[frijole]

Welcome from me as well!~ My dog will be 16 shortly(schnauzer) and she has been treated for cushings for over 3 yrs now. Doing just fine.

Looking at those numbers, even though I am not a vet, I doubt it is cushings... The ACTH test says that cortisol levels are at cushings level but doesn't mean it is cushings. You need to additional testing to confirm a cushings dx and I certainly wouldn't waste time on lysodren until a dx was certain.

Other reason I doubt it is cushings is because the liver enzymes are not elevated (alk phos especially).. plus you aren't seeing symptoms.

What other tests have been done? Have you had a sonogram done to look at the organs? Tell us as much as you can. We will help as best we can.. we've seen alot over the years and it isn't unusual for a vet to get it wrong. That's how most of us found the k9cushings forum to begin with! ha.

Kim

[jrepac]

"borderline" and they want to start lysodren? um, that does not make good sense....and, the symptoms don't really add up to cushings, based on what you describe

many vets will wait until you either cross the borderline stage or the symptoms become too troublesome, before treating

would not want to treat w/lyso unless you were absolutely sure cushings was present...

I had the "borderline" situation, but treated w/anipryl for some time to make things manageable; upon later testing, cushings was then diagnosed. Shoot, I was even taking a chance with the anipryl, but all of the symptoms were there.

Jeff

[Harley PoMMom]

Hi Brittany,

Welcome to you and Greyson from me and my boy Harley. I just want you to know that I realize all this seems pretty scary right now but we are here and we will help you, ok :) so lets just take a deep breath and lets see what's going on here.

Strong symptoms are a huge part of making the diagnosis, and a Cushing's savy vet will probably not initiate any treatment without strong symptoms and a proper diagnosis. Usually one of those symptoms is excessive hunger, which your Greyson does not have, now that could be from the diabetes but one of the protocols of giving Lysodren is to never give a pup Lysodren that isn't eating well.

Cortisol is a stress hormone, one of the "fight or flight" hormones, so if Greyson was really stressed the day he had his ACTH test this could of skewed his results, also any non-adrenal illnesses will cause false positives results on ACTH tests.

I know this is alot of information to take in, but Cushings can be a difficult disease to diagnose and not one test can confirm it 100%.

So if I were you and Greyson were my pup, I would get the Free T4 by ED run and an ultrasound done and see what the ultrasound shows. JMO, of course.

Just remember Brittany, your not alone on this journey, we are here for you and Greyson always.

Hugs.
Lori

[Franklin'sMum]

Hi and Welcome, Brittany and Greyson

I'm very sorry your beautiful boy may have Cushing's, but you have come to the right place.
The wonderful folks here have years of combined experience, and I learn something each time I look at a posting.

I'm sure others with more experience and knowledge will be along shortly.
Until then, here's my 2 cents! :)

A lot of underlying illnesses can cause a rise in the cortisol level.
If Greyson doesn't like going to the vets, and becomes stressed, that could also raise the cortisol.

If Greyson isn't showing any symptoms, it's not a great idea to start Lysodren therapy.
(You know if treatment is working (or not) by a reduction in the symptoms.

Cushing's is a very difficult illness to diagnose (symptoms over-lap with a number of other illnesses),
and just an ACTH stim test is not definitive. (My boy's GP wasn't planning on doing any further testing, till I found these incredible people here and dug my heels in, due to their education of me:))

If Greyson is only "borderline", he definitely needs further testing to confirm or rule out Cushing's.

A UC:CR can almost positively rule out Cushing's.
An LDDS test may help to differentiate between pituitary Cushing's and adrenal Cushing's.
There is also Atypical Cushing's ( a rise in the intermediate steroid/ sex hormones, that may or may not also have a cortisol increase.).
You will hear of a "full adrenal panel from the utk" to check these hormones. I'm sure the people who know more about it will chime in soon.

Please DO NOT administer Lysodren until further testing has been done. If Greyson's high cortisol is not due to Cushing's, the Lysodren may cause SERIOUS problems (Addisonian crisis, permanent Addison's, or even DEATH).
Brittany, I'm not trying to scare you, if it is Cushing's you are dealing with, it is treatable.
Do you have an IMS-Internal Medicine Specialist? I'm thinking, with the diabetes, the answer is probably yes.

Once again, welcome, and we look forward to learning more about you both.
Jane and Franklin xx
________
Lovely Wendie (http://www.lovelywendie99.com/)

[frijole]

If I read it right you were giving 1/8 of a pill once a week right?

Dogs can get too much lysodren but the dosage you described is not enough to cause addisons crisis etc. as previously mentioned. It is not enough of a dose to much of anything. (meaning it won't HELP either)

I just don't want you losing sleep over the lysodren you already gave. And as someone else said ---- deep breathes. We will help you through this. Hang tight and tell us all you can.

We have all been there and understand. Don't be afraid to ask questions either! Hugs, Kim

[acushdogsmom]

Hi Brittany,

I'm going to hope that you don't even really need to be here. But until we get things all figured out with you and for Greyson, welcome. :)

As the others have mentioned, since Greyson's ACTH stim test results are "borderline" and he is not showing the usual Cushing's symptoms, I'm not so sure it's a good idea to be starting him on Lysodren. Lysodren is a great medication for Cushing's treatment (my little Bichon was successfully treated with Lysodren for more than 6 years) but it's a serious medication and needs to be used and monitored correctly in order to be really safe and effective. And it shouldn't really be given to dogs who don't need it. And even when a dog is definitely confirmed as having Cushing's and does need to be on Lysodren, it's still not a very good idea to give Lysodren to a dog with a poor appetite.

Here's a link to (and a short quote from) a presentation about the similarities and differences in symptoms and lab abnormalities that can be seen in dogs with Cushing's, or Diabetes, or both:

http://www.vet.uga.edu/vpp/clerk/Zwicker/


Hyperadrenocorticism (HAC) and diabetes mellitus (DM) are relatively common endocrine diseases in dogs. These diseases are sometimes difficult to differentiate, as they share many clinical signs and laboratory abnormalities. Diagnosis may be further complicated when concurrent HAC and DM is present. A thorough history, physical exam, and diagnostic evaluation are often required to be able to accurately diagnose HAC, DM, or concurrent HAC and DM. And if you scroll a little more than halfway down the page at the link above, you'll see where it shows, under ACTH stimulation test, on the Diabetes Mellitus side of the chart, that
Endocrine tests can be abnormal in stressed DM patients

Would you consider getting a second opinion from an Internal Medicine Specialist Vet, to confirm or refute this possible Cushing's diagnosis?

Endocrine disorders such as Cushing's and Diabetes and Hypothyroid can be really tricky to diagnose correctly, especially if/when you may be dealing with more than one condition. Internal Med Specialist Vets often have a focus in Endocrinology, and they see many more of the complicated cases than a GP Vet is likely to ever see. After all, they aren't usually brought in to consult on the simple cases. It's the more complicated and tricky-to-diagnose cases they get called in on for a second opinion. So they see these kinds of cases pretty much all the time and an IMS Vet would be a great choice to evaluate Greyson and give you and your Vet some expert input on the case.

I noticed that you are in Little Rock AR ... and there is actually an Internal Medicine Specialist Vet in your area named Dr. Anthony Gary, who is mobile (at least that's what it says on his website). He will meet and examine patients at their regular GP Vet's office and work with the GP Vet on the case:

http://www.arkansasvim.com

phone: 501-834-0993
fax: 866- 860- 3592

Do you think you might be able to get your Vet to work with Dr. Gary? My regular Vet loves it when a client wants to bring in a Specialist for a second opinion - she learns from the Specialist and is then better able to care for the next patient who presents with a similar condition.

Here's some info about Dr. Gary that I copied from his website:
http://www.arkansasvim.com/Tables/images/AVIM_About_Hours_Location.gif

http://www.arkansasvim.com/Tables/images/Bio.gif

http://www.arkansasvim.com/Tables/images/AVIM_About_Us_RO.gif

I'm wondering if maybe a consult with Dr. Gary, the mobile Internal Med Specialist, wouldn't even be very expensive. At least not as expensive as when you see an Internist at a Specialty Clinic where they have fairly large operating costs and overhead.

My Specialist, whom I met when she was working at a private Specialty Clinic, went out on her own and mobile (like Dr. Gary seems to be doing now) for a few years before going back to work at a teaching hospital clinic. And her rates when she was mobile were really very reasonable because her operating costs were not high at all and one of her goals was to get the specialty services to the dogs and cats out there who really need it and whose owners maybe couldn't afford the big specialty clinic fees.

She used to charge the Vets for the Specialty services and then they'd charge the client. She said that some GP Vets used to charge their own fees (on top of hers) to the clients for her mobile specialty services while other GP Vets charged nothing to the clients for the Specialist consultations except for the actual Specialty service IM Vet fees. So to some clients she was actually very, very affordable. I don't know for sure that Dr. Gary would be as affordable as my Specialist was, but you never know unless you ask.

Maybe Greyson's Vet would be happy to have the expert input on the case (after all, it isn't a simple case and it can be really tricky to diagnose a dog correctly when there's a possibility of several endocrine disorders going on) and maybe your GP Vet wouldn't charge you anything extra on top of what Dr. Gary would charge for his second opinion consultation and treatment recommendations.

Can you try to find out whether your Vet would be amenable to the idea of getting Specialist input on Greyson's case and also what the cost of an examination and consultation with Dr. Gary would be?

[Coolidge]

Hi.

I just thought I'd add that I went through a similar experience with Coolidge. She didn't have all the symptoms either, except high water intake and panting.

I'd like to stress the fact that it is dangerous to load an animal on lysodren if it is not medically necessary. Coolidge had low "high" levels on her supression test (LDDST). Internal Med vet said Cushings. We loaded her in what turned out to be a very few days. Her levels after were so low she was almost addisonian.

I'd highly recommend that you 1) find an internal med vet that will look for other causes to Greyson's lack of appetite (usually with Cushings the appetite is INCREASED, or at least to my knowledge is), and 2) have the full adrenal panel done as recommended earlier. This will tell you if Greyson has Cushings and if it is atypical or typical.

For some of us on this board, it has been a very frustrating journey. Some are still in limbo land - may have it, or may not.

The suggestions made by people on this board are wonderful. If I hadn't had their knowledge base, well, Coolidge would not have made it as far as she did.

I hope you search diligently before you load Greyson. Eliminate all the possibilities beforehand.

Hugs to Greyson and you!

[k9diabetes]

So I am wondering how (if) the triglycerides fit into this picture?

Can Cushings and/or thyroid problems generate high triglycerides?

I believe high triglycerides can also throw off some test results. Would these be affected?

Sorry... I know I should search for the answers to these questions. I confess I was hoping someone might already know the answer. The Vetsulin issue has been keeping me really busy lately!

We have experience on our forum with another dog with high triglycerides, Kramer, and his blood sugar was extremely erratic. Greyson seems to demonstrate this as well. I have to go back and look to see if they thought Kramer was Cushinoid...

Anyway, I got the impression that the vet suggested there was a correlation between the triglycerides and the Cushings/thyroid.

Natalie

[lulusmom]

Natalie, there is a connection between triglycerides and cushing's but it usually involves mild elevations. Greyson's are extremely elevated so I think there is something besides cushing's going on. The normal elevations we see in cushing's, aren't there and neither are the symptoms. I've seen triglycerides this high but the dogs were were diagnosed with hyperlipidemia. One of them is Munchie, Louise's dog. He's a Mini Schnauzer and they are predisposed.

My dogs have multiple issues and they treat with an internal specialist. They really are the most knowledgable of cushing's and other endocrine disorders so I would recommend an IMS for Greyson.

Glynda

[StarDeb55]

Nat, the only thing I have to contribute from the lab end is, yes, significant lipemia can falsely elevate cortisol measurements. Based on that, my educated guess would be that Greyson's borderline ACTH result could very well be due to the lipemia. My next suggestion would be to talk to the vet about calling the lab that performed the ACTH to confirm this.

Debbie

[brittanyt]

Wow. I'm overwhelmed at all of the kind and helpful posts. I already feel so much better knowing I have a support system here.

Several of you have mentioned internal medicine. The reason I found this vet to begin with was by a referral from another vet. I originally saw the IMS to confirm his diabetes. He was only there until noon that day as he mostly does surgery. Once I talked to him right before he left, he told me another vet would be kind of taking over. Not in those words but it actually worked out because we loved her instantly and it was a bit less expensive to see her plus he wasn't as available as other vets in the clinic. She has been great and even gave me her phone numbers in case I ever needed her. Should I get another appointment to see the IMS there or just ask her if she consulted with him about the results?

As far as further testing, I'm open to anything that I can do to 100% confirm or hopefully rule out Cushings. Would an ultrasound do that? If not, what is the best test that can be done? I assumed that is what he had. I had put off having it done just to rule out cushings b/c of the cost. I think it was $150 maybe?

Should I call the lab to see which thyroid test was done or would it be in his chart? I think I need to find out if it was the free t-4? His super high triglycerides concern me. I had started him on 50 mg of niacine twice a day and then stopped the day I got the diagnosis on the thyroid and cushings. Btw, I am still surprised that I would find out he has both troubles. That is also leading to my doubt of the cushings.

I have thyroid medicine here at home but I have not given him any yet. Some of you posted questions on that. I have held off on the lysodren and the thyroid medication both until I know for sure.

His appetite seems to be getting worse and that leads me back to my original concern of another underlying problem. Could thyroid trouble decrease the appetite? I think I have read and understand that cushings causes an increase in appetite. Is this correct?

I know I have a ton of questions and I'm so grateful for you all. He's just SO young to have cushings. I am praying that this isn't what is going on. I will do whatever I can to get an answer. What specific test(s) should I ask for? I am going to include a picture of Greyson so you can see him better until I can put some pics in his album.

Thank you all so much for your time and effort in helping me figure this out. I had a 5 yr old Brussels Griffon who I lost tragically and Greyson is his nephew. I got him when he was one. His owner was keeping him in a crate all day and when he got home he went to bed and didn't ever spend time with him so he returned him to the breeder. I feel Greyson needed me as much as I needed him.

http://i34.tinypic.com/2j1lzkx.jpg

http://i35.tinypic.com/2e5l4zc.jpg

[k9diabetes]

Cushy had a chance to check Kramer's thread at my forum :o and found the following in Kramer's thread:



Well, the IMS says that by examining Kramer and looking at his blood and urine test results, she doesn't think its cushings typical or atypical. She also didn't want to do the ACTH because apparently with triglycerides as high as they are we could very possibly get a false positive.

She said that if his triglycerides and cholesterol weren't as high as they are she would want to do more tests, but, those issues alone are enough to cause terrible blood sugars and high liver enzymes.

My mom hasn't wanted to put Kramer on cholesterol meds (lipidil, lopid etc.) because of the side effects (possible muscle wasting etc) but the IMS says the benefits far outweigh the risks in this case because if we continue on this path with high blood sugars, he won't last much longer.

SO...we're thinking we're going to try Lopid this time as it has less side effects (one of them being low blood sugar...SWEET!) and double up on all of those liver protectants. We're also going to add some fish into his meals and more chick peas, and decrease the amount of turkey he gets. As well as add flax seed oil.

At this point she says that the high trig and cho are causing high blood sugars and high liver enzymes and the stress on the liver is causing high trig and cho....that is some vicious circle!!! So we don't have a choice other than to try a cholesterol lowering drug and continue supporting his liver because we've tried every natural remedy we can possibly think of!

Breanne and Kramer

Greyson's liver values are lovely while Kramer's were quite high -

ALP of 1151, ALT 394, AST 116.

His Triglycerides were 11.59 mmol/L with a reference range of 0.12-1.60.

http://www.faqs.org/faqs/diabetes/faq/part1/section-9.html


To convert mmol/l of triglycerides to mg/dl, multiply by 89.

So Kramer's 11.59 x 89 would be 1,031. Lower than Greyson's.

It seems to me that the triglycerides is what any vet should be concentrating on here as apparently Greyson's are quite high.

I will check and see if I have Breanne's email address so we can get an update from her.

I don't know much about problems generated by triglycerides. That's where my internet searching would concentrate and forget about Cushings for now.

Natalie

[lulusmom]

I have to run out in a minute but I did some research on hypertriglycerides and I found exactly what Natalie posted. It seems that sustained hyperlipidemia can cause diabetes and pancreatitis. It's impact on the pancreas could account for Greyson's lack of appetite. The site I researched also said that a dog can suffer from psuedo pancreatitis in which a dog can experience clinical signs of pancreatitis but bloodwork doesn't reveal any abnormalities. I'll try to find that site again and will post when I get back later.

Again, I don't believe Greyson has cushing's. I'm not a medical professional but I think it is more likely that Greyson has hyperlipidemia which caused the diabetes and a false positive acth stim test result. I would absolutely be getting an internal medicine specialist involved at this point.

Glynda

P.S. I also suspect that Greyson does not have primary hypothyroidism. It is more likely euthyroid sick syndrome as a result of the high triglycerides.

[lulusmom]

Here is the link I was looking for. Cushy also reminded me that diabetes can cause high triglycerides and euthyroid sick syndrome. I am not familiar with diabetes so I don't know if it can cause severe elevations in triglycerides like Greyson's. These elevations are common in hyperlipidemia. I am hoping that Louise may log on and share her experience with Munchie. I believe his triglycerides were over 1500, was misdiagnosed with cushing's and was prescribed Trilostane, which made him sick.

http://www.newmanveterinary.com/Hyperlipidemia.html

[acushdogsmom]

And there's this one, too:

http://www.veterinarypartner.com/Content.plx?P=A&C=189&A=2660&S=0


In pets, hyperlipidemia most often occurs as a consequence of some other disorder, such as diabetes mellitus (sugar diabetes), hypothyroidism (low levels of circulating thyroid hormones), Cushing’s disease (excessively high cortisone levels in the body), certain liver diseases, and protein-losing nephropathy (a disease of the kidneys resulting in protein loss in the urine). However, hyperlipidemia can also occur spontaneously after a meal of high-fat foods, particularly table scraps.

[k9diabetes]

I emailed Breanne and she has logged on at K9D! :)

http://www.vetsulin.com:80/vet/Vet_ProductAlert.aspx

By the way, there's a link to a really cute video of Greyson there as well.

Natalie

[acushdogsmom]

From what I'm reading in another google search that I just did, hyperlipidemia can have several different causes, three of the possible causes being Diabetes Mellitus, Cushing's and hypothyroidism. And I also see that one of the symptoms of hyperlipidemia is poor appetite (anorexia). Hmmm ...

Here's a few of the links I found:

http://www.veterinarypartner.com/Content.plx?P=A&C=189&A=2660&S=0

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2003&PID=6509&O=Generic

http://veterinarymedicine.dvm360.com/vetmed/Medicine/Hyperlipidemia-in-dogs-and-cats/ArticleStandard/Article/detail/456193

If your Vet is suggesting that there is a correlation between hyperlipidemia and Cushing's and/or hypothyroidism, that might be so ... but there is also a known correlation between Diabetes Mellitus and hyperlipidemia (lipemia or high triglycerides in the blood). And you already know that Greyson is Diabetic.

And since significant lipemia can falsely elevate cortisol measurements, it seems to me that it's very possible that the hyperlipidemia/high triglycerides in the blood could the reason that there was a borderline high test result on Greyson's ACTH stim test (which measures cortisol production). He also may have been very stressed on the day of the stim test, and stress can also cause elevations in cortisol levels.

I also agree with Glynda that if the thyroid values are suggesting hypothyroidism, that could be "sick euthyroid/non-thyroidal illness/euthyroid sick syndrome" rather than true hypothyroidism. See here where it says that Diabetes can cause sick thyroid syndrome:

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


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.

Without any other evidence to confiirm Cushing's except for a borderline ACTH stim test result in a dog with high triglycerides and Diabetes, and with no clinical signs of Cushing's, and a very poor appetite (as opposed to an increased or even ravenous appetite, which is what most Cushing's dogs have before starting treatment) I just don't understand how your Vet can be so sure that Greyson has Cushing's as to start him on any Lysodren at all - even just a small weekly dose. And I'm not so sure that the diagnosis of true hypothyroidism (requiring thyroid hormone supplementation) is correct either. You'd need more than just the one thyroid test (your Vet only ran a "Total T4" I think, right?) to know if it's true hypothyroidism or the kind of hypothyroidism that resolves on its own eventually, after the primary condition that caused it is under good control.

I think there are just too many other possible explanations for what's actually going on here with Greyson and not enough evidence for a confirmation of a Cushing's diagnosis or even a true hypothyroid diagnosis.


Several of you have mentioned internal medicine. The reason I found this vet to begin with was by a referral from another vet. I originally saw the IMS to confirm his diabetes. He was only there until noon that day as he mostly does surgery. Once I talked to him right before he left, he told me another vet would be kind of taking over. Not in those words but it actually worked out because we loved her instantly and it was a bit less expensive to see her plus he wasn't as available as other vets in the clinic. She has been great and even gave me her phone numbers in case I ever needed her. Should I get another appointment to see the IMS there or just ask her if she consulted with him about the results? Okay, so I'm going to guess that the IMS you saw is Dr. Larry Nafe (he is an IMS and also a Neurologist and Neurosurgeon, I think?) because other than Dr. Gary, I think Dr. Nafe is the only other IMS in your area. And if Dr. Nafe is the IMS, then your current GP Vet is one of the Associate Vets on staff at Dr. Nafe's Clinic. (Dr. Lavergne, Dr. Erikson, Dr. Butner or Dr. Razer)

http://www.hillcrestanimalhospital.org/index.asp

Assuming that your GP vet is one of the above at Hillcrest, I think that she should definitely be consulting with her boss, Dr. Nafe about Greyson's case. If I'm wrong and the IMS you saw before is not Dr. Nafe, then it must be Dr. Gary.

Either way, I think that an IMS should really be consulted by your GP Vet at this point. The IMS may want more tests done, including ultrasound (which is always a good idea, in my opinion, because the Vet can get a good look at all of the abdominal internal organs, including, but not only, the adrenal glands) and/or some additional thyroid tests, for example, at least a Canine TSH and a free T4 by equilibrium dialysis, to try to determine if you are dealing with the kind of hypothyroidism that needs thyroid hormone supplementation to treat it or not - or he may be able to figure out what is going on with Greyson just by having a good look at the test results you already have and taking into account Greyson's clinical symptoms.

I'm not a Vet and not even a medical professional of any kind, but as a fairly well informed pet owner who reads alot of the Veterinary literature and from what I learned from my dog's Specialist during our Cushing's "journey", and from what you've told us about Greyson's symptoms (or lack of symptoms) and test results so far, I really think (and hopefully the IM Specialist would agree) that you really need to be addressing the hyperlipidemia (high triglycerides) before even thinking about treating what may be (or more likely is not) Cushing's or hypothyroidism.

[k9diabetes]

I would talk to the IM about treating the hyperlipidemia. Breanne took a moment to post at K9D and they have gotten pretty good results from a human drug with Kramer.

How to proceed will depend in part on whether your vet is willing to go along down this road of thinking the Cushings and possibly even the hypothyroid are nonissues.

You can print up all of the stuff linked to her to talk with the vet. In the end, if she won't go along with this, you will need to work directly with the IM. And which one might depend on whether the vet's already talked to one about this plan... gee, I hope that's not the case.

Natalie

[frijole]

I said earlier that I didn't think it was cushings and I think you've gotten some great feedback re what to do next... but I just gotta say that I think that is ONE CUTE DOG! Those photos are great... I could just hug him! Thanks for sharing... I am sure you will figure this all out with time. Hugs Kim

[Squirt's Mom]

Hi Brittany,

A belated welcome to you and Greyson! :) I just love the name! It is so dignified and old-world sounding. My sister-in-law raises Brussels Griffons; she has about one litter a year to deal with - which is plenty! ;) Hers were my first experience with Griffons and they are a joy to be around.

I have read your thread and I think the thing for you to do is just take a deep breath and relax. HA! Easier said than done, huh? :p I can only imagine how overwhelming it was to hear that your baby has three, three, endocrine disorders! :eek: While that is possible and has been seen before, Greyson doesn't seem to fit the profile, as others have pointed out. I don't know if you got to know Marianne and Pebbles, but they are ones who had to deal with all three - diabetes, hypothyroidism and Cushing's.

Like Glynda, Natalie, Cushy, and others have said, the hyperlipidemia would be my focus for sure. And I WOULD NOT give any Lyso or Trilo to Greyson for now. There are just too many unknowns.

Bless you! I am sure your heart has been breaking over all this. I would have reverted to my bug-eyed, slobbering, hair-on-end self I was when I first came here! :eek::eek::p I'll tell you a little secret - shhhhh - diabetes scares the living daylights out of me! :eek: Truthfully!!!! If you can handle diabetes with Greyson then, even if it does turn out that he has Cushing's, Cushing's will be a breeze! But I just don't think you will have to face that right now, if ever! Hopefully never!

So just put Cushing's out of your mind and don't let the docs get tunnel vision about it either! Concentrate on finding the source/cause of the hyperlipidemia, getting Greyson on a good food/diet designed to address his issues asap, and keep in touch often! You done come over here and said "Howdy!", introduced us to Greyson, told his story, so ya'll are family here, too, now!

Keep your chin up, honey! Things will all work out, I just know they will! :)

Hugs,
Leslie and the girls

[MiniSchnauzerMom]

Hi Brittany,

A belated welcome to you and Greyson. I'm Louise that Glynda was referring to. A lack of appetite and no symptoms raises a big red flag for me as this is not typical of Cushings.

My Munchie has high triglycerides but had absolutely "0" Cushings symptoms just like your Greyson. I knew nothing about Cushings disease then and hadn't found this forum so with no symptoms whatsoever and only one test I started him on Trilostane (which actually elevated his triglycerides instead of lowering them). He ended up becoming very ill from being treated with a drug for a disease he did not have. Upon retesting he was negative for Cushings and two years after the original misdiagnosis he still has "0" symptoms. Taming the hyperlipidemia has not been as successful for Munch as it has been for Breanne's Kramer. Neither drug nor diet resolved the high triglycerides yet he is thankfully still doing well in spite of those darned tryglicerides.

I agree with everybody about bringing an IM on board to treat the high triglycerides. Usually, the first step is lowering dietary fat. They do have Rx low fat diets for this or your IM can also order a custom made diet formulated by a veterinary nutrtionist who would take all Greyson's health conditions into consideration when formulating.

Thinking positive thoughts for you and Greyson and will be looking for your update.

Louise

[brittanyt]

I'm so relieved that you all don't suspect this is cushings. As far as the hypertriglycerides the only thing that I can think that would have impacted (and looking back, I feel terrible) was that before diagnosed, Greyson absolutely adored "dental bones" (as he knew them) - any kind of chew treat such as meatybones, purina busy bones, etc.

The reason I feel so terrible is that I never once thought to look at the ingredients or fat content. I don't think i'd be exaggerating by saying he probably had one a day for over a year and a half. Could that have just caught up with him? There's no telling how long his triglycerides/cholest were elevated. Also pre-diabetes, we were a bit too giving with people food. Just little bits here and there. I was so uneducated back then as far as nutrition and that I was actually hurting him by temporarily making happy.

The night before he went in and had the cbc and other testing, he ate one of those smoked pig ears. Again, I wasn't even thinking about the fat aspect of it, just read that pig ears were a natural treat that was okay to give once in awhile. I'm wondering if that along with just having his meal an hour before made his triglycerides higher than they would have been.



I have to run out in a minute but I did some research on hypertriglycerides and I found exactly what Natalie posted. It seems that sustained hyperlipidemia can cause diabetes and pancreatitis. It's impact on the pancreas could account for Greyson's lack of appetite. The site I researched also said that a dog can suffer from psuedo pancreatitis in which a dog can experience clinical signs of pancreatitis but bloodwork doesn't reveal any abnormalities. I'll try to find that site again and will post when I get back later.

Again, I don't believe Greyson has cushing's. I'm not a medical professional but I think it is more likely that Greyson has hyperlipidemia which caused the diabetes and a false positive acth stim test result. I would absolutely be getting an internal medicine specialist involved at this point.

Glynda

P.S. I also suspect that Greyson does not have primary hypothyroidism. It is more likely euthyroid sick syndrome as a result of the high triglycerides.

[brittanyt]

Thank you Louise. I'm overwhelmed at how welcoming and helpful everyone here has been. What do you feed Munchie? Greyson is beyond picky so it's been a rough time keeping him on a certain food. I think that's why I haven't gotten his diabetes regulated yet and it's been about 4 months. Everytime he eats something and likes it, probably a month or so later he one day decided he doesn't want to even look in the food's direction.

He likes Merrick Grammy's Pot Pie canned (doesn't do well on dry) and that is 4% fat. We also give him 99% fat free ground turkey breast and organic brown rice (2% fat, i think) so as far as I know I'm feeding him low enough fat content. I've done away with any rawhide or pig ears or anything that could interfere with his triglyceride level.

I'm definately going to work on getting the IM who I originally saw to weigh in on this. Thank you again. :)


Hi Brittany,

A belated welcome to you and Greyson. I'm Louise that Glynda was referring to. A lack of appetite and no symptoms raises a big red flag for me as this is not typical of Cushings.

My Munchie has high triglycerides but had absolutely "0" Cushings symptoms just like your Greyson. I knew nothing about Cushings disease then and hadn't found this forum so with no symptoms whatsoever and only one test I started him on Trilostane (which actually elevated his triglycerides instead of lowering them). He ended up becoming very ill from being treated with a drug for a disease he did not have. Upon retesting he was negative for Cushings and two years after the original misdiagnosis he still has "0" symptoms. Taming the hyperlipidemia has not been as successful for Munch as it has been for Breanne's Kramer. Neither drug nor diet resolved the high triglycerides yet he is thankfully still doing well in spite of those darned tryglicerides.

I agree with everybody about bringing an IM on board to treat the high triglycerides. Usually, the first step is lowering dietary fat. They do have Rx low fat diets for this or your IM can also order a custom made diet formulated by a veterinary nutrtionist who would take all Greyson's health conditions into consideration when formulating.

Thinking positive thoughts for you and Greyson and will be looking for your update.

Louise

[AlisonandMia]

In light of the pigs ear and the meal just before the test it would be a good idea to redo the triglyceride/cholesterol testing. Its my understanding that these tests should be done fasting - otherwise you can be just testing the fat levels of the recent meal.

Was it a whole pigs ear that he had? Pigs ears are very, very fatty.

Alison

[brittanyt]

Leslie,
Thank you for the warm welcome. Your sister-in-law is one lucky lady! I love this breed. I used to go visit the breeder every once in awhile just to be around so many. Greyson was "returned" to the breeder at age 1 due to his owner keeping him pinned up in a crate all day. He never got much human interaction and after I lost my Brussels Griffon, Newton, to being hit by a car, she called me and told me about him. His original name was "Boy" and I knew I wanted something more original. He was grey, and my new son. Hence the name Greyson. :) Once I went in the door to see if I was interested in taking him home, before I knew it, he came right up to me and wanted me to pick him up. It was an instant bond. It was like he knew I was there to be his new mommy.

Anyway, before I found this board, I was a basketcase. Now, I'm just focused on continuing to try to get his diabetes regulated and keep him on as lowfat of a diet as possible. It's difficult lately keeping his blood sugar down b/c he just doesn't feel like eating anymore. He acts fine- he plays and has energy. It's just at mealtime he is very disinterested. It's a struggle morning and evening to even get 1/2 of his meal in him. I have another brussels griffon who I never talk about and I should probably introduce him sometime. His name is Norton. Newton was his older brother who was about to turn 5. Norton is 7 and in good health. Back to my point =) I have to get Norton to come in when Greyson eats and say "Don't you get Greyson's foodies Norton" and then Greyson will eat a bite or two and stop. I say it again, He eats another bite. You get the picture. :)

Do you all think maybe once his triglycerides are at a normal level his appetite will increase? Or if it truely is a thyroid problem would that effect his wanting to eat?


Hi Brittany,

A belated welcome to you and Greyson! :) I just love the name! It is so dignified and old-world sounding. My sister-in-law raises Brussels Griffons; she has about one litter a year to deal with - which is plenty! ;) Hers were my first experience with Griffons and they are a joy to be around.

I have read your thread and I think the thing for you to do is just take a deep breath and relax. HA! Easier said than done, huh? :p I can only imagine how overwhelming it was to hear that your baby has three, three, endocrine disorders! :eek: While that is possible and has been seen before, Greyson doesn't seem to fit the profile, as others have pointed out. I don't know if you got to know Marianne and Pebbles, but they are ones who had to deal with all three - diabetes, hypothyroidism and Cushing's.

Like Glynda, Natalie, Cushy, and others have said, the hyperlipidemia would be my focus for sure. And I WOULD NOT give any Lyso or Trilo to Greyson for now. There are just too many unknowns.

Bless you! I am sure your heart has been breaking over all this. I would have reverted to my bug-eyed, slobbering, hair-on-end self I was when I first came here! :eek::eek::p I'll tell you a little secret - shhhhh - diabetes scares the living daylights out of me! :eek: Truthfully!!!! If you can handle diabetes with Greyson then, even if it does turn out that he has Cushing's, Cushing's will be a breeze! But I just don't think you will have to face that right now, if ever! Hopefully never!

So just put Cushing's out of your mind and don't let the docs get tunnel vision about it either! Concentrate on finding the source/cause of the hyperlipidemia, getting Greyson on a good food/diet designed to address his issues asap, and keep in touch often! You done come over here and said "Howdy!", introduced us to Greyson, told his story, so ya'll are family here, too, now!

Keep your chin up, honey! Things will all work out, I just know they will! :)

Hugs,
Leslie and the girls

[brittanyt]

It was a Hartz "All Natural Pigs Ear Strip" not a whole pigs ear but the strip was a good sized one. If I just would have thought about it, I should have known it wasn't healthy. I had no idea his cholest/triglycerides were so high.


In light of the pigs ear and the meal just before the test it would be a good idea to redo the triglyceride/cholesterol testing. Its my understanding that these tests should be done fasting - otherwise you can be just testing the fat levels of the recent meal.

Was it a whole pigs ear that he had? Pigs ears are very, very fatty.

Alison

[brittanyt]

I agree Natalie. I'm praying that in this case the IM was not consulted on these results/treatment. I will go look for Breanne's post. When first hearing about the triglycerides, we were told to give him 50 mg of niacin twice a day but then told to stop once she prescribed the lysodren. Do you think I should start him back on that?

I would talk to the IM about treating the hyperlipidemia. Breanne took a moment to post at K9D and they have gotten pretty good results from a human drug with Kramer.

How to proceed will depend in part on whether your vet is willing to go along down this road of thinking the Cushings and possibly even the hypothyroid are nonissues.

You can print up all of the stuff linked to her to talk with the vet. In the end, if she won't go along with this, you will need to work directly with the IM. And which one might depend on whether the vet's already talked to one about this plan... gee, I hope that's not the case.

Natalie

[MiniSchnauzerMom]

Brittany,

Both the pig's ear the night before and especially the meal prior to the testing most definitely would cause elevated results in Greyson's triglycerides. I would fast Greyson and retest. Munchie is always fasted for 12 hours prior to having his triglycerides tested. As I said previously on Munch's first test I hadn't fasted him and triglycerides were over 2000. New test w/fasting was under 800 - not normal but a considerable difference.

Regarding the Grammy's Pot Pie canned food, the Guaranteed Analysis on pet food labels can be deceptive and the protein and fat can be higher than indicated on the label. I had Munchie's vet nutritionist check on a certain brand of canned dog food I "thought" was low fat from reading the label, which stated something like 5%. I was shocked to find out it actually was over 40%. Munchie's diet is home cooked fish and potato which was formulated especially for him by a UC Davis Veterinary Nutritionist. It's much lower than any commercial or Rx diet but the diet (nor anything else) has resolved his high triglycerides. :(

Louise

[AlisonandMia]

The night before he went in and had the cbc and other testing, he ate one of those smoked pig ears. Again, I wasn't even thinking about the fat aspect of it, just read that pig ears were a natural treat that was okay to give once in awhile. I'm wondering if that along with just having his meal an hour before made his triglycerides higher than they would have been.

If he had a meal just before the blood was drawn then I think you really need to repeat the test with him fasted. I think it is possible that he doesn't have hyperlipidemia or at least that it is nothing like as severe as you currently think it is. These tests really have to be done fasted to have any real validity otherwise you could just be measuring a temporary effect of the food.

Our vet insisted that Mia not have anything other than plain water from about 8 - 9 pm the night before. Obviously with a diabetic this is not possible and so vets will usually ask that you give a very low fat meal on the morning prior to testing.

Do make sure that the IMS is aware of Greyson's fat consumption the evening and morning before the test was run. You wouldn't want to start on treatment on the basis of a dubious test result.

Alison

I see Louise was posting at the same time as me - sorry for any duplication!

[StarDeb55]

Alison is absolutely correct. To get accurate cholesterol, & triglyceride (lipids) results, the blood samples must be drawn after a 12 hour fast.

Debbie

[lulusmom]

Hi Brittany,

To answer your question regarding low thyroid and lack of appetite, it usually works the other way around. The vast majority of dogs with hypothyroidism, as well as cushing's, have a voracious appetite. I believe others have already mentioned that 1) cushing's savvy vets will not treat cushing's in the absence of overt symptoms and 2) never, ever give Lysodren to a dog with a poor appetite. As I recall, your vet has prescribed a very small weekly dose of Lysodren which is not normal protocol. If, and I say if Greyson has cushing's, this dose would be totally ineffective so I am stymied as to your vet's rationale.

If Greyson were my dog, I would absolutely not give him Lysodren and I would have him seen by an internal medicine specialist (IMS) as soon as possible. I have two dogs with cushing's and other issues and it wasn't until they say an IMS that they were stabilized.

The one thing I forgot to mention earlier is that the normal pre or basal cortisol reference range is 2ug/dl to 6 ug/dl. Greyson's pre cortisol was over 9 ug/dl which can be indicative of stress or nonadrenal illness, both of which can yield a false positive result. That raises my eyebrows even further. :confused: In my opinion a borderline acth stim test results where the pre cortisol is high should be placed under even a greater amount of scrutiny and should be validated with additional testing. I hope this helps.

Glynda

P.S. I see from today's posts that Greyson was not fasted for his bloodwork. I agree with the others that the bloodwork should be redone.

[k9diabetes]

It seems like the clinic should have known this and arranged for Greyson to fast in advance - see if they will pick up the bill for the repeat chol/trig testing. I don't think you should have to pay for it twice.

[annee]

Welcome Greyson and Brittany,

I can't offer any real advice as my journey with Cushings was very short but I can say these people here have a wealth of experience and knowledge.

Do listen to what they say and don't be afraid to ask your vet questions and ask for a refferal for second opinions if need be.

From what I have read all the Cushings drugs are very potent and not to be given lightly.

I know I surfed the net looking for info on Cushings. It wss really hard to sort the wheat from the charf.

I am so glad I found here.

Good luck on your journey.

annee

[brittanyt]

I'm going to try to get him in for another test to check his triglycerides after fasting this time around. How would I go about getting a diet specially formulated for him? He is on organic brown rice and 1% fat turkey now but decided he no longer likes the turkey. I was going to go buy chicken breast and cook/grind it up. Do you think that would be low enough fat content?


Brittany,

Both the pig's ear the night before and especially the meal prior to the testing most definitely would cause elevated results in Greyson's triglycerides. I would fast Greyson and retest. Munchie is always fasted for 12 hours prior to having his triglycerides tested. As I said previously on Munch's first test I hadn't fasted him and triglycerides were over 2000. New test w/fasting was under 800 - not normal but a considerable difference.

Regarding the Grammy's Pot Pie canned food, the Guaranteed Analysis on pet food labels can be deceptive and the protein and fat can be higher than indicated on the label. I had Munchie's vet nutritionist check on a certain brand of canned dog food I "thought" was low fat from reading the label, which stated something like 5%. I was shocked to find out it actually was over 40%. Munchie's diet is home cooked fish and potato which was formulated especially for him by a UC Davis Veterinary Nutritionist. It's much lower than any commercial or Rx diet but the diet (nor anything else) has resolved his high triglycerides. :(

Louise

[brittanyt]

I have thought about that Natalie but the only thing is, when I took him in, it was basically just for a recheck and to tell her I was concerned about his appetite. She decided kind of last minute to go ahead and draw blood and check things out.


It seems like the clinic should have known this and arranged for Greyson to fast in advance - see if they will pick up the bill for the repeat chol/trig testing. I don't think you should have to pay for it twice.

[brittanyt]

I also posted on k9diabetes but thought i'd ask here as well. Greyson's appetite has gotten worse (didn't think that was really possible). He is turning his nose up at even plain stage one baby beef and baby chicken baby food. He isn't interested in anything i've given him. I've tried all kinds of things. He liked baby chicken and sweet potato but i'm thinking it is tearing his stomach up.

This morning he had some of that, and then about a cup of brown rice. He won't eat the ground turkey anymore. He is acting fine, playful, etc but he has had diarrhea for about a day and a half. Today, I took him out after an accident on the floor and noticed it had a little mucus in it and was a bit bloody. Is this sounding like colitis due to food changes and the food disagreeing with his stomach? I have flagyl here at home but didn't want to give it until I knew it was ok. I'm going to try and take him to the vet for a fasting triglycerides/cholest test tomorrow. I'm unable to get him there today.

I'm just worried about the blood as I've never seen him have a bloody stool before. He's drinking plenty of water so I'm not concerned about dehydration as of now. Thanks in advance for your input :)

[Roxee's Dad]

Hi Brittany,

Is Greyson still on the lyso? If yes, then I would stop the lyso treatment until he is feeling better and eating. Hope all goes well with the testing.

[brittanyt]

I never started the lyso and have no intention of starting until I know for sure he has cushings. That's why I'm so confused. Not sure what is causing his sudden loss of appetite. :(


Hi Brittany,

Is Greyson still on the lyso? If yes, then I would stop the lyso treatment until he is feeling better and eating. Hope all goes well with the testing.

[brittanyt]

He still has diarrhea and it isn't really bloody but a drop or so (tiny) of blood comes out when he goes. Does this sound like a serious issue or does bloody stools come with colitis?
thanks...

[littleone1]

Hi Britanny,

There is a Yahoo group, K9 kitchen. Monica Segal is the owner of this site. She does formulate diets. There is a fee for this. You might want to check it out.

I hope Greyson starts doing better.

[Squirt's Mom]

Hi Brittany,

I think it might be wise to get Greyson checked out at the vets since this has been going on for a few days now. If it is a parasite or infection, you don't want to let it really take hold. If it is something like colitis, then getting started on treating it early would be best, of course. Just MHO. :)

Hugs,
Leslie and the girls

[Harley PoMMom]

Hi Brittany,

I agree with Leslie, a trip to see the vet, and especially since Greyson is not interested in any food.

There is a product called Nutrical that you can buy since Greyson may not be getting enough to eat. Here is a link for it:


Nutrical
For dogs and cats who will not eat or need an added source of energy.

http://www.1800petmeds.com/Nutri+Cal-prod1340.html

I hope Greyson soon feels better and gets his appetite back soon.

Love and hugs.
Lori

[jrepac]

Hi Brittany,

I agree with Leslie, a trip to see the vet, and especially since Greyson is not interested in any food.

There is a product called Nutrical that you can buy since Greyson may not be getting enough to eat. Here is a link for it:



http://www.1800petmeds.com/Nutri+Cal-prod1340.html

I hope Greyson soon feels better and gets his appetite back soon.

Love and hugs.
Lori

Nutrical is quite good and easily found in pet stores....I've used it in special situations...not terribly expensive either

[brittanyt]

I will check out Nutrical. When Norton (my other brussels griffon) was born, he was the runt and the only survivor of the litter) and he kind of had to be nursed back to health so we fed him that on our fingers.

I was under the impression it is pretty sweet. Being that Greyson is diabetic, I am not sure if the sugar content is too high. I'll look into it though. He's gotta eat!

[frijole]

Just chiming in with the others to say I would take Greyson to the vets to be checked out. That way you catch whatever it is as early as possible. Poor little thing. Sending hugs from our home to yours.

Kim

[MiniSchnauzerMom]

Hi Brittany,

Sorry to read that Greyson is feeling poorly. I definitely agree with everyone else that Greyson needs a visit to the vet. Maybe while you're there a referral to an IMS could be arranged?? They have the extra schooling and would be better equipped to help sort things out for little Greyson.

Yes, mucus, blood and diarrhea can be part of colitis but there are many reason why the colitis could exist in the first place and that would need to be determined by a professional. High triglycerides can also cause pancreatitis (signs can include abdominal pain, vomiting, diarrhea, and anorexia) so I'm glad you will be doing another test for that. Has the test for pancreatitis ever been done? Probably wouldn't hurt.

I realize Greyson isn't eating right now but want to caution you on the baby food chicken and dinners. Please check the ingredients on the label for onions as these are toxic to dogs and can cause gastrointestinal irritation and anemia. Also check any commercially prepared broths for onions if you are giving any to Greyson.

I'm glad you are going to look into the Nutrical prior giving it to Greyson. Call me a big worry-wart but the #1 ingredient in the product is corn syrup with malt syrup as #3 and cane molasses #5, so it has its sugars! With Greyson's diabetes I don't know if the product would cause him additional problems with his blood sugars or not.

Nutrical Ingredients:

Corn syrup, soybean oil, malt syrup, cod liver oil, cane molasses, methylcellulose, water, gelatin by-products, dl-alpha tocopheryl acetate (vit. E), sodium benzoate (preservative), manganese sulfate, ferric ammonium citrate, thiamine HCl, niacin, calcium pantothenate (source of calcium and pantothenic acid), magnesium sulfate, pyridoxine HCl, potassium iodine (source of iodine and potassium), riboflavin 5'-phosphate sodium (source of vit. B2 and phosphorus), vitamin A palmitate & D supplement, folic acid and cyanocobalamin (vit. B12).

Here are links to the American Academy of Veterinary Nutrition and also the American College of Veterinary Nutrition with some resources for diets prepared by veterinary nutritionists. Munchie's doctor originally ordered his diet through UC Davis.

http://www.aavn.org/site/view/58440_NutritionResources.pml

http://www.acvn.org/site/view/103264_NutritionResources.pml

Hope I haven't put you on information overload and do hope little Greyson is feeling better soon. He's such an adorable little guy! :D

Louise

[k9diabetes]

I was worried about Brittany and Greyson so I hounded her with emails! ;0

Got a note from Brittany via text message... she has not been able to get to a computer so asked me to pass along the Greyson is feeling somewhat better. She put him on a bland diet and he's eating somewhat better.

She will be back to check in herself as soon as she can.

No vet appointments recently.

Natalie

[acushdogsmom]

Thanks, Natalie! :) I was getting worried after not hearing from Brittany for almost a week.

I'm glad to hear that Greyson is feeling somewhat better and I hope Brittany can get back online soon to update us further.

[brittanyt]

Hey all! I'm so relived to finally be back. It's been one thing after another. My internet was out almost a week. Then, my laptop charger broke and my laptop was dead so I had to wait to get another one sent to me (thank goodness I had a warranty).

Also, Clancy my 80 plus pound mixed dog got hit by a car at 11:30 pm a little over a week ago. We live on a state highway so the speed limit (if people even follow) is 45 mph. So she got hit pretty hard and it was loud. We found an emergency vet about 20 or so miles away so we got her there immediately after we noticed blood coming from her nose. She seemed fine other than that--even walked back to the front door after she got hit. I didn't want to take chances though. She had a lot of cuts and a pretty large hematoma (sp?) but no internal bleeding. She was on 3 or 4 different prescriptions and is getting better slowly but surely.

As far as Greyson goes, there is not much of a change. He's still doing fairly well with the boiled chicken and brown rice. Not a huge fan of the rice but I don't know what else I could give him with more flavor. I considered oatmeal but I'm not sure if that has any more flavor.

I haven't been able to get him to the vet due to monitary reasons but I'm going to try to get him in by the end of this week. I also was told about another local vet here I might check out. He does a bi-weekly segment on a morning news show here and a friend said when 4 or 5 different vets told her there was nothing they could do for her cat but put her down, this vet was able to help her and she lived for 2 more years.

Natalie had mentioned someone on here had dealt with Dr. N in the past. I'd love to talk to you or maybe it is posted somewhere and I missed it. Something about his refusal to see a patient if they are a part of a cushings forum??

Thank you all again for your thoughts and concern for Greyson. The only change I've seen is his eyesight seems to be worsening b/c now he is barking a lot at shadows.

Talk to you all soon.

Thank you so much Natalie for relaying my message before. :)

[acushdogsmom]

Glad to see you back here, Brittany. :)

The two or three members whose dogs were under the care of Dr. N aren't here anymore. We haven't seen one of them here since 2004 and the other hasn't been here since 2006 I think. But maybe I can sort of help to maybe clear up what you may have heard about what happened with them and Dr. N back then.

To the best of my recollection, he insisted that the goal of treatment that they should be aiming for with a Cushing's dog (on Lysodren) was "normal post-ACTH values" (somewhere between 6 to 18 ug/dl) rather than the 1-5 ug/dl (less than 6 ug/dl) values that we usually aim for ... even though the Lab report for their dogs' ACTH stim tests actually very clearly said on it that a Cushing's dog in treatment was not supposed to have post-ACTH values higher than 6 ug/dl. We also provided our members with links to the veterinary literature and texts that said the same thing - that less than 6 ug/dl was the goal.

One of the former members here (the one who was here in 2004 I think) had a dog being treated with Lysodren by him and when the dog's post ACTH stim test result was around 12 ug/dl, Dr. N thought that result was just fine. She told him what we'd told her (that the result should be lower for good control) and she then told us that he was clearly not happy (maybe even insulted, if I'm remembering correctly) when she questioned him about his Cushing's treatment goals and protocols and showed him copies of the veterinary literature written by the true experts in the field that we had found for her and which was clearly saying something very different than what he was saying the test results and goal of treatment should be.

She said that he told her to "stop listening to people on the Internet" and then she suddenly stopped posting on the board, so some of us here thought that he may have made her feel as if she shouldn't be posting here if she wanted her dog to stay in his care. But I don't know that for sure. I only know that he apparently wasn't very happy about his clients coming here and finding out that the way in which he was doing their dogs' Cushing's treatment may not have been correct.

Something similar happened with him and another of our members a couple of years later and that's all I remember from what was said back then ...

I think that Dr. N. is more focused on doing surgery than he is with Internal Medicine, so maybe that's why he didn't seem to know what the treatment goals for Cushing's dogs were supposed to be - back then, anyway.