Hi guys, new member (Jessie, female Westie, 8 yrs old, Diabetes & Cushings)

[ajtony]

Hi Guys, Just wanted to introduce myself and my Westie, Jessie (female, 8 yrs old), who has recently been diagnosed with diabetes, Cushings, and is now blind due to cataracts. And that's all happened in the last 3 weeks. It's all been a bit of a blurr but we are slowly getting into a routine (well almost). I wanted to ask those experienced in the group whether they think Jessie does have Cushings as I believe it is commonly misdiagnosed when the dog is diabetic.

Jessie went in for blood tests about 2 weeks ago. I have the printouts of the results but they don't mean much to me to be honest, apart from her b/g level being 29 (UK, 522 US I believe).

About 4 months ago Jessie fell ill. She had a swollen abdomen, was drinking and peeing lots, and was hungry all the time. She was on steroids for skin problems and had been for almost a year. I thought it could have been steroid induced Cushings as when we stopped the steroids within a week or two there was a vast improvement.

But then 2/3 months later she started drinking and peeing again and the vet diagnosed cushings and diabetes after just one blood test. She is taking 30mg vetoryl and is on 2 x 5 units of caninsulin daily. We are now on our 3rd vet since her diagnosis (long story). She is due to go in for a 'curve' on Tuesday but what should I ask the vet to test for the Cushings? The last two lines of the blood test results say:

Cortisol Base 157.3nmol/L (5.68ug/dl)
Post 678.7nmol/l (24.5ug/dl)

Does this mean anything to anyone? Or would it be useful for me to post the blood test results here? Jessy isn't showing any signs of Cushing disease at present. She isn't drinking as much, nor peeing, no swelling, just sore skin (she has had skin problems for years). Any advice would be most appreciated. Thanks. Tony & Jessie (Scotland, UK)

[BestBuddy]

Hi Tony and Jessie.

I've seen your posts on k9diabetes and am glad to see you are here. Buddy had been diabetic for many years before we got our cushings dx but you really have been thrown in at the deep end. I am heading off to work but I just wanted to say welcome.

Jenny

[lulusmom]

Hi Tony and welcome to you and Jessie.

I too saw your post on k9diabetes and am glad that you decided to post here.

Firstly, diabetes and Cushing’s share many of the same symptoms such as increased drinking, urination, eating, lethargy and both conditions can yield a lot of the same abnormalities in bloodwork and both can enlarge the liver. Uncontrolled diabetes can most certainly increase cortisol levels which yield false positives on a number of diagnostic tests, including the acth stimulation test.

Confirming a cushing's diagnosis in a non-diabetic dog is difficult enough but it becomes very difficult in a dog with diabetes. For this reason, I am extremely concerned that your vet confirmed a cushing's diagnosis based on one blood test. Those concerns are heightened by the fact that Jessie's only symptom was excessive drinking and peeing. Westies are probably the number one breed for their predisposition to allergies/skin issues so the fact that her skin is still presenting a problem does not raise a red flag for me that is screaming cushing's.

If the acth stim test was the only diagnostic bloodwork done by your vet then it stands to reason that s/he did not determine if it was pituitary or adrenal based cushing's. In order to determine this, an experienced vet will normally do an abdominal ultrasound to validate a positive acth stim test and/or ldds test but it also gives them a good look at the adrenals as well as the surrounding organs. A good majority of dogs with cushing's will have some type of adrenal abnormality and the liver is also enlarged. Again the liver can also be enlarged with diabetes. Based on the preliminary facts you have provided, I would definitely want a more definitive cushing's diagnosis and that would absolutely include an abdominal ultrasound.

It would be most helpful if you could please post the abnormal blood values for us. Also, please post the results of any urinalysis that may have been done.

Tony, cushing's is a very frustrating disease; couple that with diabetes and it spells bad mental health for the pet owner until you get things stabilized. You are in the beginning stages which is always traumatic...usually more so for us pet owners than our pups. I'm sure that I speak for all of us when I say that we're sorry for the circumstances that brought you here but we're very happy that you are now part of our community. We're all here to help you in any way we can, right along with the great members at k9diabetes. You've got the best of both worlds now.

We'll be looking forward to getting more of Jessie's history so we can provide you with more meaningful feedback.

Glynda

P.S. For members who would like to refer to Tony's thread on k9diabetes, here is the link:
http://www.k9diabetes.com/forum/showthread.php?t=1526

[littleone1]

Hi Tony,

Welcome also to you and Jessie from Corky and me.

You have found a wonderful group of very caring, supportive, and knowledgeable people.

I see that you have already got some good advice. I really don't know very much about diabetes, so I can't really offfer any help about it.

I hope you will be able to get answers to your questions.

Terri

[ladysmom06]

Hi Tony,

Glad to see you joined the board. I left you a post on the diabetes board. You'll get tons of support and info here. Good luck with Jessie and I'll keep checking for updates.

[frijole]

Welcome from me as well! Wow you have had your hands full. So sorry to hear but you have found a wonderful place for help! And its' free! ;)

I agree with Glynda that the cushings diagnosis is suspect. I would focus on getting the diabetes under control and then take a look at the cushings to see if it is in fact cushings. I say this due to the similarities in symptoms between cushings and diabetes as well as the steroids you mentioned.

The more you share with us the better we are able to serve. Hang in there!!! Kim

[ajtony]

Hi Glynda and all, Thanks for the warm welcome and advice. I hope this is Ok but I have printed the results from the vets below to see if anyone can make sense of them. These are the only tests Jessie has had. She into the new vets tomorrow for a 'curve'.
HERMATOLOGY
WBC + 22.47 m/mm3
LYM + 38.3 %
MON 3.3%
Gra 58.4%
Lym + 8.60 m/mm3
Mon 0.74 m/mm3
Gra 13.13 m/mm3

RBC 6.39 m/mm3
MCV 68.0 fl
Hct 43.4%
MCH 20.3 pg
MCHC 29.9 g/dl
RDW 9.9

Hb 13.0 g/dl

THR 187 m?mm3
MPV 8.7 fl
Pct 0.16 %
PDW + 12.4
---------------------------------------------------------------
ALB 25 g/l
ALKP 313 U/L
ALT 22 U/L
AMYL 414 U/L
UREA 3.9 mmol/L
Ca 2.53 mmol/L
CHOL 3.95 mmol/L
CREA 52 umol/L
GLOB 40 g/L
GLU 29.56 mmol/L
PHOS 1.47 mmol/L
TBIL 5 umol/L
TP 65 g/L
Na 152 mmol/L
KCG 4.5 mmol/L
Cl 111 mmol/L

CORT 157.3 nmol/L
Baseline Cortisol - see SNAP kit insert for interpretation
----------------------------------------------------------
Cortisol Base 157.3nmol/L (5.68ug/dl)
Post 678.7nmol/l (24.5ug/dl)


Would really appreciate any comments as the old vet just told us she had Cushings and Diabetes with no further information at all. Thanks, Tony

[labblab]

Hi Tony, and welcome from me, as well!

Thank you so much for posting Jessie's labwork. But now I'm going to pester you a little bit more :o, and ask you to please let us know which of these values, if any, are marked as being either "high" or "low" on the labsheet (along with the reference range that is given for "normal" results on those specific values). Every lab can have different reference ranges for indicating normal or abnormal values. So we cannot really tell for sure which of Jessie's values may be out of whack. I hate to make you go all the way through again to post reference ranges for all the lab values. But if any are indicated as abnormal, that will be great if you will point those out to us. Also, can you tell us how much Jessie weighs?

You've asked what Cushing's testing should be done in addition to Jessie's glucose "curve." The Cushing's treatment monitoring test that should be performed is another ACTH. That is the same test that your original vet performed in making the Cushing's diagnosis. The expectation will be that the Vetoryl will be reducing Jessie's circulating cortisol level, and that the post-ACTH result this time will be much lower than 24 ug/dl. However, you do not want her cortisol level to be dropping TOO low, so that is actually the most important reason to peform the testing -- especially in a situation such as this one where the Cushing's diagnosis may be suspect.

I can only "second" what the others have said. While Jessie's original ACTH results are indeed consistent with Cushing's, it is entirely possible that the elevation in her test was the result of uncontrolled diabetes INSTEAD of Cushing's. One "plus" is that of the two blood tests that are used to diagnose Cushing's -- the ACTH and the LDDS -- the ACTH is the better choice in Jessie's situation, because it is the least likely of the two to indicate a "false positive" for a dog who doesn't really suffer from the disease. But it can do so, and results are always suspect when a dog is also suffering from a nonadrenal illness such as diabetes.

I do believe that a monitoring ACTH test at this point in time is essential. The Vetoryl manufacturers recommend that it be performed within 10-14 days after beginning the medication. So Jessie is already overdue if she is at the three-week mark. On the positive side of things, it sounds as if she is physically doing well (or at least better)? As the others have suggested, however, I think it will be worthwhile to discuss with your vet the possibility of ceasing the Vetoryl for the time being, in order to see whether Jessie's glucose and cortisol levels stabilize with the insulin treatment alone. If not, then you can always add the Vetoryl back into the mix once again (and at that time, perhaps after the benefit of an abdominal ultrasound)...

I'm so glad you have joined us here! And thanks so much in advance for this additional information.

Marianne

[ajtony]

Hi Marianne, here are the figures again with the reference range used by the vet
HERMATOLOGY NORMALITY
WBC + 22.47 m/mm3 6.0 - 17.0
LYM + 38.3 % 10.0 - 30.0
MON 3.3% 2.0 - 10.0
Gra 58.4% 50.0 - 80.0
Lym + 8.60 m/mm3 0.6 - 5.1
Mon 0.74 m/mm3 0.1 - 1.7
Gra 13.13 m/mm3 3.0 - 13.6

RBC 6.39 m/mm3 5.5 - 8.5
MCV 68.0 fl 58.0 - 73.0
Hct 43.4% 35.0 - 55.0
MCH 20.3 pg 19.5 - 24.5
MCHC 29.9 g/dl 28.0 - 40.0
RDW 9.9 8.0 - 12.0

Hb 13.0 g/dl 10.0 - 18.0

THR 187 m/mm3 120 - 600
MPV 8.7 fl 5.0 - 12.0
Pct 0.16 %
PDW + 12.4 6.0 - 10.0
---------------------------------------------------------------
REFERENCE RANGE
ALB 25 g/l 23 - 40 N
ALKP 313 U/L 23 - 212 HIGH
ALT 22 U/L 10 - 100 N
AMYL 414 U/L 500 - 1500 LOW
UREA 3.9 mmol/L 2.5 - 9.6 N
Ca 2.53 mmol/L 1.98 - 3.00 N
CHOL 3.95 mmol/L 2.84 - 8.27 N
CREA 52 umol/L 44 - 159 N
GLOB 40 g/L 25 - 45 N
GLU 29.56 mmol/L 4.11 - 7.94 HIGH
PHOS 1.47 mmol/L 0.81 - 2.19 N
TBIL 5 umol/L 0 - 15 N
TP 65 g/L 52 - 82 N
Na 152 mmol/L 144 - 160 N
KCG 4.5 mmol/L 3.5 - 5.8 N
Cl 111 mmol/L 109 - 122 N

CORT 157.3 nmol/L
Baseline Cortisol - see SNAP kit insert for interpretation
----------------------------------------------------------
Cortisol Base 157.3nmol/L (5.68ug/dl)
Post 678.7nmol/l (24.5ug/dl)

Hope this helps. Jessie weighs 8.25 kg at last measure. Tony

[Franklin'sMum]

Hi Tony and Jessie,

I just have a minute to post, but also wanted to welcome you both.

Jane and Franklin xx
________
Upskirt sex (http://www.fucktube.com/categories/42/upskirt/videos/1)

[Casey's Mom]

Welcome Tony and Jessie,

Warm welcome to both of you, you are in good hands with a lot of caring knowledgeable people here for you,

[lulusmom]

Hi Tony,

Thank you for posting Jessie's bloodwork. Quite frankly, the abnormalities I see are very mild, and in my opinion, not really consistent with cushing's, at least not enough to make me change my mind about a correct diagnosis. There are a number of abnormalities in bloodwork that can be found in cushing's; however, the most common abnormalities are increased cholesterol, ALKP and ALT, the latter two being liver enzymes. Jessie’s cholesterol is low normal and so is her ALT. The ALKP is very mildly elevated and in cushing's you normally see this value a lot higher, like anywhere from 1 to 10 fold increase. Diabetes most definitely could explain the mild increase in ALKP.

Jessie has an elevation in Lymphocytes and while I'm not a medical professional or lab tech, I’m betting that this elevation is probably due to her skin problems. Westies are known to have autoimmune skin issues and this can most definitelty impact the Lymphocytes. Interestingly, lymphocytes normally decrease in numbers with cushing's.

I knew that diabetes mellitus is listed as a common health problem for Westies but a bit of research showed that Westie’s are genetically predisposed to Hypoadrenocorticism (Addison’s) which is the opposite of Hyperadrenocorticism (Cushing’s), meaning the adrenal glands do not produce enough cortisol. Cushing's is not a common disorder found in Westies.

In my opinion the probability of a misdiagnosis is high and I would be very concerned about continuing the Vetoryl treatment without a definitive cushing’s diagnosis.

Glynda

P.S. One of our members, Debbie, has been a lab technician for almost 30 years and I do hope that she will provide us with her take on Jessie’s labwork.

[ajtony]

Just got Jessie back from the vets. To say I am disgusted would be an understatement. It was a different vet. All he could say was if it was his dog he would let her go because of her skin problems. He didn't even bother mentioning any possible Cushing Disease but I am happy with that for now as the diabetes can come first. So we have stopped the vetoryl and I will try and sort a Vet Hospital appointment asap. The vet couldn't even look me in the eye. I thought he was the shop assistant. He's there if I need a prescription but I would sooner trust this forum than him. He said I may want to increase the caninsulin to 7 or 8 twice a day and when I asked for a printout of the 'curve' he said I would have to come in for it tomorrow. Anyway, I'm off to work (on nights). Just got to try Jessie's shot before I go, Cheers, Tony

[lulusmom]

Hi Tony,

I'm so sorry to hear about your terrible appointment with the vet. Believe me, you are not the only member that has been appalled by their gp vet. I'm one of them. With Jessie's multiple issues, I think she really does need to be seen by an veterinary internal medicine specialist (VIMS) so I hope the vet hospital you mentioned in your post has an VIMS on staff. I googled veterinary medicine specialists in Scotland and only got one hit for Broadleys Veterinary Hospital, Craig Leith Road, Broadleys, Stirling, FK7 7LE. Here's a link to their website:

http://www.medicinereferrals.co.uk/

Please keep us posted.

Glynda

[acushdogsmom]

With Jessie's multiple issues, I think she really does need to be seen by an veterinary internal medicine specialist (VIMS) so I hope the vet hospital you mentioned in your post has an VIMS on staff. I googled veterinary medicine specialists in Scotland and only got one hit for Broadleys Veterinary Hospital, Craig Leith Road, Broadleys, Stirling, FK7 7LE. Here's a link to their website:

http://www.medicinereferrals.co.uk/

I just had a look at the ECVIM website (where you can find a list of Boarded Internal Medicine Specialist Vets in the UK and Europe)

http://www.ecvim-ca.org/dips%20split.htm

and I do see that the IM Specialist Vet who works at the clinic on the website that Glynda just gave you is listed as a Boarded Diplomate at the ECVIM (that's a good thing :)).


Dr Yvonne McGrotty
Internal Medicine & Critical Care Referrals
C/o Broadleys Veterinary Hospital
Craig Leith Road
Broadleys
FK7 7LE Stirling
United Kingdom

Status: Active Diplomate
Employed: Private Practice

Tel: +44 1786 445665
Fax: +44 1786 446122
Email: medicinereferrals@hotmail.com

As an Internal Medicine Specialist, it's more than likely that Dr. Yvonne McGrotty would know how to properly evaluate and treat your Jessie, because most IM Specialists have an in-depth knowledge and focus on Endocrine disorders such as Diabetes and Cushing's that many General Practice Vets just don't have. The Specialists are the ones who see and treat the really tough cases, the ones that are referred to them by GP Vets who know their own limitations and know that the dog's (or cat's) best interest would be better served by a Specialist. Dr. McGrotty really should know how to differentiate between the two conditions and how to properly treat one or both conditions.

Here is the page on that same site that Glynda just gave you, where they speak about appointments and referrals:

http://www.medicinereferrals.co.uk/Appointments.html

I don't know where exactly you live (how far away you may or may not be from Broadleys Veterinary Hospital where Dr. McGrotty works) but if you are not close enough to actually be able to bring Jessie there, I also do see on the website the following information, for cases where referrals are not possible (maybe because the client lives too far away from the clinic to actually be able to bring their dog in there to Dr. McGrotty for an evaluation):

http://www.medicinereferrals.co.uk/Case%20Interpretation%20Service.html


Case Interpretation Service:

If referral is not possible then I also provide a case interpretation service. Vets can send a detailed overview of the case including blood results and radiographs and I will review the material and offer an opinion on further diagnostics and possible differentials. Prices vary depending on amount of material submitted.

Material can be submitted by post, fax or e-mail
medicinereferrals@hotmail.com

An abdominal radiograph interpretation service is also available.

Even if you are going to get a Specialist involved in the case, you will likely still need to have a nearby General Practice Vet who is willing to cooperate and refer you to a Specialist to start with and then also work with Dr. McGrotty or another Specialist long-term on Jessie's case.

I'm not quite clear on whether or not you have a GP Vet who is willing to refer you to a Specialist, but if you haven't currently got one who will do, maybe you can do things a little in reverse and contact Dr. McGrotty (or another vet hospital where there is a Specialist you might want to have Jessie seen by) yourself (by e-mail and also by phone?) to explain the situation. And if you're lucky, maybe the Specialist might be able to give you the name of a nearby General Practice Vet with whom he/she has worked well before in the past or one with whom he/she is currently still working on a case. Then, if you still really need a referral in order to have the Specialist work on Jessie's case, you can get that local General Practice Vet (whom you know works well with Specialists because the Specialist would have referred you there in the first place) to refer you back to the Specialist for consulting on the case as well.

Let the Specialist know that you want him/her to consult on Jessie's case and also say if you can't seem to find a local Vet who is willing to work with you and with an Internal Medicine Specialist to get Jessie's condition properly evaluated and treated. You could also say that your current local Vet seems to want to just give up, even though you are willing to do whatever it takes for Jessie. Let the Specialist know that you are trying to become as educated as possible about Jessie's condition(s) so that you can be a good advocate for her and take the best care of her and be the Vet's eyes and ears at home. Let him/her know that you know that Diabetic (and Cushing's) dogs can live long and happy lives with proper treatment, and that you are certainly not ready to give up.

Although my dog only had Cushing's (ie he did not have Diabetes) I had a similar situation to yours in that my GP Vet wanted to euthanise him without even really trying. He was 10 yrs old when first diagnosed and she said he wasn't going to live much longer and that the treatment was worse than the disease. I didn't believe her. So I found an Internal Medicine Specialist who was much more optimistic. We treated my dog successfully for 6+ years (he recovered so well that you would never have been able to even guess there was a thing wrong with him) and he died at the age of 16 of something completely unrelated to the Cushing's. So I can tell you that it's worth doing whatever you can to try to get a Specialist on the case. They are much more knowledgeable than most GP Vets and are much more likely to want to treat and also to get a good outcome.

P.S. I saw at the k9diabetes board that you mentioned a possible referral to the "Vet University Hospital in Glasgow". I don't know how far away you are from the Vet University Hospital in Glasgow, but I think that would be a great place to have Jessie evaluated, too. They have quite a few really really good Specialists there and believe me, they wouldn't give up on Jessie unless it was really really time to be thinking about that.

[ajtony]

Thanks again Glynda & co, Although I am unhappy with the vet basically giving up on Jessie at the first hurdle, he is still her vet and I can't think of any reason why he wouldn't give us a referral to either Glasgow or Stirling. They are both a good distance to travel, Glasgow, 4 hours, Stirling maybe 3 hours by car. Jessie has bad skin problems at the moment and this is our main concern as we don't want her to suffer. With that in mind do you think it would be better to go to Glasgow as I believe they have more specialists and would probably have a skin specialist as well as someone to look at all the other problems. Tony

[Sabre's Mum]

Hi Tony and welcome

Just one quick question .... could you elaborate on the skin problems that Jessie has? A few of us have had skin issues with our cushings pups and we may be able to assist you in this area.

Angela, Sabre and Flynn

[acushdogsmom]

Thanks again Glynda & co, Although I am unhappy with the vet basically giving up on Jessie at the first hurdle, he is still her vet and I can't think of any reason why he wouldn't give us a referral to either Glasgow or Stirling. They are both a good distance to travel, Glasgow, 4 hours, Stirling maybe 3 hours by car. Jessie has bad skin problems at the moment and this is our main concern as we don't want her to suffer. With that in mind do you think it would be better to go to Glasgow as I believe they have more specialists and would probably have a skin specialist as well as someone to look at all the other problems. TonyI think that the Vet Hospital in Glasgow to which you are referring is this one?

http://www.gla.ac.uk/faculties/vet/smallanimalhospital

Since you are willing to make the trip there and with the skin problems and Diabetes and possibly also Cushing's (or not) etc in mind, I do think it would be an excellent choice and probably your best option.

http://www.gla.ac.uk/faculties/vet/smallanimalhospital/ourservices

http://www.gla.ac.uk/faculties/vet/smallanimalhospital/ourstaff

I've heard some very good things about Ian Ramsey, the Director of the Small Animal Hospital there. He is an Internal Medicine Specialist who is very well known internationally and very highly respected. Although Cushing's is certainly not the only condition with which he is very familiar, I think that he was and may still be involved in some of the research studies that have been done with Vetoryl. And I'm sure that all of the other Specialists who work there are also very good.

http://www.gla.ac.uk/faculties/vet/smallanimalhospital/ourstaff/internalmedicineteam/ianramsey

I don't see Dermatology listed as one of the Specialty Services at the Small Animal Vet Hospital in Glasgow, but even though I can't find any mention of that specialty on the website, they likely do have several Vets there who are expert at dealing with dermatology issues. And I'm sure that even if there is no Veterinary Dermatologist on staff, the Specialists in Glasgow would definitely know where to reach the right Vet with whom they could consult if they needed to. It's a Veterinary Teaching Hospital, after all.

Once the Specialists in Glasgow have actually seen and examined Jessie and have developed a treatment plan for her, I think that both you and any local Vet who is now Jessie's Vet (or who will be in future) could stay in touch with the Glasgow Specialists via e-mail, fax and phone for any necessary consultations over the long term.

[Squirt's Mom]

Hi Tony,

A belated welcome to you and Jessie. :)

I am relieved to know you have stopped the Trilo for now as the basis for this diagnosis is quite suspect IMHO. You are doing all the right things and I am sure they will pay off. One thing this vet of yours forgot to factor in...the power of the deep abiding love we have for our fur babies. That TLC will go a long way! So you just tell them phooey, that Jessie still has a long way to go and ya'll now have a whole bunch of folks behind you! :p

I hope you find an IMS you like and can get a game plan in place real soon for Jessie's skin problems...then we can look at Cushing's IF need be. Meanwhile, you keep in touch and let us know where you end up going and what they have to say, 'k?

Hugs,
Leslie and the girls - always

[ajtony]

Hi Angela and all, I've posted some photos of Jessie's skin problem as it is now. her vulva area is very sore, black and swollen and bleeds occasionally. She has bad ear infections, worse in one ear. We have just started her on another dose of abx. We used something called atopica (In UK) a few months ago and her skin problems cleared up great but then we found out that you cant treat a diabetic dog with it, don't know wht. cheers, Tony

[ajtony]

Hi Guys, The emotions have really been up and down this last couple of weeks. After the disasterous visit to the vet on Tuesday (it was a new vet) we took stock today, and went to see the original vet who we saw when we first went to them and he was great. We told him that we just want to work with him and he was Ok with that. He said he would gladly refer us to an IMS (at Glasgow) but suggested we wait until the new year as he wants to try and get Jessie's b/g regulated first. He explained the b/g curve, gave some abx for Jessie's skin problems and told us to come back in for another curve after 10 days. He also said that we would leave the Cushings possibility until the diabetes was regulated and we were happy with that (no more trilo/ventoryl). So we all feel better today. Thank you all so much for the advice and support. Upwards and onwards, Tony

[BestBuddy]

Hi Tony,

Just looked at Jessie's pics and ouch! I wonder if high glucose is causing her girly bits to inflame. I noticed with Buddy when his glucose was high it spilled into his urine and it was a lot thicker and more syrupy than normal. Maybe it irritated the skin more. Could you maybe use a damp cloth and pat (don't rub) those bits after Jesse pees to keep the moisture off her skin?

Jenny

[acushdogsmom]

Hey Tony,

Thanks for the update. Thank goodness that the good "Dr. Jekyll" Vet has agreed to be the only one there to see Jessie from now on (you certainly don't need that bad "Mr. Hyde" Vet ruining any more of your days!) and I think that your plan sounds good - ie to work on the Diabetes and skin issues for now and get a consult done in Glasgow in the new year, if necessary.

I'm not a Vet, but as far as I know, it's fairly common to get a borderline or even a positive result on an ACTH stim test in a dog who is otherwise ill or stressed. Non-adrenal illness such as all the types of things going on with your Jessie (the ear and other infections/skin problems, unregulated Diabetes, etc) can cause a higher than normal cortisol production which then can give you a false positive on an ACTH stimulation test.

By the way, if you find that you are able to regulate Jessie's bg without any Cushing's treatment, I think that would be another strong sign that she doesn't have Cushing's. Uncontrolled Cushing's tends to make it near impossible to get control of the blood glucose in a dog who does have both conditions.

I'll be following along with your story on the k9diabetes board, and I hope you'll also come back here to update us when you can.

[ajtony]

Hi acushdogsmum and Jenny, Thanks again for all the advice and support. I will keep you informed here on how Jessie is doing. best wishes, Tony

[ajtony]

Hi Guys, Haven't posted for a month as we have been concentrating on Jessie's diabetes. The good news is that Jessie's blood glucose does now seem to be regulated. She is on 8 units of Caninsulin, twice a day, and her curve last week was really good. Apart from the morning post meal high of 277, the readings were 160, 101 and 155 and the guys on the diabetes discussion site were very pleased. And so were we!

So we are now returning to look at the possibility of Cushings, which was diagnosed by a previous vet in December after just 1 ACTH test which was a bit suspect according to the experts on this site. A quick update on Jessie. She is eating well, drinking and peeing normally, has her usual walk every day, and as far as we can see has no symptoms of Cushings, APART from her skin problems, which are getting worse. She has had skin issue all of her life so we don't know if this is Cushings or not. She has scabs on her skin which is turning black in areas and she is very itchy. Funnily enough, her coat is Ok and no fur is falling out apart from where she is nibbling herself. She also has a sort of spotty rash. She hasnt got a pot belly either and after losing weight initially she actually has put 0.2 kilos on in the last 2 weeks. Also, as her b/g has come down in about 8 weeks does this indicate it may not be Cushings as I believe a diabetic/cushing dog's b/g is difficult to regulate.

I would appreciate any advice on whether to now get the tests done again for Cushings or whether to spend the money on a dermatology expert.

Jessie, canine, 8 year old Westie bitch. Diagnosed diabetes/cushing Dec 2009. 2 x 8 units Caninsulin, 8.1 kg, Blind due to cataracts, fed on Bakers Complete dry food, diabetes appears regulated now, Scotland, U.K.

[AlisonandMia]

Hi Tony,

I have only just got a moment but if you are finding that Jessie's BG is now well regulated then Cushing's is most, most unlikely. Although Cushing's is hard to conclusively diagnose in a diabetic because of false positives on the Cushing's tests because of the stress of diabetes there is one "advantage" and that is how the diabetes behaves (or not) can be a really strong indicator as to whether Cushing's could be in the picture. Typically a diabetic untreated Cushing's dog will not be regulatable because of the high cortisol levels causing such severe insulin resistance.

From what Natalie says, one common pattern is that they will seem to hold stable for a week maybe on a certain insulin dose and then control is lost again and a larger dose of insulin is needed, the BG comes down again for a brief period and then the pattern repeats. I gather that some just have persistently high BG almost no matter what, even on maximal doses of insulin. Of course other illness's (like, say a UTI) can create a very similar picture and insulin requirements can change over time for all sorts of reasons - but the picture with Cushing's seems to be pretty dramatic and severe and persistent.

I would think that if Jessie has regulated that you probably don't need to worry about Cushing's at this stage.

Alison

[labblab]

Hi Tony,

If it were me, I believe I'd make the dermatology consult the top priority right now. In re-reading your thread, I see that Jessie has had long-term skin issues for which you had been administering steroids up until a few months ago. Since I am assuming that the steroid therapy has not been resumed, it would make sense to me that any underlying dermatological condition may be strongly reasserting itself once again. So I'd want some feedback from a specialist in that area, both in terms of diagnosis and possible non-steroidal treatment options.

I'm really glad to hear that Jessie's glucose levels are stabilizing, and that she is feeling perky!

Marianne

[ajtony]

Thanks Alison/Marianne for your encouraging words. A dermatology consultant will be our priority now then to see if we can relieve some of Jessie's discomfort, and then if all goes well, cataract surgery. Thanks again, Tony