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Noodle
08-14-2010, 07:59 PM
Hello :)

I'm a member of the k9diabetes board and have read here from time to time as well. My lab mix, Noodle, has had some recent issues that prompted blood tests and the results led me here, at Natalie's suggestion. I've been reading the stickies and some of the threads like a crazed person for the last week or so, lol.

Some general information about Noodle:

~ Male, neutered, Lab mix
~ Weight around 50lbs, give or take a pound.
~ 8 1/2 years old
~ Diagnosed with diabetes Jan 2009
~ Very well regulated on Humulin N, 33 units - 2x day
~ Blue Buffalo Healthy Weight dry & BB Wilderness Turkey canned.
~ L-Thyroxine, .5mg - 2x day

Noodle had been doing very well, but his water consumption had started to increase again earlier this year. Initially, with the heater still running constantly, we thought it was just very dry and he would step back to normal when the heater was shut off. But Spring came and went and the increased drinking continued. This was brought up with our vet in March during a visit for a thyroid re-check and it was dismissed. I didn't push further since I had already decided it was time for a new vet and was in the process of looking.

In early May, Noodle developed some spots of infection on the back of his legs and groin area and his hair fell out in those spots. We took him to the new vet who took skin scrapings and other samples, and it was diagnosed as staph. He was started on Simplicef and medicated baths. Initially it was for one week, with a re-check, which led to continuing for a second week. All of the samples were negative for fungal infections or any other problems and the infection resolved.

In July, the infection popped up again in the same areas. Naturally, this was on a weekend when my new vet had just left town for a week's vacation. But one of the reasons we LOVE the new vet (besides her skills and compassion) is that she is available by email and uses her own cell as her emergency number! She called in a prescription for Cephalexin to get things under control, which it did. By that time we already had an appt scheduled for his regular yearly and she had plans for drawing blood work and doing a urinalysis, with C&S. The original infection had resolved by the time of the appt, but he had now popped a new spot under one front leg - despite still being on antibiotics at the time.

At that visit, she also noticed what she believes are lipid deposits in his eyes. Noodle has thus far managed to not develop cataracts related to the diabetes. He does have a "Buddha belly" and has had one since his initial diabetes diagnosis in 1/09. The first vet ran a UCCR which did not rule Cushing's out, but he said didn't "scream Cushing's". Noodle was not yet regulated at that point so further testing was put off. Once he became well regulated, the entire topic was dropped. Despite repeated requests, I never received copies of the initial lab work from the old vet. After 2 fax requests and phone calls, my new vet was able to get the copies. The new vet feels he has probably had Cushing's the entire time and that was why he required a higher than normal amount of insulin to regulate.

Here are the most current lab results for anything that came in above or below normal range:

Hematology
RDW - 17.7 (%) - 4.0-15.0
Eosinophil - 1390 (uL) - 0-1200

Chemistry
Creatinine - 0.30 (mg/dL) - 0.5-1.6
Magnesium - 3.5 (mL/dL) - 1.36-2.1
Triglycerides - 373 (mg/dL) - 29-291
ALT - 488.0 (U/L) - 12.0-118.0
GGT - 23.0 (U/L) - 0.0-19.0
Lipase - 163 (U/L) - 0-150
CALP - 516.0 (U/L) - 0-40
ALP - 835.0 (IU/L) - 5.0-131.0

Urine (this was a free catch)
USG - 1.005
pH - 7
Protein - 30+
Bacteria - +++
Crystals - N/A
Casts - granular
Cells - epi (squamous)

The C&S was negative for infection. I also just noticed that at the top of the blood work results page it says:

Specimen was Hemolysed
Specimen is Lipemic

Noodle's diabetes regulation has continued to be fantastic, so that is what initially had me scratching my head. He is still energetic, loves walks, and has a very joyful personality. He does however seek out cool places to sleep - mostly the tile in our upstairs bathrooms, right next to the AC floor vents. He has episodes of panting, though not extreme - more like after some low level activity as opposed to a run outside on a hot day. I think his skull has become more boney looking the last year or so - my husband says it always looked that way. His skin infections continue to pop up, but the hair grows back after successful treatment. Recently he does appear to be having some thinning of his hair under his arms and on the lower part of his belly area. He has also had some thinning around the eyes. My daughter says he is starting to poop out on walks and needs a break half way through.

Our vet would like to proceed with blood testing and then follow that up with an ultrasound. She uses a board certified group for the ultrasound and would consult with board certified IMSs from the university we are near. I'm comfortable with that combo. I know having an unregulated diabetic can dictate which test to start with, but is there a recommendation for a well regulated diabetic?

I know this post is exceptionally long...but I know the K9D and K9C boards like LOTS of initial information and ask LOTS of questions. :D

I've been watching for my confirmation registration email, but it hasn't shown up...not even in my spam folder. :confused:

I'm happy to be joining another great board of supportive and knowledgeable members, even if the reason isn't the most welcome.

Thank you!
Noodle & Daisy

AlisonandMia
08-14-2010, 08:42 PM
I've been watching for my confirmation registration email, but it hasn't shown up...not even in my spam folder.


Hi and welcome,

Weird that the confirmation registration email hasn't shown up yet - but there can be delays in emails systems(:rolleyes::confused:). Anyway, I've just approved your membership without waiting for the email so you are good to go now.

Alison

Harley PoMMom
08-14-2010, 08:55 PM
Hi and welcome to you and Noodle from me and my boy Harley! Your post was not long it was detailed and We love detailed posts!!! I really don't know alot about diabetes but from your post you got Noodle covered there so one question I have is about his thyroid, is it responding to therapy?

I believe even with a well regulated diabetic pup an ACTH stim test and an ultrasound would be your best diagnostic tools.

I am so glad you joined our family and we are here to help you and Noodle any way we can. Sometimes weekends are alittle slow around here but I am sure the others will be along shortly to welcome you and Noodle and offer you advice.

Love and hugs,
Lori

AlisonandMia
08-14-2010, 08:56 PM
It is strange that his BG is so good if he has Cushing's - I'd think that would just about rule out Cushing's (high cortisol that is). But I do wonder if he might not have some other steroid hormones (particularly significantly elevated androstenedione and/or estradiol) - maybe hormones that can produce some Cushing's symptoms but not create that much insulin resistance. The real "baddies" for insulin resistance are (as I understand it) cortisol and progesterone. The other hormones possibly have some effect which could explain his need for a high dose of insulin - as well as the mild-ish Cushing's-like symptoms - but possibly don't necessarily lead to uncontrollable BG's.

I think the very best Cushing's test for a diabetic dog is the UTK full adrenal panel - especially if it is looking like cortisol isn't necessarily a problem. It is an ACTH stim but instead of just measuring cortisol, other adrenal hormones are measured too. That is the test that I'd start with with Noodle I think. (They also offer the panel with a combined ACTH stim/LDDS test but most people just do the ACTH stim).

Here's a link to some info: http://www.k9cushings.com/forum/showthread.php?t=198 and in particular the testing (see #3, especially para 3g) http://www.vet.utk.edu/diagnostic/endocrinology/pdf/endo_tests_info_07.pdf

Alison

RudyW
08-15-2010, 02:33 PM
Hi Noodle/Daisy and welcome to K9C. I too am a new member and was referred over by K9D. Rudy and I are also struggling with diabetes and possible Cushing's. Rudy was diagnosed with D in April and had been under good control until about 2 weeks ago when his glucose level began to rise, his muscle control and eyesight worsened, and his thirst and urination increased. We just started treating him with Vetoryl and need to wait until next week to see if it is helping.

You were very helpful to us on K9D so if I learn anything helpful regarding a diabetic dog with Cushing's I will be sure to pass it along.

Regards,
Rudy/Don

Bagel's Mom
08-15-2010, 11:05 PM
Hi! Bagel and I have had a fabulous summer with me being home..My Cush dog is going on a year and a half with that, and then diagnosed with Diabetes last November..

She NEVER has consistent BGs,,,ranging from 200s to 400s and never the same twice...

Being home from teaching has been so good..We go out in the dog buggy before the heat gets up each morning...She walks fine. The buggy is for ME to get some exercise! Then she finds the coolest tiles to lay on all day..Her appetite is fabulous and losing 7 pounds this year was a great thing for her. She takes 18 units 2 X a day of insulin and Lysodren 3 X a week...1325 Mg....She has grown cataracts due to the high BGs- It has been a year since the last ACTH test- but I just don't want to rock the boat. before the D was diagnosed, she had all kids of UTIs, bladder stone, skin probs...so I am just thankful for this LONG hiatus of great health...School starts back in 2 days so we are not happy! Sande

Noodle
08-16-2010, 02:24 AM
Thank you for the welcome! :)

Alison, thanks for activating me without the email response. It still never showed up...very weird. I know the vet mentioned wanting to start with the ACTH, so I will definitely print out all of the information about the UTK adrenal panel and request it. His incredibly flat blood sugar curve sure makes me question whether there are other hormones coming into play here, other than cortisol.

Lori, he does appear to be responding to the thyroxine. At the time it was started he had lots of shedding, some lethargy, and hind end weakness. The shedding stopped very quickly and he grew a new soft puppy like coat at the time. He perked up and the weakness abated. But it was also early in his diabetes regulation, so I'm not sure how much that came into play as well.

So far the hair he has more recently lost has been in the spots he has infection (back of legs and groin area), some thinning on his stomach, and he has lost most of the hair under his front arms in the last 2 weeks. The hair on his legs and groin area grew back, but he also had a spot under his arm and the hair isn't growing back so far. His energy is still good (loves walks, runs for the door when anyone comes home, up and down the stairs throughout the day) but he seems to be wearing out as the day progresses, sleeping a lot in the afternoon.

The new vet retested him and he was high normal. She did say that physiological stress on the body can "burn up" more T4 and that she suspects he is actually higher. She wants to retest again when whatever is currently going on is determined and treated to get a more accurate reading. We also plan to have an ultrasound as well - more than likely next month.

Hi Don & Sande - nice to "see" familiar faces, though I wish it wasn't due to additional problems with our diabetic pups. It feels a little overwhelming, much like it did with the original diabetes diagnosis. But I'm grateful we have another board to come to with a wealth of information and support. I'll be following Rudy's & Bagel's threads and wishing them success with each of their treatments. :)

BestBuddy
08-16-2010, 05:14 AM
Hi,

It is strange that you are getting such good BG numbers with a cushings dx hanging over your head. Noodle is on a highish dose of insulin so maybe that and your attention to the other details is keeping those numbers so good.

Buddy had been diabetic for years before cushings reared it's ugly head with us and his first signs were higher BG numbers which for a while we were able to keep regulated by increasing the insulin but if he got stressed (visitor at the door etc.) then he spiked high. Over a few months there were more highs than we liked and we started our testing.

I'm not sure that I would have started cushings treatment if we had been able to keep the BG regulated and other signs were not evident. Buddy lost a lot of hair, not patches but it got very thin and his skin was a bit flaky. He didn't have the pot belly but had that insatiable appetite and panting. Buddy was also on thyroid meds but when we started trilostane he didn't need it anymore.

Jenny