Severe leg weakness

[flappyfingers]

Hi, new to the forum and think it is great to have such a support group out there all dealing with our pets and cushings. My almost 11 year old lab, NutMeg was found to be diabetic 2 weeks ago. Put on insulin and more symptoms arose--panting, hair loss, increase water... and back leg weakness. Soon more tests-- a positive for PDH cushings. She then developed front leg weakness, now to to the point she cannot walk or even stand on her own. We now must with two lift harnesses take her outside for her to do her business. She was started on Trilostane 3 days ago but so far none of the symptoms have dissipated or changed. How long does it take before the panting and water drinking subsides? And has any of your pets experienced such severe leg weakness as my girl has now? The vets are suggesting a neurological problem but we first will deal with diabetes (blood sugar to normal)and the cushings hoping the leg weakness will lessen too. Any comments?

[addy]

Welcome,

You have had a lot thrown at you all at once. I am glad you found your way here. We have many members dealing with Cushings and diabetes. Our sister site is K9 Diabetes. They are wonderful and if you have not yet checked that forum out you should. Many members go back and forth between the two forums.

Normally the drinking and urinating are the first symptoms to resolve, often in the first few weeks but with diabetes thrown into the mix, I am not sure.

Could you post any test results? It helps our members give better feed back.

Others will be along soon so hold tight.

Hugs,
addy

[Squirt's Mom]

Hi and welcome to you and Nutmeg,

If you haven't already, go now and register at k9diabetes - www.http://k9diabets.com/forum

Tell them in detail the dose and schedule of the insulin, the type of insulin, test results and describe her behavior in as much detail as you can.

This type of sudden muscle loss is not typical with Cushing's. Weakness is common but it doesn't suddenly happen and usually is confined to the rear legs. I am more concerned it may have to do with BG or something else.

Please go talk with them asap and come back to tell us what you have learned from them. Do this now....

Hugs,
Leslie and the gang

[mytil]

Hi and welcome.

I am sorry your girl is having these troubles.

Firstly, here is a great site for dealing with diabetes - http://www.k9diabetes.com/forum/. Please do check it out.

Secondly, when you get the chance post the results of the tests performed to diagnose the Cushing's. That way we can see the actual numbers. Also if you had any blood panels done, post those results.

Regarding the leg weakness I wish I could give you a direct answer, but it could be a combination of things or a coincidence or not when starting the insulin and will abate when the insulin dose is set or possibly she hurt herself somehow.

Did this start after the Trilostane was given?

Terry

[mytil]

What is the Trilostane dose you are giving?
Terry

[frijole]

Welcome from me as well. I would bet that the leg issues you are having are from neuropathy related to diabetes - it is common in humans I know. So I'd guess getting the diabetes under control would help you with the leg issues. You have your hands full. Are you doing to a specialist? Kim

[flappyfingers]

What is BG??

[flappyfingers]

Hi all thanks for the great info. Meg is now on 12 units of Humulin N U-100 twice a day. Her initial bg was 495mg/dL with a very high ALK phosphatase of 1515U/L. Her cortisol serial 3 (Dex) was: 8.2 then 2.0 then 2.7 ug/dL.
She is on a dose of 70mg once a day as her weight is down to 73 lbs. We go for another blood glucose test tomorrow. Will update as I get that result. Yes they did suggest being referred out to a neurologist but was hoping things would resolve with other conditions. She really only developed the excessive thirst once she got her first insulin shot. Funny thing is she is trying to walk but no strength and front paws doing the clubbing effect as she is carried. Thanks for all the input!!!

[mytil]

BG = blood glucose

Here is a link with additional information about Trilostane - http://www.k9cushings.com/forum/showthread.php?t=185

Keep us posted
Terry

[lulusmom]

Hi and welcome to the forum.

Was the only diagnostic test for cushing's, the LDDS? If so, I have concerns about a misdiagnosis. The LDDS is much more likely to yield a false positive result in a diabetic which is why the acth stimulation is preferrable. Even then, it's very difficult to diagnosis cushing's in a diabetic dog as symptoms are much the same for both conditions. Dr. Mark Peterson, a reknown endocrine specialist, discussed this in his blog. I have cited the Q & A below:


diabetic dog said...
Hello,

It is my understanding that when diagnosing a diabetic dog suspected of having HAC, the ACTH stim test is preferred because it is less sensitive and therefore less susceptible to false postives. Is this true? If so, can you please explain why and if not, then what is the best test to do under this circumstance especially if controlling the diabetes before hand is not an option? Thank you

May 25, 2011 4:55 PM
Dr. Mark E. Peterson said...
You are correct that the ACTH stimulation test has the best test specificity of any of the 3 screening tests. In other words, you would be less likely to falsely diagnose a dog with Cushing's based on the results of an ACTH stimulation test than you would using the LDDST or UCCR tests.

That said, none of these screening tests for Cushing's are very good diagnostic tests when we are evaluating dogs with known nonadrenal disease. The "best" diagnostic test for Cushing's disease is and always will be a good history and physical examination.

Both dogs with Cushing's and diabetes will show signs of PU/PD, have hepatomegaly, and have high serum alkaline phosphatase activity. So we have to start looking at other signs, generally those of the skin or hair-coat, to really know if hyperadrenocorticism is also contributing to the signs seen in your dog with diabetes.

This can be a difficult diagnostic challenge (ie, making the correct diagnosis of concurrent Cushing's syndrome in a diabetic dog). But in my mind, it is almost always better to err on the side of not over-diagnosing Cushing's syndrome than it is to make a false diagnosis of the disease when it really isn't there!

I don't recall you mentioning a ravenous appetite which is one of the hallmark symptoms of cushing's, along with excessive drinking and peeing. Since Meg didn't start the excessive drinking until you started the insulin, my concerns about a possible misdiagnosis is even greater. If Meg does not have cushing's, Trilostane can throw her into an Addisonian crisis. With her debilitated condition, I'm not sure you'd readily recognize the signs of extremely low cortisol unless she started throwing up and having diarrhea. If this were to occur, you need to get her to the vet or an er facility asap. Did your vet give you any prednisone in the event Meg has an Addisonian crisis? Is your vet a general practioner? If so, I would highly recommend that you consider having Meg seen by an internal medicine specialist asap. She has multiple issues which would best be addressed by a specialist. I have two cushdogs with multiple conditions and they treat exclusively with an internal medicine specialist. Most members also have specialists treating or associating in with their general practitioner.

I agree with the others and highly recommend that you sign up right away at our sister site, www.k9diabetes.com

Glynda

[lulusmom]

Hi again.

I am not as familiar with diabetes as I am cushing's so I did a quick google to see if I could find anything on Labs with diabetes who suddenly could not walk due to front leg weakness. I didn't find anything scientific but I found a thread on a Lab forum. This member sounds like she went through the exact same experience with her Lab.

http://www.lab-retriever.net/board/general-health-issues/7378631-my-yellow-lab-almost-paralyzed.html

[frijole]

Wow Glynda good catch - I too am wondering about the cushing's diagnosis! Especially since it was so shortly after the diabetes dx. Do you think that giving trilo to a dog without cushing's could cause the legs to fail? Just curious. Kim

[pupdog]

In my searching for answers I found that leg weakness is usually a symptom of pain, not arthritis, and parkinsons disease doesn't exist for dogs so it won't be that. A pain in the abdomen or the back can make it painful to walk, making it appear as leg weakness. Kidney damage causes whole body tremors.

My dog developed hind legs weakness on trilostane in 1wk, and after 2 weeks she had front leg weakness too. After the pills were stopped the weakness went away. Then she was put on a antibiotic and it had the exact same effect. Multiple kidney profile tests and an ultrasound didn't show that the drug(s) were destroying my dogs kidneys, she almost died of acute renal failure.

Anything could be causing pain in your dog, it doesn't necessarily mean the kidneys are failing but in a older dog that is taking medications its a big possibility and risk to be aware of, and as my experience shows you cant really trust what the tests say.

[lulusmom]

Kim, low cortisol can cause serious weakness but I think Meg's front leg problem started before Trilostane was given. Hopefully member can confirm for us.

The more I research, the more I agree with Kim. I think Meg's problem is peripheral neuropathy caused by diabetes. Here's an abstract from a study which includes two or three Labs with diabetes.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2387263/

[k9diabetes]

Diabetic neuropathy is fairly rare in dogs. I've seen it occur in two general cases:

- when the blood sugar has been extremely high for an extended period of time, such as 600 - 800 for days.

- when the dog has some other form of impaired nerve function and the layering over of high blood sugar has brought on neuropathy at lower levels of blood sugar.

But diabetic neuropathy typically occurs only in the back limbs, not the front, and the addition of insulin and Trilostane should be improving diabetic neuropathy, not making it worse.

The other time I've seen severe weakness in a diabetic dog was actually from a dog who is very sensitive to Trilostane and whose cortisol was going too low.

Lowering cortisol levels even to a normal range can unmask severe inflammation problems. And taking it too low can cause weakness in general.

My best guess is that this is not diabetic neuropathy but is either a reaction to the Trilostane (perhaps causing cortisol to go too low) or there is some other neurological issue.

Given the concerns expressed about the diagnosis and the possibility that the Trilostane is contributing to the hind leg weakness, I personally would give serious thought to discontinuing the Trilostane and seeing a specialist. Probably an internal medicine specialist first to deal with the Cushing's question and what effect the Trilostane might be having.

Then, if you stop the Trilostane and the limb weakness persists, I think a neurologist consult would be an excellent idea.

I have worked with a neurologist with two of our dogs, one with diabetes and one without. There is a lot they can tell from some simple, noninvasive tests about exactly where the impairment is occurring.

I worry any time diabetes and Cushing's are diagnosed simultaneously. I generally like to see the diabetes tackled first, since it can cause fatal events if not treated, and the question of Cushing's set aside until you find out if the diabetes is controllable. If the diabetes regulates well, Cushing's disease is unlikely.

I worry when a dog seems to be suffering so much more since starting treatment. Please don't wait to consult the vet about seeing a specialist and checking her cortisol levels. An Addisonian crisis (too little cortisol) is a very dangerous thing and can also make the blood sugar drop sharply.

Natalie


Hi, new to the forum and think it is great to have such a support group out there all dealing with our pets and cushings. My almost 11 year old lab, NutMeg was found to be diabetic 2 weeks ago. Put on insulin and more symptoms arose--panting, hair loss, increase water... and back leg weakness. Soon more tests-- a positive for PDH cushings. She then developed front leg weakness, now to to the point she cannot walk or even stand on her own. We now must with two lift harnesses take her outside for her to do her business. She was started on Trilostane 3 days ago but so far none of the symptoms have dissipated or changed. How long does it take before the panting and water drinking subsides? And has any of your pets experienced such severe leg weakness as my girl has now? The vets are suggesting a neurological problem but we first will deal with diabetes (blood sugar to normal)and the cushings hoping the leg weakness will lessen too. Any comments?

[HarrysMom]

Has your vet ruled out inner / middle ear infection? My dog is also diabetic / cushingoid. He generally suffers from rearend weakness, but we found out he had inner ear infection when he became wobbly - both in front and rear.
My dog definitely has rear end neuropathy - it is worse when his blood glucose is high, and when his cortisol is too low.