Spooner diagnosed today (12 y/o toy poodle) diabetes, Cushing's

[Spooner723]

Hi everyone,

My story is a bit different than many of the others here because I just found out that the dog I am fostering, Spooner, has Cushing’s disease. My husband and I offered to foster Spooner when I saw him on the Urgent List at Animal Care and Control in December. He was going to be euthanized the next morning if he wasn’t pulled by an adopter or foster. He arrived the next day with a terrible case of kennel cough, which was the first thing we had to treat. We already have a (very high maintenance) dog and we weren’t planning on having two, so our finances have been unexpectedly strained this month with the new addition. But, despite the fact that we weren't really prepared to do this and that it wasn't the most practical thing to do, I do love this little dog and continue to hope that we did the right thing by giving him a second chance at life.

Spooner is a 12 year-old (approximately) toy poodle who has lost his vision from diabetes. He is one of the most gentle and loving dogs I have ever met, and I absolutely adore him. Over the past few weeks I have been reading up on diabetes management and I feel like we finally have that under control with two shots of insulin each day. His glucose levels are in the 100-200s range, and he is drinking and urinating much less frequently. Just when I felt like I finally had it under control, the vet called today to say that he tested positive for Cushing’s disease…. :(

Honestly, I have been so preoccupied by the diabetes, I can’t even tell you what test the vet gave him (I understand there are two). I do believe that the results are accurate, however, because he shows many of the symptoms. He has a big appetite and always appears hungry, he has a bit of a pot belly, and his skin feels very thin and sensitive. The vet wants to start him on a 30mg tablet of trilostane once a day and then test his cortisol levels in three weeks.

I’m beginning to feel concerned that we may never find an adopter for Spooner because of all his ailments and their associated costs. I am also concerned about the costs quickly adding up and that there is a chance we may not be able to keep this dog in good health, even if we had all money in the world.

Obviously, my heart bleeds for dear Spooner and I have become incredibly attached to him. But, I don’t know that I can afford all of the most high tech tests, numerous trips to the vet, and daily medicine regimen that seems to be required to keep a dog in this condition alive for many more years. If I can’t maintain his health, my main goal is to keep him as comfortable as possible and to spoil him with love and snuggles as much as possible.

I guess my question is… how would you approach treatment if you were in this situation? I plan to try the trilostane and pray that it works, but after that, what are the next steps/options? I don’t think I would want to put him through a surgery or on a medication that has horrific side effects.

I feel so torn up over this. Any advice or expertise would be so greatly appreciated.

Thanks for taking the time to read this.
~Spooner's Foster Mom

[lulusmom]

Hi and welcome to the forum.

I can so relate to your situation. I am a rescuer who already had a dog with cushing's so when I pulled Jojo from the shelter, I knew he had cushing's. He had every symptom in the book. Like you, I couldn't turn my back on him because the alternative was unthinkable. With medically needy dogs, finances are always tight for us. We pretty much work to pay vet bills.

I am thrilled to hear that you have the diabetes under control. It does sound as though Spooner presents as a cushingoid dog but I am still concerned because 1) it is very difficult to diagnose cushing's and it becomes even more difficult to diagnose with the complication of diabetes and 2) it is extremely difficult to regulate a diabetic dog with uncontrolled cushing's. Usually the excess cortisol which is the hallmark of cushing's has to be brought down to therapeutic levels before you can gain the upper hand on the diabetes. Did you have any difficulty? Lastly, it is very odd that the excessive drinking and peeing resolved after getting the diabetes controlled. That normally would not happen if a dog has cushing's.

Do you happen to know what tests were done to diagnose cushing's? Any chance you can get your hands on copies of the tests and post the results here? When pursuing a cushing's diagnosis in a dog already diagnosed with diabetes, it is very important that the vet do sufficient testing. No one test, especially if a dog has another underlying condition that can transiently elevate cortisol, should be used as the sole basis of a diagnosis. Additional testing must be done to validate in the event of a false positive result of prior test and also depending on which test was done, to differentiate between pituitary and adrenal disease. Do you know if an abdominal ultrasound was done?

Sorry for all the questions but cushing's is a serious disease requiring serious medications so it's important that the diagnosis is correct. As far as costs, there are ways to save. How much does Spooner weigh? Toy Poodles are pretty little so 30mg sounds like a mighty big dose for a tiny guy. I assume you are treating with Vetoryl, right? If that's the case, Dechra, the manufacturer has not changed the information in their packaging insert but they now recommend a dose of approximately 1mg per pound. If Spooner required a smaller dose like 15 mg, because Vetoryl does not have that dose available, you can get it compounded for much cheaper. My dog, Jojo was on 15mg twice daily and got his compounded Trilostane at Diamondback Drugs for about $87 for a three month supply.

The bloodwork needed to monitor treatment is called an acth stimulation test. It is important that this test be done within 14 days after starting treatment, again at 30 days and then every three months. If a dosing change is made, you start over at 14 days, 30 days, etc. If the vet using cortrosyn as the stimulating agent, you may be able to save a whole lot of money. We call cortrosyn liquid gold because it is this stimulating agent that makes the acth stim test so costly. Most gp vets are not aware that you don't have to use the entire vial for a small dog. The cortrosyn vial is 250 micrograms and directions say to use the entire vial but there have been more than a few studies done that show you can get accurate results with 50micrograms per kilogram. We've had more than a few members with small dogs who shared this information with their vets who were able to get four and five acth stimulation tests out of one vial. I don't have time at the moment but I can provide you with a link you can share with the vet that has information on how to reconstitute and store the unused cortrosyn for future tests. This information is provided by a reknown endocrinologist so the vet should not question his credibility.

This has turned into a novel so I better close for now so that you don't tilt or fall asleep. :D While I regret the circumstances that brought you here, I'm sure glad you found us. We're all here to help in any way we can but being a rescuer, I really want to help you help your precious little shelter dog.

Glynda

[Skye]

Welcome, i am so grateful you came to this site. you are now surrounded by angels.
LOTS of knowledge, and experiences here. Please know that you will be able to lean and count on them so much. i could have never made it through my ordeal with out them. They helped me each step of the way, and helped me be the best advocate i could be for my darling....had they not helped me her tumor may have never been found on her adrenal. (one of the most dangerous surgeries ever for dogs)
Glynda...great awesome guidance and questions.
dont fret to much Spooners Mom......I think there is more hope to see....so dry your eyes so you can begin the journey to put this plan into place and fit each piece of puzzle together!

[Spooner723]

Thank you both so much for your thoughtful replies to my original post! It really means a lot to me and I feel so much better knowing that there are some ways to limit the cost of the medicine and tests.

The vet performed the LDDST to diagnose. I haven't been able to get my hands on the actual numerical results today but I have asked them to fax them to me when I return to work on Monday. You have given me hope that perhaps he doesn't actually have Cushing's disease, as I understand there is a possibility for false positives with this test.

I know it's probably hard to say without seeing the actual test results but, what would you do in terms of moving forward:
- wait it out to see if he shows any more symptoms?
- ask the vet to run another test? which test is more conclusive?
- start the medicine and run another test in two weeks?

Right now, he is quite alert, mobile, and happy for an old blind pup with diabetes. He has a hearty appetite, goes on 40 minute walks with me, and sleeps well. And again, his drinking and urination seems to be in the normal range on days that his glucose levels are stable. I'd love to keep him living the good life and out of the vet's office for as long as possible!

Thank you again for reading and responding. Your advice and the support on this board keeps me from having constant anxiety attacks. :)

[Squirt's Mom]

Hi and welcome to you and Spooner! :)

Just his name sounds loving, doesn't it? ;)

First, I want to tell you what an angel you are for taking him from that shelter and giving him not only a second chance, but a safe, loving foster home. You have a heart of gold!

Second, I am the proud mom of two blind babies, Trinket and Brick, both less than 5 lbs - and fully grown! :D Trink lost her sight due to glaucoma and her eyes were removed, Brick to Hydrocephalus tho he still has his eyes. Neither one is aware they are blind, tho, so don't tell them, ok? ;):p Seriously, the first time our vet met Trink, she was roaming around his waiting room. He watched her for a bit then said, "Well, Leslie, I think she can see a little bit." To which I replied, "Dr. B, she ain't got no eyeballs!" :p She operates by sonar, like a bat, the best I can tell, while Brick operates by the feeling in his paws and his nose - he is strongly tactile oriented and can smell an empty pizza box a country block away! For a blind, gimpy old man he can pick 'em up and put 'em down, too, let me tell you! :eek::p

Third, I want to tell you about my Squirt, my cush baby. She tested positive on five Cushing's tests - LDDS, HDDS, ACTH, UTK panel and two ultrasounds. After the second ultrasound, I was told about a tumor on her spleen. Once the tumor was removed her cortisol returned to normal and has remained within range since. The tumor was causing internal stress and her body responded, as it was supposed to, by releasing excess cortisol. The cushing's tests can only tell us if the cortisol level is high but not WHY the level is high. This reason, plus the fact that the signs for Cushing's are shared with many other conditions, is why the testing phase is so important. When you already know your pup has an existing endocrine problem, like diabetes, it becomes that much more difficult to diagnose Cushing's so the testing becomes that much more important.

You asked what we would do in your shoes....I would have an ultrasound done. Not only should the adrenal glands be visible, which can go a long way in diagnosing Cushing's, but organs such as the kidneys, liver, gall bladder, intestines, stomach and others will be seen as well so other causes for the elevated cortisol might be ruled out, OR discovered, all at the same time. As one of our Mods says, "it's the test with the biggest bang for the buck". ;) I would not start treatment just yet...I wouldn't even order the med just yet. ;)

Panic is common around here so don't feel embarrassed. Just wait...one of these days you will see a post on my Squirt's thread and it will be the silliest thing you've ever read in your whole life - like self-diagnosing cancer at 10pm one nite after feeling some lumps only to learn the next day at the vet's I was feeling her boobs. :o:rolleyes::p So, please, go ahead and panic....you won't be alone I can promise you that. We have our own little looney bin here and any time you feel the need just holler, I'll scoot over for you. :p

The most important thing I have to share with you today is this - you and Spooner are not alone on this journey. No matter where it leads we will walk with you every step of the way. I am glad you found us and look forward to learning more as time passes.

Hugs,
Leslie and the gang

[lulusmom]

The LDDS is the gold standard in cushing's diagnostics but it is also the one most likely to yield a false positive result if there is a non adrenal illness involved or severe stress. Like I mentioned in my previous post, I would question the diagnosis based on 1) diabetes not difficult to control 2) excessive drinking and peeing resolved once diabetes controlled and 3) difficult to get a correct cushing's diagnosis if the dog has diabetes or any other condition that can transiently effect cortisol. Was hypothyroidism ruled out?

In your shoes, if the rescue or shelter is willing to do an ultrasound at a facility with a good quality, high resolution machine, I'd let them. Otherwise, I'd hang tight until I saw a reason to pursue cushing's, such as losing control of the diabetes or seeing overt symptoms commonly associated with cushing's. Drinking buckets and peeing lakes is definitely a sign as is a voracious appetite. I think you mentioned that Spooner has a healthy appetite but is it an over the top appetite like constant foraging for food, begging for food and/or becoming food aggressive? It is common for dogs diabetic dogs to have voracious appetites too. Speaking of diabetes, I highly recommend that you join our sister site, www.k9diabetes.com. The folks there are amazing and being members of both sites, you will have the best of both worlds.

Glynda

[Skye]

i would do ultrasound....be sure the doctor has the most up to date equipment and experience in taking them. That was the best test i had done. Found what is so very difficult to ever find. Adrenal tumor. And it shows all the major organs
i would recommend the double cavity
hoping you doing good this evening....and ohhhhh goodness.....anxiety...I actually asked the one of the nations top animal hospitals to build a cocktail bar and have Xanax and Valium dispensers, lol ((((((((((((hugs))))))))))))))

[Lady's mom]

Some foster groups have funds available for medical treatment. Have you asked about it? And some groups will put out a special request for donations to help in a specific situation.

Might be worth looking into. Good luck. I can feel how fond you are of him.

[Spooner723]

Hello again!

Thank you again for your incredibly helpful responses. Leslie, your story about the vet thinking Trink has a little vision made me laugh out loud!

After thinking about it, researching, and observing Spooner all weekend, I think I am going to hold off on any treatment. I did another glucose/blood curve on him to be sure that the diabetes is being controlled and his levels fell into an almost perfect insulin curve. I watched his water intake more closely as well, and he truly isn't drinking any more than my other healthy dog. He has a hearty appetite, but he's not food aggressive or eating poop or digging through trash, or anything like that. So, until he shows more of the clinical signs of Cushing's, I am going to wait it out.

In the meantime, I will begin saving my pennies for the ultrasound and medicine so that if he needs it in a few months, I will have the money to spend. The rescue group who helped me pull him from the shelter did originally contribute to help cover some of his veterinary costs but they have now told me that are out of money to spend on him, and they need to focus on younger more adoptable dogs. But, perhaps I can reach out to other rescue groups or try to start a chipped-in account.

Thank you all again and best wishes to all who are caring for Cushing's pups.

Cheers,
Margaret and Spooner