12 y/o Lhasa (Cushing's and Diabetes)

[Rosierod]

Hi my name is Rosie, I have a 12yr old Lhasa who was diagnosed with Cushing & Diabetes 2 1/2 yrs ago. He was diagnose with a cataract @5 then @ 7 had a hip replaced & had an eye removed when he was diagnosed with the diabetes, he has been thru a lot but he is such a trooper, such a good boy. He is on Vetoryl 90mg per day 60mg in the morning & 30mg in the evening, he also get insulin twice a day & he is on denamarin for his liver & gentile gel also twice a day... A lot of meds a lot of $ monthly but he is worth every penny. He is my baby & what ever I have to do to keep him doing well i will.:)

[labblab]

Hi Rosie!

Welcome to you and your sweet boy! I have only a moment to post right now, but wanted you to see that I have taken the liberty of moving your reply so as to create a brand new thread that is dedicated exclusively to you two. This way, it will be easier for our members to reply to you directly with their suggestions and feedback. :)

I am really glad you've found us, and look forward to hearing more about your boy.

Marianne

[Rosierod]

I was talking with Glynda today & she thinks Gizmo may have been misdiagnosed with cushing, she is going to do some research for me & I am going to try & get her his blood results when he was 1st diagnosed.
Gizmo didn't have the typical symptoms with cushing (no excessive eating no pop belly) & since he was also diagnosed with diabetes at the same time there is a possibility, he may have been misdiagnosed. I am upset & grateful at the same time, for him not to have cushing would be a blessing, but for 2 12 yr he has been taking vetoryl & what has this done to him physically, did it harm him?

[frijole]

Welcome from me as well... I had a dog that was misdiagnosed... over and over... so it does happen. You are in good hands with Glynda. Glad you found us. Kim

[lulusmom]

Hi Rosie.

I'm glad you found us. Just so others have a bit more background, I'll recap our conversation.

Gizmo was tested for diabetes and his symptoms at that time were loss of appetite, excessive drinking and peeing and some hair loss. Rosie's old vet in New Jersey felt that Gizmo may have cushing's because he had elevated liver enzymes. The vet did not try to regulate the diabetes before doing the LDDS, which was consistent with cushing's but then, I would have been surprised had it been normal. Gizmo was diagnosed solely on the results of elevated liver enzymes and the LDDS. No abdominal ultrasound was not done.

Treatment for cushing's was not started until Gizmo's diabetes was stabilized. According to Rosie, it was not that difficult to get the diabetes under control, which is very odd because diabetic dogs with uncontrolled cushing's are very difficult to regulate.

Gizmo is 18 pounds and has been on huge daily doses of Vetoryl. 60mg in the morning and 30mg in the evening. I did a bit of research and I read the studies submitted to the FDA by Dechra and one study involved young and very healthy Beagle dogs. These dogs were given large doses of Vetoryl with Group II getting the lowest dose of 6.7 mg/kg twice daily, which is about what Gizmo has been getting. These dogs tolerated it well for at least 90 days and were still able to respond well to stimulation. Cortisol readings were much the same as the readings for Group I dogs receiving empty capsules (no treatment). This tells me that dogs without cushing's can tolerate rather large doses with no ill effects. Dogs in two additional groups received really massive doses and all experienced serious side effects.

Rosie and Gizmo moved to Florida and saw a new gp vet who told her that Gizmo did not have cushing's but after speaking with the New Jersey vet, he changed his mind, agreed with the cushing's diagnosis and prescribed treatment. That was 2 1/2 years ago and Gizmo is doing fine on the current treatment for diabetes and cushing's. Rosie does not know what an acth stimulation test is and advised that the only time he had bloodwork done was in April 2011 and he was in the vets office for a long time, so I suspect that may have been an acth stimulation test. Rosie will try to get the results of the test and share the results with us.

Rosie, can you please tell us if Gizmo started treatment on 60mg and 30mg or were there adjustments made? You mentioned that the diabetes was under control when you started the Vetoryl. Did the excess drinking and peeing resolve once you got the diabetes under control? Did Gizmo have any cushing's symptoms at all when you started the Vetoryl? i.e. excessive drinking/peeing, voracious appetite, panting, hind end weakness, muscle wasting (boney looking appearance)? Can you also remind me how many units of insulin Gizmo is getting? For our diabetes savvy members, Rosie does not do home testing.

We'll be looking forward to seeing the results of all testing done for the original diagnosis and the bloodwork that was done last year.

Again, I'm glad you're here. Please let me know if I got things straight and let us know if you have any questions or anything further to share.

Glynda

P.S. Here is a great article by a renowned endocrine specialist, Dr. Mark Peterson, about the difficulty in diagnosing diabetic dogs with cushing's.

http://endocrinevet.blogspot.com/2012/01/q-diagnosing-cushings-disease-in-dogs.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+InsightsIntoVeterinaryEndocri nology+%28Insights+into+Veterinary+Endocrinology%2 9

[Rosierod]

Thanks u all for welcoming us...Glynda u got most of what we talked about the only thing was he had also hair lost it got very very thinned out & had lost about 8lbs since his last dr visit which was about 6mo's b4 he was diagnosed. He weight in yesterday during his check-up 18.9 vet said he had lost about 1 lb since our last visit in April, & told me to keep an eye on him, Gizmo has days he eats all his food & days he doesn't want his morning food, but will eat a bone or beggin if i give it to him, he will most times et what we have for dinner chicken or most meat I cook & then there r days he doesn't want any. But he was always like ths even b4 being diagnosed.
I will be making some phone calls today to try & get his previous test results...My biggest concern here is that if he hasn't had cushing for the passed 2 1/2 yr how is this going to affect his health, has there been any damaged done.
Gizmo has been on the same dosage all along as far as I remember, he was taking 2 30mg in the morning & 1 30mg in the evening...until i found that a 60mg pill was available which was a little less expensive if I bought the 1 box of 60mg & 1 box of 30mg as apposes to 3 boxes of the 30mg.
Gizmo is on 5units of insulin they started him on a lower dosage & little by little it was increased...
Glynda i so appreciate you looking into this for me, as I am clueless, & have done whatever the vet has told me to do.
Glad I found u all as well, i got ur name thru a rescuer friend on FB who has been trying to help me & Gizmo in raising donations for his meds which run me about $250 monthly , my unemployment benefits ended last week & I have been unable to find a job & was so afraid i couldn't get Gizmo his life saving meds & when I shared with carrie my situation she has been trying to help me. On a good note i had yet another interview yesterday & God willing I will get a call with a job offer...
Thank you all for this opportunity to share with you.

[Rosierod]

Just called my old vet in Nj they will be mailing me all his test results so i should have them in a few days...whoo hoo keeping my fingers & toes crossed & Gizmo has his paws crossed as well :-)
Rosie

[addy]

I have not yet had a chance to welcome you. I will keep my paws and fingers crossed as well that Glynda can help you sort things out.:) She is really good to have on your side.:D:D:D

Give Gizmo a really big hug from me. I have a Lhasa as well. She came to us from Animal Control so we can only estimate her age 10-12 years, so close to Gizmo.

I am so glad you found us.

hugs and positive thoughts sent your way,
addy

[Rosierod]

Thank u all for ur warm welcome...God willing he won't have cushing...
Rosie

[Squirt's Mom]

Hi Rosie and welcome to you and Gizmo! :)

Boy! Did you luck out being put in touch with Glynda! I doubt there are many laypersons out there who know more about Cushing's than our sweet guru Glynda. AND she sent you to us, the very best bunch of folks you will ever meet! ;)

Since my knowledge of diabetes is limited - and it scares the crap outta me :o - I tend to simply read threads that involve diabetes so even if I don't respond often, know you and Gizmo are being watched over by many folks here, wishing you both the very best.

One think I can assure you of - you and Gizmo are no longer alone on your journey. Ya'll are now family and we will be with you all the way. Never hesitate to ask questions or simply talk, or vent. We will b here to help you anyway we can.

Looking forward to seeing those test results and getting to know more about the both of you as time passes.

Hugs,
Leslie and the gang

[Rosierod]

awww thanks Leslie, i do feel this is a blessing as well...glad to meet so many caring people...

[lulusmom]

Hi Rosie,

Just checking in to let you know that I'm thinking about you and Gizmo. Hopefully test results are in the mail. FYI, when I get the results from you, I am going to take a chance that Dr. Mark Peterson (a renowned endocrinologist) will answer my questions about Gizmo's diagnosis. He has a blog for pet owners and vets so everybody keep their fingers crossed that I get a response.

One of our administrators, Natalie, is also the site owner or our sister site, www.k9diabetes.com. She is very good about checking in on our cushdogs with diabetes and am hoping she will drop by to offer any information she may have on diabetic dogs misdiagnosed with cushing's. My specific question is "have any k9d members discontinued cushing's treatment and if so, were there any clinical problems.

Glynda

[k9diabetes]

Hi Rosie,

I'm the admin from the K9 diabetes site - just read through the account of the process of Gizmo's diagnosis with Cushing's disease... I think it's distinctly possible that Gizmo never had Cushing's disease.

I have zero faith in any diagnosis of Cushing's disease made concurrently with diabetes unless the dog visually just screams "Cushing's!!" Your story about Gizmo is one I hear commonly in dogs misdiagnosed. The only obvious symptoms of Cushing's disease were ones that are shared by diabetes.

I hope you took time to read the Mark Peterson column where a vet similarly jumped to a Cushing's diagnosis based essentially on a single blood test.

Cushing's is an excess of cortisol. And there is a direct link between cortisol levels and blood sugar levels in a diabetic dog. The more cortisol running around in the dog's body, the more insulin they will need to reduce the blood sugar at all. So when a diabetic dog has Cushing's disease, the blood sugar is basically impossible to control.

So the easiest way to know if a diabetic dog has Cushing's disease is to forget about Cushing's and work to regulate the blood sugar.

Oversimplified, if the blood sugar regulates with a normal dose of insulin, then there's no Cushing's disease.

Since Cushing's is bad for the body only over a long period of time untreated, there's generally not a rush to treat Cushing's disease. The Trilostane could be discontinued so you and the vet can see what happens without it.

I would certainly consider a new veterinarian - maybe without the cost of the Vetoryl for a while you could afford a consult with an internal medicine specialist at some point.

I liked that the newer vet was skeptical about Cushing's but concerned that s/he wasn't confident enough with the disease to make the decision and instead was swayed by someone else who took a very poor approach to diagnosing it. That suggests that the new vet isn't knowledgeable enough on the subject.

If nothing else, it would be good for the current vet to get in touch with Dr. Mark Peterson directly to discuss what to do now.

If Gizmo was my dog, I'd be getting him off of the Vetoryl altogether to see how he does without it as that would be a pretty good indicator of whether he ever had Cushing's disease, plus will save you a lot of money - obviously he needs a smaller dose if he does have it - and whatever effects it is having on him if he doesn't.

Natalie

[Rosierod]

Glynda, I received today Gizmo blood results from his vet in NJ would u like me to mail them to you? There r many from 5/18/09 thru 4/17/10.
Rosie

[lulusmom]

Rosie, I just responded your PM. Yes you can snail mail them to me and I'll scan them and email them back to you so that you have electronic copies. I'll also post important test results here for you.

[Rosierod]

Hi Natalie, was re-reading ur post. If I took Gizmo & he does have cushings how would I know...

[lulusmom]

Hi Rosie,

Sorry for the delay in getting Gizmo's test results together but I'm happy to say that I've finally finished with his most recent bloodwork. Please note that the test results I have in blocks were done by the new vet in Florida. All others were done by past vet. I have some comments based on my conversation with Rosie that might help us understand Gizmo's history. I'd like to hear from Debbie who is a seasoned lab technician for her expertise in interpreting this labwork; Natalie for her diabetes expertise, Marianne for her extensive knowledge of Vetoryl and any other members who would like to comment.

In speaking with Rosie, she said that about a month prior to the intial bloodwork done on 5/3/2009, Gizmo was not eating, losing weight, drinking lots of water and experiencing hair loss. Gizmo was started on low dose of insulin at this point. Somewhere between May and July, 2009, the vet removed one of Gizmo's eyes due to severe ulceration. I noted that in addition to complication of his eye problem, the vet did an ldds only four days after bloodwork showed that the diabetes was nowhere near controlled. Within a week of the ldds on June 16, 2009, Gizmo was started on 60mg Vetoryl in the AM and 30mg PM.

There was a definite increase in ALT and ALKP after starting Vetoryl. The ALT was hugely elevated by September 2009, and while improved seven months later on 4/17/10, it's still too high. That's odd because a stim test done on that day showed that cortisol was well controlled. :confused: Perhaps something else was going on with Gizmo at that point in time? I will say that glucose definitely improved after starting Vetoryl, which would support high cortisol as possible reason for inability to control diabetes. See bloodwork done on 7/20 and 9/30. However, Gizmo was started on low dose of insulin and I don't know when that was increased so not sure if low dose of insulin could have been the problem. :confused:

We've all seen Dechra backpeddle and lower their recommended dosing and we're aware that UC Davis is even more conservative. Based on their conservative protocol, I'm conditioned to go low so I was surprised that Gizmo was on what I thought was a huge dose.....that is until I remembered that my own dog was on an even bigger dose. Gizmo is getting a total daily dose of 90mg which is 11mg/kg or 5mg/lb. For two years, my Lulu was on 30mg once daily which equates to 13.2mg/kg or 6mg/lb. 90mg is still a healthy dose but the stumper is that Gizmo's last bloodwork done on 2/27/12 looks like neither diabetes or cushing's is well controlled.

Rosie, what did your vet have to say about the latest urine and blood abnormalities? Did he suggest an acth stimulation test, any change in insulin? Can you let me know if I omitted or misstated anything?

657

[lulusmom]

Bumping up.

[k9diabetes]

I don't have a lot of information to go on as far as the diabetes, and giving Vetoryl would, I believe, reduce cortisol and thus blood sugar regardless of whether Gizmo ever had Cushing's disease.

I don't think I can say much about the situation until we have an update on what Gizmo is and isn't taking in terms of meds and his current blood sugar and insulin levels. The glucose value on the February 27 test is decent.

It would be helpful in determining whether Gizmo ever had Cushing's disease to take him off the Vetoryl altogether for a while and see what his diabetes does without it.

Natalie

[labblab]

Sorry to take so long to check in, but hopefully better late than never...:o

However, I'm afraid I don't have any enlightening suggestions at the moment, other than really wondering what a current ACTH would show. Am I correct that it has been about two years since the last ACTH was performed.

In terms of dosing -- I agree with you, Glynda, that although Gizmo's long-term dose is high, it is not unheard of. Certainly much lower initial starting doses are currently being recommended. But in the early trilostane research studies, I believe that at least half the dogs ended up needing dosing increases with a final ceiling even higher than 5 mg./lb. for some dogs. So as long as Gizmo is not showing ill effects from overdosing, then I guess we have to assume that his dose is not too large for him to handle (but that's also assuming that he needs the trilostane at all, which seems to be the big question).

Once again, I'd surely like to see a current ACTH result.

Marianne