New here: Jake my miniature schnauzer

[sheehs1]

Hi my name is Sandra and my schnauzer's name is Jake. We are coming here from the diabetes forum. A little about Jake. He is going on 12 years old, diagnosed diabetic last October 2001. His weight prior was 26 pounds and he is currently 19 pounds. We have had our ups and downs with the diabetes. The last few days I sensed another crisis that was different from the others.
Jake has not been doing well the last 3 to 4 days. Symptons were frequent urination, accidents in the house and drinking a lot of water. Also would not eat his WD food. Turned his nose at it and spit it out if I managed to get it in him. He will eat chicken and rice....so he does have some appetite. Typically with these symptons I would suspect high BG levels but his levels on my meter were within normal ranges for him. I say normal because schnauzers are notoriously difficult to regulate and Jake has been no exception to that!

Took him to the vet this morning and she suspects cushings but I'm not so sure. Would like ya'lls opinion. The only sympton like Cushings he has is the frequent thirst and urination. He has not gained weight and does not have a pot bellied appearance. He also is not ravenously hungry.

His current meds:
HumulinN 11 units twice a day
Tramadol twice a day for pain
Methocarbomol - a muscle relaxer twice a day (although I backed off of this 2 weeks ago and have only given it to him for maybe 2 days. I backed off because he became lethargic and slept all the time.
Two eye drops twice a day for his dry eye -prednisone drops and cyclosporin.

Previous Diagnoses:
Diabetes
UTI's
Pancreatitis - one very severe crisis and several episodes not so severe
Dyskospondylitis (sp) bacterial infection of the spinal column-on an antibiotic for 8+ weeks. Stopped that a good month or so ago.
Dry Eye - severe.

Todays Vet Visit: There is no infection from the blood work and BG levels were acceptable. However there were some abnormal readings.

RBC 4.34 (5.65-8.87)Low
HCT 30.3% (37.3-61.7) Low
HGB 10.7 (13.1-20.5)
LYM 0.89 ((1.05-5.10) LOW
MONO 1.64 (0.16-1.12) HIGH
PLT 550 (148-484) High
PCT 0.55% (0.14-0.46) High
Vet Concern: Anemia

Some abnormal Kidney readings
GLU 303 (70-143) HIGH (but Jake is always slightly high here)
BUN 40 (7-27) High
CREA 0.4(0.5-1.8) Low

High Liver Enzymes
ALT 272 (10-100) High
ALKP >2000 (23-212) High - off chart
GGT 23 (0-7) High
CHOL 400 (110-320) High
LIPA 1998 (200-1800) High

GLOB 4.6 (2.5-4.5) High



Specific gravity of urine was low...but I don't have that reading.

Vet said he is dehydrated.

For today and tomorrowI'm injecting him with subcutaneous saline and to rehydrate him. She also put him on metronidazole as a preventive for further escalation of possible pancreatitis.
Stopping prednisone drops.
Stopping Tramadol and muscle relaxer).

Will reassess and possibly do STIM test on Monday for Cushings.
I am confused as Jake does not have any of the physical symptons of Cushings. Is this possible?
I suppose my question is ...do ya'll think some of his meds could have cause these liver and kidney enzymes to spike...as well as cholesterol and the others.?

Tonight, after 2 pills of the metranidazole today and 600 cc's of saline injections he did eat some of the WD canned food with his chicken and rice dinner. But even with the saline injections he is still drinking water. Not as often but more so than before all this happened.

I'm worried. His labs did not look like this in May.
Thanks everyone!

Any thoughts are appreciated.

[frijole]

Oh boy... it's so hard when they get diabetes and cush like symptoms... because it is often misdiagnosed... What caught my eye was the prednisone drops. Prednisone is a cortisol and excess cortisol is what causes cushings symptoms... peeing, water intake. So I suspect it could (stress could ) be affecting Jake. I guess by Monday the prednisone would be out of the system but I'd wait a couple more days and if the symptoms go away you could save the cost of an acth test which is not cheap.

I worry because non adrenal illnesses can cause false positives and you are dealing with diabetes already.... I'm almost thinking maybe a better route would be to have an ultrasound done - on a high resolution machine (not available at most vet offices - have to go so specialist)... the reason being that you could get a good look at the heart, liver adrenals and all organs. I think you'd be able to tell whether it warrants further cushings testing or if it is something totally different (example tumor)

Interested to hear what others think. Sending best wishes, Kim

[sheehs1]

Thank you for your well wishes Kim,
The diabetes has been a roller coaster for us. Just when I think I have him stable something else comes along. That said, Jakes labs did not look anything like this in late May. This came on very quickly. It makes me wonder about the meds he was on.

Just wondered if his labs looked like "typical labs for Cushings". He seems to have some of the clinical labs for Cushings but on others I'm not so sure.

He's better this morning without the Tramadol, the muscle relaxer and the prednisone drops yesterday. Has a bit of spring in his step. No urine accidents last night. His eyes are brighter...etc.

I think I will take your advice and wait a few days if not a week (as long as he continues to improve) to let these meds clear out of his system. I researched his meds last night and it is possible he had some sort of reaction to them. Then I'm going to have them rerun this same lab work....and will include thyroid testing in it and will go from there depending on what those labs indicate. Yay....I have a plan!

We have another schnauzer from the same blood line, Nick (11 yrs) , that is hypothyroid and on thyroxin. Nick is the one I have always thought had Cushings as he is overweight, always hungry and has a pot belly. He just doesn't drink or urinate frequently and his labs don't indicate Cushings so I have not been able to get my vet to go there.

The possible anemia in Jake bothers me. We had another schnauzer before Jake from this same breeder. His name was Max. At 3 years of age, Max went into hemolytic anemia. After doggie ICU, blood transfusions, chemo, Max did not make it. I've always been on the look out for this in our other two.

Thanks so much for any and all thoughts and comments.