cockapoo: diabetes, Cushing's, seizures

[windy]

My 15 year-old cockapoo, Chester, has had diabetes for several years. My daughter also has type 1 so I use both short and long-acting insulins and test his blood sugars by pricking his tail, and using a meter. He stands for this cooperatively, even eagerly, because he always gets a little milk or glucose after the test.

About two years ago, his blood sugars got a lot worse and I increased his insulin. Then, I noticed that he was drinking and peeing a lot even when his blood sugars were fine. (High blood sugar causes the same increase in urine and thirst that Cushing's does, and we are used to oceans of urine on our wood floors and beds.)

I changed vets for him and the vet said that he probably had Cushing's. His hair is dull, very weak hind legs, bumps all over, a little pot belly, and the thirst/urine increases. Chester also has arthritis in his front legs. At the time, the vet thought we should hold off on treatment, and the reading I did online seemed to support that. Chester is old, fairly comfortable, still (at that time) walked and played (less now), and we were afraid he would be in a lot more pain from arthritis if the excess cortisol went away. He also has some allergies and asthma-like periods. Cushing's is nature's prednisone, so to speak.

Lately, in the last month, Chester has had a few episodes of what seem to be seizures. These can conceivably be caused by low blood sugar for a dog on insulin, though he has shown no tendency for this. The first two times his blood sugar was 50 something or 60 something, and since blood was taken from his tail, I figured there could be a time lag with the glucose level in his blood at tail versus central body and so maybe he could actually be lower (low for a dog is 45). However, this really is not low enough to cause a seizure, and he has been fine walking around at 30. Still, I chalked it up to blood sugar issues.

However, two days ago, he had a seizure-like episode and blood sugar was 224. Not low, for sure.

He has had the circling thing, with his head tilted, which we though might be inner ear (or stroke, at first) for brief periods, infrequently, but noticeably, in the last year. The "seizures" he is having now involve him while he is lying down, and it is like a large quiver all over his body, not the same as dreaming at all. It lasts a couple of minutes I think. Two days ago, while it was happening, he put his head up and it twisted back and forth rhythmically. He is scared and anxious afterward, some of the time, other times, he goes back to sleep.

I know this could be a brain tumor. It could also be a macroadenoma according to the reading I did online, meaning the tumor causing Cushing's, if it is Cushing's, might be large enough to cause seizures by pressing on the brain, though that is relatively unusual I gather.

I am going to wait for one more episode and test blood sugar, I guess. It Chester does not have a low blood sugar at that time, I will know for sure there is something that needs to be checked.

I would love to hear from folks who have dogs with both diabetes and Cushing's, and also from folks whose dogs have seizures as a result of either. It is possible that the diabetes has caused kidney issues, who knows, which would limit meds. Some anticonvulsants raise blood sugars. It's complicated! I have read about meds for Cushing's, including Vetoryl, Lysodren, Anipryl, Ketoconazole, and have actually tried "Cushex" in the past, which made him more active in some ways.

I do not know our new vet well, and we have very limited money, but I love my dog and though he is old, am still ready to do whatever I can both to keep him around and to keep him comfortable. Would love advice. Thank you!

[labblab]

Hello and welcome to you and Chester! I am so sorry that I do not have the time to write out a "proper" reply tonight, but I wanted you to know how glad we are that you've joined our family. And also to give you the link to a sister forum that is dedicated to caring for diabetic dogs:

http://www.k9diabetes.com/forum/

We do have several folks who are members of both groups, and therefore are able to give/receive support and guidance re: both conditions.

My own Cushpup suffered from some neurological abnormalities that we believed to be consistent with an enlarging macrotumor, and I currently have a non-Cushpup who suffers from seizure disorder. So I do have some experience with both issues and will be happy to pass along some thoughts. But I'm afraid it will need to be tomorrow. :o

However, in the meantime, I'm so glad you've found us!
Marianne

[Trish]

Hi Windy
Poor Chester sure has a lot going on, sounds like you taken great care of him through the years. I am not so good on the Cushings side of things but there are very smart people here who are! I wanted to welcome you two though and I'm sure you will get some very good advice here soon! :)

Trish xx

[windy]

Thank you both and I look forward to advice when you have time!

[goldengirl88]

My Tipper does the head tilt, and goes in circles. I called her name and she looked up at me, I picked her up and held her. When I put her back down she continued the behavior. She once did this 2 times after an ACTH test. It seems from what I read this could be a problem with the inner ear. If you find out for sure what it is I would like to know also. Also at night Tipper's whole body shakes sometimes, it seems to be muscle contractions or something to do with the muscles. I know she only did it after she started on the Vetoryl I hope this helps you some. Good luck to you and your baby.

[windy]

The video I checked out from the K9Diabetes site that was supposed to be a hypoglycemic seizure, was not a seizure. Low blood sugars make dogs (and people) shake a lot and also flail around on the floor, because legs don't work w/lows. But that's not a seizure and that's not what is happening to Chester (though that does happen with him, occasionally, caused by insulin and exercise).

The circling can supposedly happen with brain tumor and stroke but can also be ears. Thank you Golden Girl for reminding me of that idea. One site on Cushing's said the circling, like the "seizure" could be from Cushing's with a tumor that was pressing on the brain.

I guess I will just wait and see if Chester has another seizure-like episode and test his blood sugar at the same time. If he is not low, we will head to the vet.

Otherwise, I guess I could ask for his kidney function to be tested (whether diabetes has done damage over the years) and ask for some preliminary Cushing's evaluation.

If he does have Cushing's, and the vet feels pretty certain, would you recommend treating or not. Everyone on the forum knows a whole lot more about this than I do. I am unfortunately pretty experienced with diabetes, human and canine...

[lulusmom]

Hi and a belated welcome to you and Chester.

At 15 years old anything is possible so if it were me, I would want a full senior panel done to check thyroid, kidney and liver values. A senior panel includes blood chemistry, complete blood count and urinalyses. Diabetes is very difficult to control in a dog with cushing's and even the dog with severe arthritis is fairly comfortable until treatment brings cortisol levels down. Since you don't seem to be having a problem regulating Chester's diabetes and his arthritis is apparent, cushing's is not the first thing that I'd zero in on Additionally, if Chester had pituitary cushing's and had a macroadenoma that started causing him problems a year ago, I seriously doubt he would still be with you today. That's not to say it's not in the realm of possibilities but based on what I know, I doubt it.

The circling and head tilt you mentioned sounds like old dog's vestibular disease but if those are symptoms he experienced shortly after a seizure, then I doubt that is what you are dealing with. Many dogs with Vestibular Disease are euthanized unnecessarily as they cannot walk, will not eat, head is tilted and they just seem miserable. That is very sad because these dogs can see a full recovery in days to weeks. When is the last time Chester was circling and had a head tilt? Have you tried waking Chester when he is having a seizure to make sure he is having a seizure? I had a poodle years ago that I thought was having seizures in her sleep but it turned out she was having very vivid dreams and was doing some horizontal sleep walking. She was also a little vocal at times which I figured was just a dream. It scared me to death and I called my vet as soon as he opened. He asked me if I tried to wake her when she seizing. I did but it was at the tail end of things so I wasn't really sure what was going on. He told if I ever saw her do it again, try to wake her. She did it again a few weeks later and I woke her up. She looked at me like, WHAT??? So sorry to interrupt your awesome dream. :D

My cushdog, Lulu, has infrequent seizures and there has never been a question as to whether it is a dream or seizure. She will start to stumble, falls over, eyes glaze over and begins to stiffen up with her front paws slowly pulling up until they are on both sides of her face. They only last a minute or so and within three to five minutes she is usually acting like nothing ever happened. Because they are infrequent and not grand mal seizures, we have chosen not to treat with anticonvulsants.

Poodles nd Cocker Spaniels are both breeds that seem to be genetically predisposed to idiopathic epilepsy so that is definitely a real possibility. No matter what, in my opinion, a complete check up and senior panel would be in order.

Glynda

[windy]

Thanks for all the wise advice. I am pretty sure it is a seizure. his eyes were open and he was not responsive. I'll try harder to wake him out of it. I know what you mean about dreaming, and it doesn't seem like that is what it is. Another possibility might be the one someone mentioned about muscle activity/relaxation, but these episodes are probably a couple of minutes long.

You're not going to believe this, but my daughter, the one with diabetes, also has epilepsy, so it is not entirely unfamiliar either, unfortunately. Twenty years of this stuff with her.

Chester's diabetes is actually hard to manage, but I manage it because I am here with him a lot. I found a new vet because I felt that overall blood sugar patterns should not change in a way that insulin needs go way up, and my first thought was infection, including hidden dental infection, but none was found and he never got sick or a fever. The first vet did not understand what I meant. The new vet right away suggested Cushing's. So it was a change in blood sugar levels that first led me to the vet about all this.

I have read that Cushing's would have a continuous effect on blood sugars, but what I see is more of what you might call spurts, with more high blood sugars, more urinating and drinking, compared to other times, which seems like a gland might be sputtering and releasing hormones in bursts that last maybe a week or so.

In the last year, Chester has had maybe 2 or 3 circling episodes, and each time they lasted less than a full day (or maybe two). So ears as an explanation is comforting.

I guess I will take him to the vet and see what he says.

Yesterday and today I gave him a couple of drops of Cushex. Has anyone else tried this? It sure does perk him up. He played a lot more. The Cushex may, for all I know, just have some sort of energizing herb that has nothing to do with Cushing's, but it was fun to have him like that.

Poor dog, he is almost blind, pretty deaf, arthritis isn't bad right now but sometimes is painful, gets shots three times/day, tail pricks 1-2 times/day, coughs at times, but he still loves to cuddle, walk, go to the dump, plays a little, is affectionate, and relatively content.

I would not want to do any treatment that affected quality of life, I guess, because it seems like he still has some.

[windy]

My 15 year-old cockapoo Chester has diabetes and also probably Cushing's, according to the vet (for the last 2 or 3 years most likely). He drinks and pees a lot (diabetes does this too), has weak hind legs, bumps on his skin, dull hair etc. As the Cushing's progresses, he needs more insulin, since the cortisol bumps his blood sugars up. He is also nearly blind and quite deaf. His arthritis has been better lately, which is great but another sign the Cushing's has progressed.

I posted before about him possibly having seizures, having episodes of circling and wandering around the house, and things have gotten worse pretty quickly this week. I have him sleep right next to me so that I can feel his seizures (whole body quivers and shakes, not from dreaming). He is also jerking every few minutes. He gets anxious afterwards: this morning he was barking a lot for no reason.

The neurological things are really making me face the fact that Chester is probably on his way out, and possibly fairly quickly. I am going to the vet today for advice. Cushex made Chester playful a few days ago.

I have a feeling that testing and treatment won't be recommended. If that is so, then we will try to make Chester's last days here pleasant. I am going to stay with him as much as I possibly can, as I have for the last few years.

Please keep him in your thoughts. Any advice is appreciated.

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about Chester getting worse into his original thread. We like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed.

[jma1154]

I am so sorry to hear about Chester, hugs to both of you. We are enjoying Casey's last days as well, we've had some very good ones lately, we also put together her food bucket list, last night we had salmon and a little hotdog, this morning we had chicken and carrots' tonight we are having steak. She's always been such a happy puppy and still is, sometimes it easy to forget that we are living her last days. But her tremors are worsening slowly, they are happening less frequently but when they do occur they are more than just the head, they now include her shoulders as well. But she is still excited to go outside and plays with her toys occasionally, tail still makes quite a racket when she sees mommy or daddy so we continue to walk the tight rope which is our life at the moment. I hope you and Chester are enjoying those same moments together. Please keep us informed, we are here & we all understand what you are going through. I myself know just how hard dealing with seizures can be, its devastating to watch them aimlessly wonder and you feel so helpless to do anything for them. I am truly sorry you are going through that. Take care, Jill

[molly muffin]

Oh dear, poor Chester. :( I'm sure you are very worried. It hurts to see them like this.
We are here for you, any time you need us.
How long have you had Chester? How did you come to have him in your life? We would love to hear more about him if you wanted to share that.

Sharlene and Molly Muffin

[addy]

I am so sorry for Chester's health problems. It is so hard to know what is happening to them. I hope the vestibule issue is explored.
As Sharlene said, we are here for you.

[windy]

We got Chester almost exactly 15 years ago, as a puppy at a breeder's. My youngest was then 5. Now my kids are 26, 23 and 20. A long time. I am living alone with Chester right now: with him here, it is not an empty nest!

Managing his blood sugars is very hard right now. We are going to the vet tomorrow at 7:30am.

Thanks for the support everyone.

[molly muffin]

I hope tomorrow goes well! Crossing fingers

Oh little chester has been with you since he was a baby. What a sweetie. They sure do bring life to a home don't they. Happy little paws tapping on the floors. :)

hugs,
Sharlene and Molly Muffin

[windy]

The vet agrees that the Cushing's has had a surge, reflected in high blood sugars (and relief from arthritis). I am going to still try to get blood sugars under control, and got a bag of fluids to use to hydrate Chester subcutaneously if needed.

Because the seizures and twitches happen at night (or late evening), the vet thinks it is actually epilepsy and not a tumor. That means not a macroadenoma related to Cushing's. We can give him anticonvulsant meds but right now we agreed that Chester is not suffering too much.

I will continue to watch the seizures and how they affect Chester, and continue to deal with the diabetes problems related to Cushing's. The vet is going to look up Cushex and get back to me (I have some in the house), but otherwise, no treatment suggested for the Cushing's unless I cannot get the blood sugars under control due to the cortisol's effect on blood sugars.

I feel reassured for sure. We have our work cut out for us with all this but Chester is not at death's door, if the vet is right about the epilepsy.

Thanks all!

[Squirt's Mom]

Hi WIndy,

To repeat something I have said many times about Cushex - it contains herbs that should never be given to a cush pup, that stimulate the adrenals. This is nothing but a snake oil designed to achieve one purpose and one purpose only - to line the pockets of the seller. It is simply not logical to believe one product can treat two disease that are polar opposites, which is what Cushex claims - it treats both Cushing's and Addison's.

If you want to use herbal support, find a Holistic vet who is trained in this area and who will work with individual herbs, not scam products like Cushex and Supraglan.

Hugs,
Leslie and the gang

[molly muffin]

I hope you can get the blood sugar under control again. That would certainly help with everything else too. It sounds like a good visit to the vet, in that you got some answers.

Sharlene and Molly Muffin

[windy]

When I have tried Cushex, 3 drops, it revs Chester up and he gets playful. As I said before, this makes me suspicious that the Cushex is giving him false energy which would actually tire him out. The explanation that it stimulates the adrenal glands makes sense. If that is true, then the Cushex would also raise blood sugars.

Once I get blood sugars under control by establishing the best insulin levels for Chester's new Cushing's status, which apparently crossed another "threshold," I am not sure whether to pursue meds like Trilostane or not.

Finally, a clear question I can ask, though I am sure the answer is not at all clear. If Vetoryl will actually lower cortisol, maybe it is a good idea. Chester just seems a lot sicker since this latest surge, even when blood sugars are okay, as they have been today.

So, like many others, I ask, "Medicate or Not?" Appreciate people's experiences and opinions. Thank you!

[Jenny & Judi in MN]

Hi: My Jenny had Cushings and Diabetes, diagnosed in May and July 2011. I was stubborn and did not go to a specialist and we wound up overdosing her with Lysodren making her Addisonian for most of 2012.

When her cushings was raging my 8 pound dog needed 7 units of NPH insulin twice a day. for the 8 months she was regulated she felt great and her insulin needs went down to 3 units.

She was definitely happier with the cortisol under control. I felt like I got my dog back.

If I were you, I'd give it a try. The whole point of the cushings meds is to relieve the symptoms. The ACTH tests are expensive and if going to the vet stresses your dog out, that is a concern. Jenny loves going to the vet. She assumes the entire world loves her and exists to pet her and tell her she is wonderful.

So sorry about the seizures and good luck! Judi

[windy]

Wow, that is quite a difference in insulin levels! It is great to hear from someone dealing with both diabetes and Cushing's. I am going to talk to the vet about medication.

But first, good news that might seem bad to some, but people here will understand. Chester's anal gland burst a couple of days ago, the same day he had gone to the vet in the morning! He is on antibiotics and I am doing compresses and other things to help healing along. There was a massive infection in there and the thing looked ugly and smelled worse.

This accounts for some of the high blood sugars and insulin resistance, and also for some of the strange pacing and standing behaviors. And for how sick Chester has been acting.

I am going to wait until all this clears up before making any long term decisions. The high cortisol may have contributed to the infection, I suppose. I will ask. I also need to make sure that high blood sugars don't dehydrate him, which changes poop and could contribute to the anal sac problem.

[windy]

ps any reason why your dog did Lysodren versus Vitoryl? how should I make sure dosing isn't too much? start very low and move up? Thanks!

[Jenny & Judi in MN]

That IS good news about Chester LOL. I bet he is going to feel so much better! When Jenny gets ear infections her blood sugar increases a lot so I'm sure that is contributing!

Our vet went with Lysodren because that is what he felt comfortable with. At the time he also incorrectly thought she had an adrenal tumor vs the pituitary kind.

After she went too low we finally consulted a specialist. He told me if Jenny had been his brand new patient he'd have started her on Trilostane. Since we know Lysodren definitely works on her if she ever needs cushings meds again, for her, he'd be ok with sticking with the Lysodren.

For Jenny her overdose symptoms were lack of appetite and very low blood sugar. What messed me up is that on 12/22 last year her ACTH was really good, pre was 2.6 and post was 4.7. In January of last year her blood sugar went really really low (40's) and her insulin needs dropped from 3.5 units twice a day to around 1 unit twice a day. My mom was really sick and then I was swamped at work and refused to believe her cortisol could have suddenly plummeted.

I was wrong. When I finally tested her in April when she wouldn't eat her pre & post #'s were .2 and .3. She was on prednisone from April till August.

So, watch for low appetite, low blood sugar, diarrhea and lethargy.

I am entirely responsible for poor Jenny but the good news is in August her cortisol had risen a bit. And her hair has grown back in black and healthy where it was all grey and crappy.

I'm having just the pre part of the ACTH done on her tomorrow to see where we are at. Her blood sugar has had some lows and her insulin is still at 1.25.

Sorry this is so long, hugs to Chester! Judi

[molly muffin]

Yep, anything like an infection can mess with other test results, especially cortisol levels and how the body reacts to them. I would imagine it reacts with the blood sugars, much the same way. So, get that cleared up first. I'm kind of glad you found it so now you know at least.

hugs,
Sharlene and Molly Muffin

[windy]

Thanks all. This forum is one of the nicest I have ever run into.

[molly muffin]

Hi, checking in to see how Chester's bum is today. :)

I know that sounds really wacky right! Hope it is doing good though.

Hugs,
Sharlene and Molly Muffin

[windy]

His bum keeps improving. I am still doing hot compresses and washing him, giving him a little Miralax, antibiotics and probiotics, and doing a lot of blood glucose tests.

I know he has Cushing's but it is not as dire as I thought, so I am still grateful to have found out that it was his "bum" causing so many problems, no matter how much work it is for him and me!

Thanks for asking...

[Boriss McCall]

I had a min-pin who's anal glad burst once. It was yucky.. but, it healed up pretty fast. Hers was not from an infection though. She was our first dog. We had no idea we needed to take her in to get her anal glands expressed. :o

Now I have Boriss by BT & Pearl my bulldog. We have to take them in every few months to get them expressed.

Hope everything heals fast.. poor you & baby..

[Squirt's Mom]

My Trinket had butt eruption, too! :eek: A week ago today in fact when the vet offices were all closed of course. ;) This is the second time it has happened for her. The first time Doc thought she had been bitten because when he flushed it the fluid came out a second hole...but not this time. :( Everyone kept telling me how bad this should smell but there was absolutely no odor, none, and I put my nose IN it to double check. :eek::o

What are you using as a compress? I started out with a mix of herbs for antibiotic and antimicrobial, anti-inflammation, and anti-itch properties but two days ago switched to a simpler wash / compress of Marshmallow and Chamomile which will help seal and sooth the area. The warmth of the earlier compresses sure helped keep that draining, which was good!

I hope Chester is doing better and better each day. Keep up the good work, Mom!
Hugs,
Leslie and the gang

[molly muffin]

Yay, glad to hear that the bum is getting better! One doesn't really think about how aggravating I bet it is to have an anal gland get infected and burst. I really cannot imagine and really don't want to be able to either, but I'm sure it is very bothersome for them.
All that just to say, yay chester! ROFL

hugs,
Sharlene and Molly Muffin

[Squirt's Mom]

Another question....what are you doing about diet with Chester? I have to believe diet is at least partially to blame so I'm working hard to find the right balance for Trink...who is a finicky little thing at times, keeping me on my toes! :D Too much fiber and she starts to flare (colitis) but I fear that too little is contributing to the anal gland issue. And her labs always get out of whack - BG and / or thyroid values - on the diets she has been on so far. So I figured we could put our heads together. ;)

[windy]

Chester is definitely feeling a lot better. The large purple swelling on his butt is almost gone. His blood sugars are so much better. His afternoon insulin is down from 9 to 6 units already.

I put some betadine (diluted a little) on the wet wash cloth and used that in the compresses, the rinsed with a cup at the end. Now I am just doing hot water.

For diet, I heard that canned pumpkin is good for fiber. The pet store advised this, but the vet said no, that would bulk him up, and suggested a tsp. of Miralax. I have been putting Miralax powder in a small amount of water and making a solution, then using a dropper to give it by mouth.

Chester has had a tendency to have those small, hard balls that are typical for constipation. Also, I have osteoporosis and walk him less when it is icy. The Miralax is keeping his poops perfect (!) in a form that would stimulate the anal sac glands enough.

I am giving him probiotics in small amounts of pumpkin. I break open a capsule and put 1/2 of the contents in a few tsp.'s.

It is hard to give him food with antibiotics with the diabetes. So I have had to give him meat, or even a little bit of that pumpkin, to have anything at all in his tummy at 7 am for the meds.

Otherwise, Chester continues on his Nutro chicken and oatmeal dry food. His insulin is tailored to that and it would be hard to change. Also, it is hypoallergenic. He tends to have sensitivities to lots of food that cause him to vomit on our couch!

As for Cushing's, we'll see how that goes. I always wondered if the blood sugar patterns reflected infection of some sort. I mainly thought of his poor mouth. The neuro symptoms may have been partly from the infection too, so we'll see.

I gave him a bath and he smells and looks spiffy, and he is following me around again! Thanks all!

[Jenny & Judi in MN]

so glad to see this!

[windy]

Better and better! Thanks all!

[gummysmurf]

Hurray for good news!