Whitey, 12 yr old Maltese, diagnosed with Cushings and Diabetes

[Kristi]

Hi everyone,

My name is Kristin and my dog’s name is Whitey. I am so thankful to have found this forum. I have been feeling a little overwhelmed lately and terrified and did not realize there was such a vast wealth of knowledge in this forum! So I’m in the process of catching up and hope to be better able to control his sickness.

Some background information:
Whitey is a 12 yr old Maltese (turns 13 this May) that usually weighs about 12-13lbs. He was diagnosed with Cushings in December 2012. He does have the panting, thin skin, hair loss, skull like head and enlarged pooch. He was originally diagnosed on 20mg of Veteroyl for a few months, then increased to 30mg for a few months, and now he’s at 10mg twice a day. He’s had his ACTH test and I was told the amount he is currently taking is actually perfect for him. He’s actually doing well on the 10mg that he is currently on twice a day. His laundry list of sicknesses include: cushings disease, gallbladder enlargement, heart murmur, and now recently diabetes. I honestly suspect that the Waggon train chicken jerky is what started all this. He was a huge fan of that and I feel horrible for not doing more research on the product. If I didn’t purchase it, then someone else would because the entire family all love to spoil him.

The diabetes has been the hardest for me to deal with. I was out of town and had him stay with my parents this past November. I came home just before Thanksgiving to find him with a wound on his face, limping around, and losing weight. My dad said it all happened within 3 days prior to me being home. I rushed him to the vet to find out he had an abscessed tooth that had ruptured through his cheek so although the vet did not like it, they had to operate as he refuse to eat anything. So after surgery, I took him home thinking he would bounce back and he did not. He kept throwing up blood and water and would refuse to eat at all and was just thirsty all the time so I rushed him back to the vet. He dropped about 5 lbs in several days and I had to leave him with the vet for several days because he had to be on IVs because he seemed to be slipping into a coma. That was extremely hard. That’s when we found out he had diabetes and he registered about 550+ (off he scale). It’s been a process trying to regulate him. His glucose is still all over the place and he’s currently on Hills G/D canned and dry with a little chicken broth and chicken and Metamucil for fiber twice a day. He gets about 7 U/L right now but he’s still at 330mg/DL-415mg/DL at his peak times. I spoke to his vet and his vet thinks that he may be insulin resistant or his cushings is throwing his glucose off track.

It’s still an ongoing battle but I hope that I will be better informed through reading everyone else’s experiences. Thank you so much!

[addy]

Hi and Welcome,

What a scary time you have had with Whitney. I am so glad you found your way here and now I am hoping you will also go join our sister site
http://k9diabetes.com/

We have active members coping with both Cushions and Diabetes and they have a wealth of knowledge to share with you and you will reach your goal of being better informed.;)

If you could round up that last ACTH test and post the results that would be great!!! In fact, if you could post all of Whitney's ACTH tests that would be even better. What prompted the change to twice day dosing?

Take a deep breath, you have been through quite a lot and we'll help sort it all out. Best part is- you don't have to do it alone anymore.

[molly muffin]

Hello and welcome to you and whitey. I bet he just get spoiled, it's the cutness factor, happens all the time.
My first thought is that I hope you Do join our sister Diabetes site, they are just full of information
I have to admit, my first thought is that the diabetes is more important to get control of than the cushings at this point. First you get that under control, it's most important and can cause those things like comas, shock, etc.
Oh dear yes, we have another member who went through the tooth thing becoming abcessed. Horrid thing to go through. That too can become a part of the problem as the infection gets into the entire system.

The test results would be immensely helpful and ask any questions you might have.

Sharlene and Molly muffin

[frijole]

Just to clarify because I might have missed it - your dog was diagnosed with cushings' in December and the episode with diabetes was at Thanksgiving so late November. Did by chance they diagnose both at the same time or was the diabetes first?

We really need to see the acth test results to make sure the cortisol is under control. If it isn't then that could be why you cannot regulate the diabetes. Thanks. Kim

[molly muffin]

Oh gads, Kim did I have that backwards? The cushings needs to be controlled before the Diabetes? I thought it was the other way around. I do remember that if you have a cushings dog with diabetes, then it's twice daily dosing, which helps to prevent spikes in the insulin, which whitey is on now.
Yep, need test results. :)

Sharlene

[frijole]

No not backwards at all. I was asking because I have seen too many cush dogs misdiagnosed at the same time they are diagnosed with diabetes and I am trying to understand the timeline.

There are some dogs that have both and without a doubt you should always focus on getting the diabetes under control. I have no idea when diabetes treatment started. Diabetic dogs are hard to regulate when they have cushings so sometimes you must add the cush drugs in order to get the diabetes under control.

That is why the timeline of treatment is so important. Sorry to confuse. Kim

[Kristi]

Thank you for catching that! I meant to state that he was diagnose with Cushings first in December 2011. I actually thought he was doing a lot better because when he was on Veteroyl he was panting a lot less. I never knew how extensive Cushings can get as a disease because I remember the vet said that most dogs once regulated will pretty much maintain the same standard of life they had before. I hope that will be the case!

In October of 2012, I noticed he started drinking a lot more water which the vet thought was attributed to his cushings at the time and he was suppose to come in and get checked in November. He was diagnose with diabetes in November 2012. I believe he's only had one ACTH test and one urinalysis and I will definitely get the test results and get it posted. The vet said we should have taken it sooner after he was on veteroyl but because he had so many issues we were dealing at once and he was not on a constant dosage that we did not. I've actually seen 2 different vets and took him to the Kansas State College of Veterinary School and that's where they took his urinalysis. His "family" vet actually referred him to the one vet we have been seeing since December of 2011 and that is his main vet since because I live in a small town and we don't have sonogram and the equipment necessary to diagnosis him. When he had his diabetic episode I was referred to Kansas State because in addition to his diabetes he started getting anemic but that has since gotten better.

Thank you so much for the recommendation for the k9diabetes website also! I also registered for the site yesterday :). Initially I tried to focus one on thing at a time. I've been so focused on dealing with his diabetes that I forgot how interrelated his diabetes and cushings is.

[NoonelovesmelikeNorman]

Hello Kristin and Whitey, I am relatively new to the group and just wanted to say welcome and to let you know the site is so supportive and informative. They know there stuff on cushings, and many other conditions that go along with the disease and aging pupps.

Wishing you and Whitey the best. it is nice you have the KCC Vet School to go to and your vet is willing to recommend and work with them. with that and this site your Whitey is in good hands.

Peace, Sharon and Norman :)

[frijole]

I live in a small town in Nebraska and I had to go to K State for my Annie. I love that place. I am so glad that your local vet can get advice from them. I have found that there is a huge difference between my vets in Omaha and where I live now - just not as up to speed on this stuff.

When dealing with two diseases like you are most vets would find it challenging and so having K State as a resource is invaluable. Use them when you can. They were actually cheaper than the vets here on a lot of things. Kim

[molly muffin]

Okay, so cushings first, and that seemed to be controlled until the drinking increased and then diabetes was diagnosed due to testing during that time.
So, now the issue is getting the diabetes controlled too? I am sure in that regard that the diabetes forum will be very helpful. They are super good with that. I think though that seeing the ACTH test will be helpful. The Post number is very important, especially when you are trying to control both disease. So, you aren't going to want too high or cortisol in your post number. Optimally it will be under 5, but not too low either.
Tricky isn't it.
We'll have a great big group hug. You aren't alone in this and you aren't alone in dealing with both either. Several of our members are doing so.
Once they controlled, then yea, they Can have a normal life and life span. It's just getting into the golden zone. That will mean having to have more ACTH test done though in all likely hood. It's great that you have the University Vet hospital that will be very helpful I think.

Sharlene and Molly muffin

[SoggyDoggy]

Hi Kristi, welcome to you and Whitey, but I'm sorry you and he are having to deal with all of this.

As you will have noticed, everyone keeps saying they would like to see Whitey's blood test results. If you don't have them already, it is a great idea to get copies of all of the blood tests done for Whitey and keep them together in a folder or something so that you personally have a record. I would suggest this is especially important if you are dealing with multiple vets as it can get confusing and it is possible that somewhere along the way something gets forgotten.

We all understand the overwhelming feeling and terrifying fear that can go with it. I myself was at that point just a few months ago, but the level of support here, and I would assume at the k9diabetes site as well, is just so amazing that you will soon get past that and get a handle on everything again. You have dealt with the cushings for 12 months already, you will get through this bit too. The great thing is that you can feel free to vent those fears and frustrations here and there will be any number of people holding your hand through it.

[Kristi]

Thank you very much everyone for the warm welcome!

It does make me feel so much better knowing that I’m not facing this alone and that there are others that have dealt with this for years and have had good results. I’ve been reading through the diabetes website and will be updating on that. I will be changing the home monitor I’ve been using since I’ve realized how inaccurate it is based on others experience! I’ve also requested all lab samples of all tests that Whitey has taken and will keep everyone posted.

Thank you for the advice on keeping an organized folder on him. That is a wonderful idea! Especially because I do travel for work a lot and I’ve always been able to make work arounds with him but now that I have the diabetes to contend with it will be better to have a folder with his entire history. I have heard that the Kstate Vet clinic is one of the best in the state so it does make me feel better having them but unfortunately it’s a four hour drive away. I believe Whitey’s cushing is under control from what his vet said but it’s his diabetes that I’m having trouble with right now. I get so confused because from what I read online I’m not a fan of science diet because of the ingredients/carb content but he is currently on Hills G/D (since he hates Hills W/D). I will have to read up on that further since I do see several other members on k9diabetes that is regulating their dog on Hills W/D. Thank you once again for the great support system!!

[Kristi]

Hi all,

I have been able to obtain his testing results and it looks very foreign to me.

His bloodwork was taken on 11/26/2012:

WBC: 28.1 K/uL Critical High; Ref range 6.0-15.0 *confirmed by repeat analysis*
Neu %: 72.8 % (blank) ; Ref range 60.0-74.0
Lymphocytes %: 2.7 % Low ; Ref range 12.0-30.0
Monocytes %: 17.1 % High ; Ref range 2.0-8.0
Eosinophils %: 0.0 % Low ; Ref range 2.0-8.0
Basophils %: 7.4 % High ; Ref range 0.0-2.0
Granulocyte #: 20.4 K/ul High ; Ref range 2.0-10.0
Lymphocytes #: 0.8 K/ul Low ; Ref range 1.0-5.0
Monocytes #: 4.8 K/ul High ; Ref range 0.1-1.0
Eosinophils #: 0.0 K/ul (blank) ; Ref range 0.0-0.4
Basophils #: 2.1 K/ul High ; Ref range 0.0-0.2
RBC: 3.51 M/ul Low ; Ref range 5.50-8.50
HGB: 7.6 g/dl Low ; Ref range 12.0-18.0
HCT: 23.90 % Low ; Ref range 37.00 - 51.00
MCV: 68.1 fL (blank) ; Ref range 61.0-79.0
MCH: 21.5 pg (blank) ; Ref range 20.5-25.0
MCHC: 31.6 g/dL (blank) ; Ref range 30.0-36.0
RDW: 13.6 % (blank) ; Ref range 10.0-20.0
Platelet Count: 667 K/ul High ; Ref range 150-600
MPV: 8.7 fL (blank) ; (blank)
Glucose: 149 mg/dL High ; Ref range 71-115
BUN: 72 mg/dL Critical High ; Ref range 7-27 *confirmed by repeat analysis*
Creatinine: 1.5 mg/dL (blank) ; Ref range 0.0-1.5
B/C Ratio: 48.0 Ratio High ; Ref range 7.0-25.0
Sodium: 152 mmol/L (blank) ; Ref range 145-155
Potassium: 3.0 mmol/L Low ; Ref range 4.0-5.6
Chloride: 107 mmol/L Low ; Ref range 112-124
ECO2: 30 mmol/L High ; Ref range 13-29
Anion Gap: 18.0 mmol/L (blank) ; Ref range 10.0-18.0
Calcium: 9.1 mg/dL Low ; Ref range 9.8-12.0
Phosphorus: 6.7 mg/dL High ; Ref range 2.5-5.0
Total Protein: 7.4 g/DL (blank) ; Ref range 5.3-7.8
Albumin: 0.9 g/DL Critical Low ; Ref range 2.3-4.3 *confirmed by repeat analysis*
AST: 51 U/L High ; Ref range 0-40
ALT: 30 U/L (blank) ; Ref range 4-66
Alk Phos: 1123.0 U/L Critical High ; Ref range 0.0-88.0 *confirmed by repeat analysis*
TBIL: 0.3 mg/dL (blank) ; Ref range 0.1-0.6


From his veterinary hospital his diagnostic test show 11/28/2012:

Physical Examination: Distended abdomen, pale mucus membranes, mild lymphadenopathy, grade 3 out of 4 heart murmur

Diagnostic tests:

Urinalysis: +1 glucose, +1 protein, negative for ketones

Urine culture: results pending (I will check to see what that was)

CBC and reticulocyte count: elevated WBC (29,700) with a left shift; hematocrit 24% (nonregenerative)

Blood chemistry: blood glucose 307; BUN 44; creatinine 1.3; ALKP 1766

Baseline Cortisol: 272 nmol/L (reference 26-125)

Assessment: Whitey's most recent increase in drinking and urinating (beginning in early Oct) appears to be caused by diabetes mellitus. With both Cushing's disease and Diabetes mellitus, it will be important to carefully monitor both diseases with ACTH stimulation test (Cushing's dz) or blood glucose curves (diabetes).

His ACTH test taken on 12/17/2012:
Cortisol, Baseline: 53
Cortisol 1 hr post ACTH: 250

This information is provided to me from one of his vets. I will attempt to see if there is anything additional from another vet that he was seeing. I had him tested for his diabetes today and he was at 184 mg so I'm very excited about that! Finally I feel like I'm getting somewhere. He has increased to 8 units of insulin at this time to help to regulate him better. But the downside to all of that is that I noticed this week that he is losing his eyesight drastically so I had him checked for that. He's been having cataracts but it never progressed to what it has now. I have noticed that he can not find his food as well and the other day he was staring at the light assuming it was me I believe and was begging for food. It was heartbreaking. One of his eye is completely blocked by his cataract and the other is almost gone to. I'm not sure if he can have cataract surgery due to all of the conditions he has. I hope he really isn't hurting though. He still seems content and playful but mainly he brings so much joy to me that I hope he is getting the quality of life he deserves :( I am grateful for the support this forum provides. It helps knowing that there are others that understand exactly what I'm going through. Thank you everyone!

[frijole]

Thanks! If you don't mind, we need the ranges for normal next to the items on the blood panel. To save you time you can just provide the ones that are above or below normal. (abnormal) Each lab is different so we need that info.

It is important that you get the diabetes regulated so don't worry about the cushings at this time. No rush to treat that at this time. Kim

[Kristi]

Sorry about that! You can tell I didn't even know there was a difference between labs but I was able to input all the information on the lab result. This was taken during Thanksgiving and when I was really concern that he would not make it since he seemed like he was starting to slip into a coma and when we discovered his diabetes and initial reading was greater then >700 per his lab report. I will probably check today to see if he is a candidate for cataract surgery but with his conditions I don't have much hope. I don't believe he has the best sense of smell because even when fed he can't find the food right away and has to kind of search around for it. I also notice him bumping into walls and having tiny scratches on his legs more probably from that. Have a great day everyone!

[Harley PoMMom]

Some of the things that really concern me with his blood work results are his: elevated WBC, when high usually means an infection somewhere, was Whitey checked for an UTI?; elevations in the BUN, phosphorus and a high normal creatinine, which usually points to a kidney issue, since the phosphorus is high did the vet mentioned using a phosphorus binder? or kidney problems?

Sending hugs to you both,
Lori

[frijole]

Hello, it's me again. One of our members is a med tech with over 20 yrs experience reading bloodwork and she is very helpful. She asked me to point this out to you as she feels it is critical information:

HGB: 7.6 g/dl Low ; Ref range 12.0-18.0
HCT: 23.90 % Low ; Ref range 37.00 - 51.00

For a human, these results are close to being critically low. I don't see a retic count in that lab report, so that is something that probably should be done. Of course, the diabetes is the first priority, but some serious questions need to be asked of the vet about the anemia.

Did your vet do a retic count? Please check the report. Also please don't waste time - if your vet has not mentioned anemia you need to phone THEM and bring it up.

I trust this person's opinion implicitly so please know she is legit ok? Thanks! Kim

[Kristi]

Thank you for your input! Yes, he was seen for the anemia at the Vet Hospital. I was advised that once his diabetes is under control that will even itself out also. I believed that was the case was because initially his gums looked almost completely white but he has color in them again. I think he is due for another ACTH test/blood work since this was initially done when he was severely sick. The infection is from a tooth that he had that actually "blew?" out from his cheek..I've never seen that happen before but that was one of the reasons I rushed him to the Vet and Vet Hosp during Thanksgiving. His tooth was removed despite the fear of complications because he was refusing to eat at the time. The Vet did think he would bounce back after the tooth was removed, however he continued to to throw up blood and refuse to eat so I took him back to the vet and that's when the diabetes was discovered. It's been a work in progress and there's been so much going on. The vet told me he is one of the more complex cases..since normally it's one or two condition but Whitey seemed to have so many conditions combined. =T..