New here/Cushings? and diabetes

[lemstar]

I have an 8 yr old Springer who was diagnosed with diabetes on 2/26/13, and is possibly Cushnoid as well. Here's some background:

Strider had a large lipoma that began to grow very rapidly, on his chest/side. We decided to remove it in September, and biopsy revealed it contained hemangiopericytoma, which was removed the best it could be. This is a cancer that doesn't tend to metasticize so much, is mostly treatable only with surgery, and then it tends to recur anyway, and is harder to remove surgically when it reappears, so prognosis isn't great. (It often occurs on a limb, and amputation can lead to a better prognosis.) It was a rough surgery, with drains in place for 2 weeks, and 2 big incisions.

Bloodwork done prior to surgery indicated high Cortisol and lipid levels, which led to testing for Cushings, which came back negative. I was sent to a specialist for an ultrasound to look at his lipoma, and also to look at adrenals. The adrenals appeared normal, and he had the surgery.

In February, he was feeling poorly, and I suspected the cancer was returning. Blood tests instead indicated diabetes. Again, we had the specialist take a look at his adrenals, and liver and kidneys, and all appeared mostly normal (liver slightly enlarged). He was in ketosis, and getting sicker by the minute, and was hospitalized and treated by a young diabetes specialist, who discharged him 4 days later on HumulinN twice daily. My vet also has a lot of experience with diabetes (and Cushings), and has me test urine for ketones and glucose twice daily. Ketones have gone down to negative or trace almost always, but glucose remains high, and we have been adjusting the dose of insulin, and are up to 48u twice daily. Strider's blood curves still show consistently high blood glucose.

The vets involved are all aware of the suspicion of Cushings. One told me that its common to test and test and test, and finally get a positive test result, and then you can treat for Cushings, which requires a lot of monitoring, and is just not always successful. So far, all the vets feel it is essential to get diabetes under control before intitiating more testing for Cushings.

I do not want to go to any lengths at all to keep my doggie alive. His quality of life is my primary concern. I would rather lose him than to torture him for years with tests and medicines that leave him feeling lousy anyway. Don't get me wrong--my dogs are easily as important to me as anyone in the world. That is why I feel this way. I don't want to keep subjecting him to so much stuff just for me.

How much testing have you guys had to undergo to get the diagnosis, and then how about regulating meds? And what are the side effects of the meds? Add to this the diabetes, and the cancer, which is now returning as well--I am not sure how to proceed.

I am lucky in that I have two actively involved vets who I communicate will with, and who are experienced in both Cushings and diabetes. My regular vet is at a conference this weekend, and hopes to get some more input on my Strider....

Any thoughts? Answers? Help? Thanks!

[Harley PoMMom]

Hi and welcome to you and Strider,

I am so sorry for the reasons that brought you here but so glad you found us as we will help in any way we can.

It seems that Strider is seeing vets that are very knowledgeable, kudos to you.

Treating a elder dog for Cushing's that also has other major health issues, like cancer, is a very difficult decision to make and I am sure your vets will be able to help you when and if that time comes. Right now getting the diabetes under control is the first priority. We have a sister site that deals with canine diabetes and I do strongly urge you to join there also, here's a link: http://www.k9diabetes.com/forum/ There are many members at our sister site that can help you and Strider tremendously with the diabetes.

Please know we are here for you and Strider and if you have any questions please do not hesitate to ask them.

Love and hugs,
Lori

[labblab]

Hello and welcome from me, too!

I heartily "second" Lori's advice that you check out our sister forum, k9diabetes.com. And I also agree that the decision whether or not to pursue Cushing's diagnostics is all the more complicated given Strider's circumstances. We do indeed have dogs suffering from both conditions who are being treated very successfully. But the differential diagnosis can be challenging.

You may be interested to read this article by Dr. Mark Peterson re: diagnosing Cushing's in dogs suffering from diabetes. He is a highly respected veterinary endocrinologist who treats dogs suffering from both conditions in his practice. But as you'll see, he does caution against leaping forward to a Cushing's diagnosis prematurely. Since you'll see him asking about this in the article, has Strider yet exhibited any changes in the condition of his skin and coat? How about any other external symptoms?

http://endocrinevet.blogspot.com/2012/01/q-diagnosing-cushings-disease-in-dogs.html

I am really sorry that Strider is having all these problems. He is too young to have to be dealing with all this medical "stuff"! But I am very glad you've found us, and we'll try to help in any way we can.

Marianne

[lemstar]

Thanks for your replies. The k9 diabetes forum folks are the ones who directed me to you! So I am sharing and listening carefully on both sites. When I began to ask more Cushings questions, they reminded me to join up over here, so here I am.

To answer your question about skin and coat, Strider came rather.....different. He was a puppy store puppy--I know, I won't do that again--and he has had various issues since we brought him home. His hair was silky as a pup, and as he grew up, he retained the typical silky coat across his back, but down the sides the fur got....almost downy....fuzzy. He had frequent skin infections, including in his mouth folds. His nose is all crusty instead of smooth and rubbery. He drinks and pees a ton, has a ravenous appetite, yet he is emaciated. And through all this, he seems quite happy, although I have my eye on him the past couple of days.

I will read that article---thanks, and I will be back....

[lemstar]

I just read the article, and he agreed with what my vet says: we don't label a dog insulin resistant until they do not respond to 1u/lb. Strider weighs 60 lbs, although is proper weight is more like 70 or 75 lbs, and he is on 48u twice daily. So we have a little way to go before we diagnose him with insulin resistance---confirms what my vets are saying.
Thanks.
Sigh.....

[molly muffin]

Hello and welcome to you and your furbaby. Testing and treating for cushings in the midst to possibly having a recurring cancer could be tricky. Getting a proper diagnosis of cushings could be tricky in the circumstance too as having something else majorally wrong can cause false positives on cushings tests. The cortisol naturally will rise to combat when things are wrong, trying to keep the dog feeling better.
Unfortunately high cortisol makes it difficult to get the diabetes under control.
I don't think I'd go down the cushings road just yet till the other things are sorted out. That is just my opinion but making sure your sweet pup who has been through so much, feels as good as he can right now is important too.
I'm glad you are on diabetes site already, between the two of us, you'll have lots of support as you wind your way through this.

Sharlene and Molly Muffin

[Harley PoMMom]

Thanks for your replies. The k9 diabetes forum folks are the ones who directed me to you! So I am sharing and listening carefully on both sites. When I began to ask more Cushings questions, they reminded me to join up over here, so here I am.

I am so happy and relieved to see that you are a member at our sister site.


He drinks and pees a ton, has a ravenous appetite, yet he is emaciated. And through all this, he seems quite happy, although I have my eye on him the past couple of days.



Dogs that have EPI have a ravenous appetite but do not gain weight, has Strider been tested for this?

[lemstar]

I mentioned EPI to my vet after reading about it online, and shesaid that his poops wouldn't be normal formed poops if he had EPI.....

[mytil]

If your dog had EPI he would physically change within weeks and you would start noticing no energy, dull eyes, diarrhea and the weight loss would be so much so that his bones will start to show. They do have ravenous appetites but unlike Cushing's, dogs with EPI actually starve to death before your eyes as they cannot produce the pancreatic enzymes to digest food - it just goes right through them.

You mentioned your dog is emaciated - this has me a bit concerned and maybe need a clarification. Dogs with untreated Cushing's start to show some loss of muscle, especially looking emaciated in the head regions, but typically look pot bellied. Dogs with EPI that has progressed actually have ribs, hip bones, elbows etc sticking out as the weight loss is so tremendous - is this what you mean when you mention emaciated?

EPI is treatable, but like Cushing's medicines, treatment is for the rest of their lives.

Terry

[Squirt's Mom]

Hi Lem and a belated welcome to you and Strider! :)

I just love that name! Brings back many fond hours immersed one of my all time favorite worlds - Tolkien's Middle Earth - and one of my heroes of that epic tale. You boy has been through so much it is easy to see that the spirit and courage of Aragorn resides in him as well.

Something I wanted to share with you about our journey. I was first told my Squirt had elevated cortisol when she had pre-dental labs run. As testing progressed, a tumor was discovered on her spleen that had to come out. Once that tumor and half her spleen were removed, her cortisol returned to normal. It was the stress of that tumor causing her cortisol to be elevated. Cortisol is one of our bodies natural responses to stress of any kind - internal or external. You say Strider's cancer is coming back (which I pray is not so) and if it is, that could skew the tests for Cushing's, resulting in false positives. I'm not saying don't do the testing but wanted you to know about this facet of cortisol - an elevation in this hormone does not always mean Cushing's and when there are non-adrenal conditions present causing stress, the tests can be skewed and therefore worthless.

The most important thing I can tell you today is this - no matter what you decide, you and Strider are now part of our wonderful family, too. You will never be alone. We will be here anytime you need to talk, to ask questions, even to scream. Strider is so lucky to have you on his side, and I am glad you both are here with us.

Hugs,
Leslie and the gang

[lemstar]

Leslie--and everyone else--
Thanks for the warm welcome. Leslie, I am crying after reading your post. I was going to say I am not an emotional mess, but maybe I am...LOL. While I am married and have a son at home, I feel so alone in dealing with all of Strider's issues.

Terry--he looks emaciated: head bones haven't really popped out (I know that look!), but his ribs and hip bones and spine are all showing. I do doubt its EPI since my vet dismissed it so easily, and his poops are normal. He has some energy, although he is a bit weaker.

Strider looks to me like he fits the Cushings thing: pot belly, hair loss, weight loss, thirsty all the time, skin problems, frequent infections of his mouth folds. But my vet called me this morning (Sunday morning) to tell me she just came from a class on diabetes at her conference, and she feels we are on the right track, and should stick to our plan of monitoring urine glucose and ketones, and increasing insulin when glucose is up, which is always, until we reach 1u/lb of body weight. So I am breathing deep, girding my loins, and moving on....

Thanks Leslie for the reminder that the cancer could be causing raised cortisol levels. I will discuss this with the vet again.

And thanks for the kind encouraging words, and for including me as part of the "family". I needed that.....
Jayne

[frijole]

Hello. I'm sorry for what you are going through. I did not deal with diabetes but I did deal with emaciation and a false positive diagnosis of cushing's. At one point I investigated EPI but ruled it out. By chance does your dog have high blood pressure or at least intermittent high levels of panting? If not don't worry about it, but if so you might have an ultrasound done of the adrenal glands to look for a tumor called a pheochromocytoma. Very rare but dogs act normal but lose a ton of weight. If you click on my screen name and look at my Annie's album you will see before and after photos. Just a thought as you look for answers. Kim

[lemstar]

Hi Kim--
Yes, he does pant a lot. Left that out. He pants A LOT! His breathing is sometimes raspy when sleeping, and he snores. (No "swollen" glands in his neck). I am not sure about his BP, but he has had ultrasounds of his adrenals twice so far, and there is no tumor or enlargement visible.
How did you get a false positive for Cushings? What test was used? Did you treat for Cushings?
Thanks for your thoughts.....
Jayne

[frijole]

My saga was a very long one and it took over a year before I got a diagnosis. At the time there were ZERO internal med specialists in Nebraska and I ended up going to Kansas State Univ Vet Hospital (5+ hrs each way) to get answers. In the meantime I spent thousands of dollars on guessing games.

My dog had 2 false positives on the 8 hr low dose dex suppression test (she only had it done twice) and like 5 on the acth test. Only one acth test came back as no cushings. In short - some diseases mimic cushings and they can result in false positives. Yes we began treatment with lysodren but it didn't work and we now know why - she did not have cushings.

I also had an ultrasound on a high res machine in Omaha but they didn't capture both adrenal glands. When I went to K State they took a lot of time and got alot of film and spotted the small tumor.

A pheo is not cushing's but can mimic it. That is why you don't rush to treat until you know for sure. A dog that is skeletal would not typically have cushing's. It's the opposite. My other dog had it - plump little thing. ;)

If you are feeling helpless you might have to seek the help of a specialist. Not sure where you live or what options you have but I can assure you it gave me peace of mind in that I knew what was wrong. I also quit experimenting and throwing thousands out the window. That is why I shared her story - just in case. Kim

[lemstar]

Kim--
Thanks. I have a good vet, and am lucky to have several specialists in town, and more an hour away. Your story has dissuaded me from my idea of trying Cushings meds without a diagnosis. We will hang tight for now. Between his possibly returning cancer, some other underlying reason for possible insulin resistance, and the diabetes itself, I am focusing on his quality of life.

My fingers are crossed for him to gain some weight and feel better....

[lemstar]

My vet called me yesterday after her conference to say that our approach was confirmed, and if we decide to start him on Cushings meds, she has proper doses, but we are not there yet.....

[juliwilliams]

Strider sounds a lot like Cooper, except coop doesn't have cancer that we know of. I'm subscribing to your thread now so I can keep up with him. Good luck and keep us updated!

[lemstar]

Well holy cow, Strider had a urine glucose reading under 1%! With Keto-diastix, readings have almost always been at 2%. So this is the first sign of responding to insulin in a major way. Ketones were up, and have gone done after a month of insulin. Spoke to my vet after that reading to make sure I should give him his full dose of insulin, which had been raised from 48u to 50u in the morning. She suggested we go to 48u for last night, and if glucose was up again in the morning (urine), to go back to 50u, which it was and I did.
Could it be we are finding the correct dose of insulin? ::::fingers crossed::::
(and no, I don't blood test at home--we havent been dealing with any lows, curves show he stays with high BG all day, so it hasn't been necessary yet--I don't want to test at home, and I don't want to badger Strider any more. He is cringing when I walk over to him, and with all of his issues, I want to actively safeguard his quality of life).
Jayne

[molly muffin]

Oh I really hope that you've found a good insulin dosage for Strider. What great news this is. :) Keep up the good work, you are an excellent mom to Strider.
Guess you are going to have to spend a lot of time on belly rub duty :)

Sharlene and Molly Muffin

[Wally P's Mom]

I did not want to test my dog's BG either. I scared me to death. However, it was quickly learned and easily tolerated by Fritz. I am able to do his curves at home and know his lows as they don't always present symptoms.

I use a meter specific for animals called an Alpha Traker 2 and purchase his test strips online for savings.

Human meters read low for dogs as the make up of the blood is different between dogs and humans. The test strips are coded for dogs. Most people meters don't code.

Controlling and monitoring his BG will add to his quality of life.

Marge

[Simba's Mom]

Welcome Jayne and Strider, you have found an awesome site lots of info and hand holding along the way...I hope you find some peace with this site too, I know I have, I don't feel so alone anymore...and knowledge is power, and there's plenty here...Take care and welcome to the family!!!

[lemstar]

Strider's urine screen last night and this morning was back up. Ketones still negative, but 2% on glucose. So today we are up to 52u. I think Strider seems peppier though, and is a bit waggier than he has been in the prior week.

As far as treats associated with shots/testing, Strider has always loved certain foods, but would pass them up if it meant a haircut, nail clipping, eardrops, or whatever. He used to be very difficult to approach with any "treatment", hiding, and slinking to the floor all sad. He has done so well with me catching his urine (he almost waits for me...almost!), and his shots. But the food is not a big motivator for him--fear is more motivating. He HATES any medical/grooming treatment. I wish he was a food hound like my other two--

We are going away tomorrow for 3 days (going with 18 yr old son to see UNC Asheville, where he will likely attend in the Fall). A dear friend will dog-sit, and she will be catching urine, and giving shots. Now THAT'S a friend!!

Thanks for the support! You guys are great....
Jayne

[molly muffin]

Wow, great friend!
Have a good trip!

hugs,
Sharlene and Molly Muffin

[juliwilliams]

48 units!! Oh my goodness! I thought I was paying a ton for Cooper insulin, he's at 30 units. You must go through a bottle in just over a week. I think we'll be going over 30 units in a few weeks and I'm not looking forward to giving him 2 injections for each dose!

[lemstar]

juli--
Why 2 injections for each dose? I use syringes that go up to 100u. Strider is up to 56u today. Likely 58 tomorrow.

And yeah, its expensive! I am looking for a place to get HumulinN cheaper. So far, Costco sells a vial for $84. I also found a coupon, but I haven't used it yet, so I am not sure if it will work, or how much it will be....

[juliwilliams]

I didn't realize there were larger needles. I guess we'll find out about it if Cooper's dose goes up any higher.

I get the humulin N from target and it's $78. And after you fill 5 prescriptions they give you a 5% off for a day coupon. And needles count as filling a prescription. I get 100 30 unit needles for $10 from target.

[lemstar]

Juli--
Thanks for the Target tip! I'm gonna check my local Target!

Jut back from our 3 day trip. My friend did great with Strider, and after getting 56u twice, the next morning Strider's urine tested negative for glucose! Then he got another 56u, and the doc said it should have gone down to 54u and to give him some lunch. The next urine was at 1/4, and now its back up to 2. So tomorrow I will up the dose to 55u, and then talk to the vet. Maybe we are getting there?

jayne

[molly muffin]

How is Strider doing? Hope he's doing well.

hugs,
Sharlene and Molly Muffin

[lemstar]

Sharlene--
Thanks for asking. Strider continues to have no ketones in his urine, and urine reads at 2%, which is high. We are up to 57u of HumulinN twice a day, and I expect that to be 58u tomorrow. Each day, if the urine glucose is up, I am raising the Humulin 1u, until we get to 60u, at which point we may be considering him insulin resistant. So if things keep going this way, we will hit 60u on Saturday....maybe by Monday, he will respond.
The good news--fantastic news in fact--is that Strider is peppy and waggy. I think he is feeling better than last week.
Sigh....

[molly muffin]

I'm glad he is feeling better but don't like that the insulin keeps having to be increased. Did you join our sister diabetes forum? I'm sure Natalie would have some ideas on the insulin issue.

A peppy, waggy Strider is good though!
hugs,
Sharlene and Molly Muffin

[lemstar]

Well kids, here goes:
Strider had one urine reading of negative for glucose (I was away, a friend was taking care of him--what a friend!), followed by another reading of 1/4, and then back up to 2 for the past week and a half. He was on 54u twice daily at that time. Since then, we have crept up to 61u (today) twice daily, and a mid day BG check at the vet was 437 on Monday, which is just a bit lower than his BG has been at that time in the past. I have not seen it go below that ever yet.

Interesting tidbit: Strider's nose was getting very crusty, even before his diabetes diagnosis in February. It wasn't smooth and rubbery, it was thick and dried and cracked. He had seen several vets during the intitial diagnosis/treatment, and they all said, yeah, that happens sometimes. Strider is 8 yrs old. He has always had strange fur--he is a Springer, and his fur has not been typical silky Springer hair. Along his spine it is, but his sides always had fuzzy wooly hair growing out--we would clip it, and it would re-grow all fuzzy and wild. He had hair grow near the corners of his mouth sort of like terrier hair. And in the past 6 months, hair began to grow under his nose, above his lip, so much that it would get knotted and I had to clip that. All of this has changed! Strider's fur is smoother and silkier, the hair under his nose is gone, and his nose is getting smooth and rubbery again!

We know cushings causes problems with skin and fur, but this is a vast improvement. So I spoke to the vet, and described these changes, and we decided to do a resting Cortisol level, just to check. It was 2.4! (normal is between 2 and 8). So Cushings is looking less likely (his adrenals were normal by ultrasound twice).
Then why so insulin resistant? 61u twice daily is breaking the bank, and yet BG stays high.

The best most important news? Strider is feeling very good! He still pants and drinks and pees a lot, but he is very smiley and waggy and happy, also an improvement. He is still soooo skinny, but is eating heartily. We have 1 more unit to go before we truly declare insulin resistant. I will say this: if this is what insulin resistance looks like, it looks good to me (except for the huge expense).
jayne

[molly muffin]

I am so happy that Strider is feeling good and his coat is coming back It does seem that cushings isn't the issue and the diabetes is the largest factor. I'd say that's good news too. Everything that you can eliminate worrying about is good. :)
You're doing awesome!
hugs,
Sharlene and Molly Muffin

[juliwilliams]

Glad to hear that Cushing's is hopefully not going to be part of his diagnosis!

You probably posted this already and I missed it, but have you checked for bladder infections? Cooper was drinking and peeing tons when he was first diagnosed with diabetes and then cushings. To the point that he was peeing in the house multiple times at night. He had a terrible bladder infection. We thought it was gone for a while because he stopped peeing in the house and started drinking a bit less, but a full urine culture (not just a urinalysis) showed that the bladder infection was still there. We're months into it and he still can't shake this infection. From what the vet said, an infection, especially a bladder infection can cause insulin resistance.