Poppy newly diagnosed - Cushing's and diabetes

[Bichon2]

Hi everyone. I am so glad to have found this forum as it is very reassuring to have a lifeline other than the vet!

Poppy is a 10 year old bichon. We got her from a puppy farm (unintentional - long story - won't bore). We believe her father and grandfather are the same dog. At three months, it was discovered she had a hole in her heart. Fortunately, the hole shrunk as she grew so there was no treatment required. She does have several defects:-

Patches of brown fur
Poor coat
Straight tail
Twisted hind legs
She is only half the size she should be
Occasional bouts of upset tummy (she's a scavenger who rakes bins and eats rabbit droppings and even plants!)

Despite this, she is a determined and occasionally objectionable little character who is cunning, manipulative and very ego-centric! She has a wide repertoire of tricks which she will perform as long as there is "something in it for her"!

She has never been overweight (quite the contrary) so when she started to put on a bit of a belly recently, we thought it was just her getting a bit older and related to her general slowing down (she was always a blitzer/dancer/jumper).

Three weeks ago, I noticed that she was drinking an awful lot and of course, peeing too - all over the floor. I thought it might be because we'd had a sunny spell of weather that she was so thirsty. However, when her hind legs gave way under her on the third day of excessive drinking/peeing, I took her to the vet. Her blood sugar was very high and she was immediately started on insulin. I have gone from being someone who feels faint at the sight of needles, to being a dab hand at giving injections! Needs must.

However, her condition continued to deteriorate, and she got weaker by the day. On Tuesday last week, the vet had her in for a glucose curve and over the day, the lowest reading was 24 - despite the insulin. Her insulin was increased.

The following day I felt she was deteriorating further so I got googling and found Cushings. It seemed that every box was ticked - even down to the pot belly (my husband had remarked several times that she looked pregnant!). I called the vet and asked if she could have a blood test for Cushings. She was admitted immediately and tested positive. It turned out that the vet had suspected Cushings and this was already on her notes as plan B if the insulin proved ineffective). She was kept in for several days whilst she got started on Vetoryl. We got her home on Friday and over the weekend, she was very poorly indeed. I ended up having to mash her food and give her water with a dropper. I honestly thought she was on the way out on Saturday.

Then yesterday, she seemed a tiny bit brighter. Legs still very weak but following us around and begging at the table (I give my dogs carrot and cucumber for treats, both of which have been given the green light by the vet). She was also drinking from her bowl again and going outside to pee. Drinking and peeing were definitely reduced though.

Today she seems brighter still and her glucose is down to 8.8. She is still very wobbly on her feet, but trying to jump up on me and very interested in all that is going on (especially if it is food or other dog related).

I wouldn't have given tuppence for her on Saturday so I am delighted with these small improvements.

We have a veterinary "plan". At the moment, she gets her main meal in the morning with her Vetoryl and 100% of the insulin (she gets 3 ius). In the evening, she gets a snack.

The next part of the plan is that the vet has said it would be better if she could be fed twice a day and get her insulin twice a day. She does seem less well in the evenings so this is making sense to me. I want what is best for Pops so we are starting with this tomorrow.

Due to her general weakness, she has been refusing her usual diet of Baker's Complete (dried food). We resorted to giving her mashed up cooked chicken just to get her to eat *something*. Chicken is her favourite food, but the vet isn't happy about her living on a diet of pure protein. I've been given some proprietary diabetic food to try (tinned). There is a strong chance she might refuse it, but even if she does eat it, it's very expensive indeed!

I am wondering if I can make my own and freeze it? Why can't I cook chicken, vegetables and rice then mash and freeze them? The vets says the best thing for her is routine - same food in the same quantities at the same time each day. Since now is to be the phase of intensive blood testing, med stabilising etc, I'd like to find out about this ASAP.

I'd appreciate any advice.

[labblab]

Hello and welcome to you and Poppy!

I regret that I have only a moment to post right now, but I will try to stop back by before long and I'm sure you will be greeted by others, as well. I hope you don't mind, but I am taking the liberty of adding a bit to your thread title so that people will know that Poppy is being treated both for diabetes and Cushing's.

Also, I am giving you a link to our sister forum that focuses on caring for diabetic dogs. I think you will get really helpful info there re: questions related to such things as diet and insulin.

http://www.k9diabetes.com/forum/forumdisplay.php?f=2

Once again, welcome, and I hope to return soon to add some Cushing's-related thoughts.

Marianne

[Budsters Mom]

Hello and welcome from me too.:)
I am sorry for the reason that brought you here, but so glad you found us.You have come to the right place! There are many K9Cushing's angels standing by to help and stay with you every step of the way. They love details, test results, any information you can get your hands on. The more the better. We will do all we can to help. So again welcome to you and Poppy.:)

Hugs,
Kathy

[molly muffin]

Hello and welcome to you and Poppy. Marianne already gave you the link to our sister diabetes site. It works the same as here, and has some awesomely great people, who are very knowledgeable.

I just want to check and see which test was done to check for cushings and what were the results of that. (the numberical values with ranges). Also, how much does Poppy weigh and what dose of vetoryl was she started on?

Also, was a UTI and thyroid also ruled out as possible issues. Was normal blood work done and if so where there any abnormal (high/low) values? If so what were they?

I know that is a lot of questions, it's all the things that we need to know to give you our best feedback.

Again, welcome to the forum.
Sharlene and Molly Muffin

[Bichon2]

Thank you all for the welcome. I am just about to take Poppy to get her blood sugar checked and I shall ask what her blood results were (although I think it is a kennel nurse who is doing today's check so she may not have access to the results).

She is terribly unsteady on her feet - swaying all the time and struggling to position her head for eating/drinking (she does manage it). Yet she seems happy, alert and interested. This morning she took herself outside to have a good bark at a passing dog-walker! She follows me around constantly.

I started her on the new regime of 50-50 feeding and insulin today - twelve hours apart.

It's all such a steep learning curve. >> :eek: :confused:

[labblab]

Hi again -- I'm finally back again, as promised!

These are the couple of thoughts that I wanted to add. First, as far as the Cushing's diagnosis...I don't want to upset the apple-cart, but I do feel compelled to add this note of caution. We've found from our experience here that it can be really hard to accurately diagnose Cushing's in a dog who has recently been found to be diabetic. This is because the two diseases share so many of the same symptoms and the diagnostic tests for Cushing's can return "false positives" in the face of other illnesses such as diabetes.

One of the pieces of advice that we've read is that it may be a wise idea to hold off on Cushing's testing in a newly diagnosed diabetic dog unless the dog ends up seeming to be insulin-resistant (which did seem to be your vet's initial thinking -- to first try to get the insulin regulated if possible). Another key distinguishing feature seems to be skin and coat issues: they are characteristic of Cushing's but not of diabetes. So on that score, Poppy does has a "check mark" on the Cushing's side of the ledger. But regardless, I am including a link to an article by an endocrinology specialist, Dr. Mark Peterson, who offers some diagnostic tips. Now, I am not saying that Poppy does not have Cushing's. But I just want you to be aware of the diagnostic difficulty in the event that "question marks" come up regarding her response to the Vetoryl.

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

But moving on, and assuming that the Cushing's diagnosis is accurate -- there is reason to believe that diabetic dogs do much better when they are dosed twice daily with their Vetoryl, just as they are with their insulin and food. This tends to keep a more consistent endocrinological balance throughout a 24-hour time period. Shifting to twice daily dosing means giving half the once-daily dose every 12 hours -- NOT doubling the once daily dose. Since brandname Vetoryl comes only in limited capsule strengths, it can be more expensive and more challenging to shift to twice daily dosing. Especially since Poppy has started out on 30 mg. once daily. But if it turns out that her dose ends up shifting either downward or upward, it may be easier to arrive at a combination of Vetoryl capsules. Or in the alternative, here in the U.S., it is possible to obtain custom doses from compounding pharmacies.

I know I've thrown a lot of info at you right now, but hopefully it will end up making sense in the long run, and may include things you want to discuss with your vet in greater detail.

Marianne

[Bichon2]

Hi there,

I'll start from the beginning and be as brief as poss.

10yrs Bichon not speyed because of hole in heart.

Very small dog (3.5kg) - was always very skinny but over recent months had developed a double chin and plump in the middle leading to comments like "are you sure she isn't pregnant?". She had become less manic and I put it down to aging and middle-age spread.

15/5 - 17/5 - we noticed she was drinking a lot and peeing a lot
17/5 - I was taking both dogs out every hour or so because of Poppy's accidents. When we returned from the after dinner walk, she got slower and slower and struggled to make the two steps into the house. When we got inside, her legs gave way under her.
18/5 - took her to the vet first thing. She weighed 4.2 kg. He asked how long her eyes had had a bluish tinge and said this was a sign of diabetes. I'd noticed this over recent months, but again thought it was just a sign of aging. Blood sugar test was high. Started on 3 ius of insulin. Told to switch her main meal to the morning and give insulin after food.
21/5 - returned to vet because I was worried about the leg weakness. Saw a different vet who said her knee caps were dislocating. She was started on a trial of Glucosamine to be given in meat paste.
28/5 - In for Glucose curve. Result was unsatisfactory as her blood sugar was 24 at it's lowest point. To be repeated in one week and insulin to be increased to 3.5 ius daily.
29/5 - Poppy very wobbly and clingy. I got googling - found Cushings which seemed to tick a lot of boxes. Called the vet and asked if her blood could be tested. Seen immediately. Poppy taken in for observation. Results of ACTH were:-

Baseline - 116 nmol/l
Post - 524 nmol/l

Given 5mg of Vetoryl on first day. Increased to 10mg

31/5 Poppy came home in the evening. Very sorry dog.
1/6 Very poorly, reluctant to eat so gave cooked chicken so that I could give insulin. No interest in drinking so I gave water orally throughout the day and night.
2/6 On her feet in the morning, ate breakfast. Staggered around all day after us (she likes to be involved). Begged at the dinner table. Drinking on her own again but not excessively. Peeing normally.
3/6 On her feet and wanting to go out for sniff/pee first thing. Wolfed breakfast. Had a poo (first in days). Alert and interested. Blood sugar was 8.8. Vet revised plan - INsulin reduced from 3.5 to 3.0. "Royal Canin Sensitive" tinned food - 3/4 - 1 tin per day splt 50/50 between two meals, 12 hours apart with 1.5 ius of insulin each time. Vet said she would expect her blood sugar to be higher after only half the insulin today.
4/5 On her feet, tail wagging but still extremely wobbly and swaying. Loved the Royal Canin. I gave the insulin but strongly suspect it didn't go in because when I did the little rub, my fingers got wet. Blood sugar tested 4 hours later and was 26.

Advised to stick with plan. She will get the other half of her Royal Canin Sensitive in half an hour with 1.5 ius of insulin.

She currently weighs 3.8kg - very thin though. No muscle tone at all. She is struggling with co-ordination but very willing to attempt things. Determined not to let me out of her sight (but this is a nosy thing rather than a clingy thing - she loves to people watch).

She is slower to eat things, but when her sister tried to steal her food, she stood her ground and snarled her off quite ferociously (fell over in the process). She also staggered outside a couple of times to bark at passing dog walkers!

Both my dogs love carrot and cucumber and I have been advised that this is fine to continue for "treats". They only take tiny morsels being such small dogs.

Have I missed anything? Many thanks.

[labblab]

Thanks for this info, and I see I totally goofed in thinking Poppy is taking 30 mg. of Vetoryl. Are you actually able to get it in 5mg. capsules? If so, then you could give her 5 mg. twice daily rather than 10 mg. once daily if your vet agrees that the dosing switch would be good.

Marianne

[Bichon2]

Not sure. It's a 10mg capsule once a day but the instructions say not to break the capsules so I presume it's got some slow release feature?

[Bichon2]

Sorry - reading back through the thread.

She has not been tested for UTI or thyroid to the best of my knowledge. She is peeing a lot more normally now though so I would guess not a UTI. Also does not seem to be suffering - quite alert, happy and interested.

[labblab]

Not sure. It's a 10mg capsule once a day but the instructions say not to break the capsules so I presume it's got some slow release feature?
No, the capsules should not be broken. I was confused because you said you had given Poppy 5 mg. on the first day of treatment? That's why I thought you somehow had 5 mg. caps on hand...