Ailidh - Westie with Cushings and Diabetes

[GillH]

Hello everyone, I am just introducing myself as I am new to this forum. I have come across from the K9diabetes forum where I have already got lots of useful information.

I don't have a specific question to ask at this time but if anyone has a dog with both Cushings and diabetes I would love to hear from them with any advice and their personal experiences.

I am giving Ailidh's history here, as much for my own records as for your information. It's good to have somewhere to record these things as well as any advice along the way.

She is 13 ½ years old, has been fed a mostly home cooked/raw diet with some exceptions, never been vaccinated but has received Homeopathy Nosodes instead. She weighed in at around 11kgs when I first took her to the vet in 2011/2012. She is now close to 9kgs, possibly slightly under.

Ailidh was doing well on Vetoryl since being diagnosed with Cushings in October 2012. I had taken her to the vet originally in May of 2012 due to a nasty skin condition. She was then twelve and had been in very good health up to that point, apart from one incidence of Kennel Cough the previous year which both my dogs had quickly recovered from.

The skin condition cleared up with antibiotics but her ears became dry and itchy in the October and that's when the vet suspected Cushings. I mentioned that she seemed hungry all the time and panted a lot at night even though it wasn’t particularly hot. She also had a bit of a pot belly but as she’d always liked her food I assumed she was simply a bit overweight, despite getting lots of exercise. She seemed well otherwise and was happy, her usual feisty self and always eager to go for walks.

When Cushings was confirmed she was started on 30mgs of Vetoryl daily. This was increased to 40mgs after further tests. She becomes very stressed at the vets so I would take her for the first part of the test then return home with her and take her back an hour later to try to minimise her stress, so that she didn’t have to stay between the first and second parts of the test. It didn’t really work as she was still very stressed as soon as she was taken in to the consulting room.

However, she seemed to be doing very well. Coincidentally one of the vets at the practice also had a dog with Cushings, diagnosed around the same time. Her dog wasn’t responding to the treatment as well as Ailidh who had never seemed ill, apart from the original skin problem. Once on the Vetoryl the panting and excessive hunger was resolved, although she continued to enjoy her food but was no longer constantly begging for more.

Fast forward to July 2013. We had been on holiday in May, beginning of June with no problems (my dogs come with us). She enjoyed her walks and was her normal self. There was no indication to outward appearances that there was anything wrong with her. The Vetoryl continued on 40mgs a day, in the morning with food.

She was due her regular blood test towards the middle to end of July. We had the opportunity to go away again for a few days at the end of June. During that second holiday she had a couple of accidents in her bed at night and also on the journey home. She was also reluctant to go for walks so that by the end of the holiday I was leaving her behind with my husband and taking my other dog on his own. Knowing that her blood test was due in two or three weeks’ time I was thinking that her Vetoryl probably needed adjusting and so phoned my vet as soon as we returned home. Long story cut short, on 8th July diabetes was confirmed.

The vet’s advice was that we needed to now ‘forget’ about the Cushings, i.e. not do any tests although they were due and to continue with her treatment as before. The priority had to be the diabetes, starting her on 2 units of insulin twice a day until I was able to do the first blood curve.

Did the home curve on 18th July (another long story that I won’t go into here) and my vet adjusted the insulin to 3 units twice a day.

Next curve was on 29th July, emailed results to the vet and adjusted insulin to 4 units twice a day. That’s where we stand at the moment, next home test due in a few days’ time.

As far as her Cushings is concerned I have no idea as we haven’t been able to do the test. She sleeps most of the time but eats well. She went blind during the few days between taking her to the vet and the result of the blood test that confirmed the diabetes. She manages to find her way around by moving very slowly and sniffing her way. When diabetes was first diagnosed she started to get very wobbly on her feet, falling over quite often. She has improved from that but is still a little unsteady, some of which might be due to not being able to see. She is possibly not completely blind but she does bump into things. She is a shadow of her former self and to think when we were on holiday less than two months ago we had no idea of what was about to happen and how quickly things would change for her.

Her Cushings has taken a ‘back seat’ at the moment while we try to regulate the diabetes, although she is still being treated as before. I would love to hear from anyone who has walked a similar path. Any words of encouragement would be welcome but also any realistic prognosis would be equally taken on board. I need to be fully prepared for anything that might be thrown our way.

Sorry for the very long post, as I say this is as much for my benefit as anything, but thank you if you have taken the time to read it.

[goldengirl88]

Hello:
Welcome to the group. This is certainly a scary story, and the diabetes is always in the back of my mind too. Did you dog show any signs on the blood work previous to this happening? What was the glucose level then? I don't know a lot about this, but am always scared my dog will end up with this too. I hope everything turns out well for you two. I have seen many Terriers on here with Cushings. It seems to run high with the breed for some reason. Blessings
Patti

[GillH]

Thank you Patti, as far as I'm aware there was no indication of this in the previous blood works, but without specifically asking my vet I don't know for sure. My vet is very thorough and has been extremely helpful and supportive through all this, so I would like to think she would have flagged up anything unusual if it had been seen.

I don't know if there is anything you can do to prevent it happening, except to give your dog the best of care in any case, which to be honest is what I did. I don't think there is anything I could have done differently that might have prevented any of this and sometimes you just have to accept the inevitable. My other dog is fourteen (collie x springer) and in excellent health and both have been brought up exactly the same way, and yes some breeds seem to be predisposed to certain illnesses and conditions. Hopefully you are worrying for no reason!

[GillH]

Does anyone have any experience of treating Cushings with natural holistic remedies? I have a Homeopathic vet not too far from me and I am considering consulting him for Ailidh, but I have no knowledge as to whether it is realistic to stop the Vetoryl in favour of an holistic remedy and would like to hear from anyone who has gone this way and with what results. Thanks!

[goldengirl88]

I don't believe there is anyone on here that has had any success except with the traditional drugs. It would seem the other methods however good intended do not work. Blessings
Patti

[lulusmom]

Hi and welcome to you and Ailidh.

I'm sorry for the reasons that brought you here but am glad you found us. I'm doubly glad that you are already a member at k9diabetes as you will have some very seasoned guidance from those folks.

I would be particularly interested in knowing if Ailidh's eyesight was lost to diabetic cataracts and did this happen before or directly after the diabetes diagnosis? I ask because if she lost her vision quickly, there is a good possibility that she could have SARDS. A veterinary opthamologist is the most knowledgable professional to make this diagnosis. Was she seen by an opthamologist?

I would also be very interested to know if Ailidh's cortisol was well controlled with the Vetoryl. Can you please round up copies of all of the ACTH stimulation tests that were done by your vet to make this determination? Cushing's can be a contributory factor in a dog developing diabetes but if it is well controlled with treatment, this usually doesn't happen. Therefore, looking at test results may help a lot in figuring out the progression of Ailidh's issues. If you don't have copies of testing, your vet should be happy to provide copies. We actually recommend that members keep a folder with all medical records. I don't know about Ailidh but my own dogs seem to get sick or have urgent issues after hours that require a trip to the ER. Attending er vets appreciate having their patient's most up to date medical history at their finger tips. It also helps when members ask you to post test results. We can be a thorn in your side but it's only because we care and want to provide more than moral support. Folks here have years of experience under their belt, the benefit of following hundreds of case studies here and the lots of science based reference material to share with you so that you can become the best advocate you can be for Ailidh.

You have definitely come to the right place(s). Dealing with one of these conditions is difficult enough so you have the best of both worlds to help you and your precious girl. You are part of our related families and you will never have to walk alone. We're here to help in any way we can and you can help us do that by providing as much information as possible.

Glynda

[GillH]

This is what I understood when I first researched Cushings last year and why I went with the Vetoryl, but it has crossed my mind that I might have missed something or that maybe there is something holistic that can be used in conjunction with the Vetoryl that might help her, just trying to consider if there are any other options. Thanks Patti.

[GillH]

I would be particularly interested in knowing if Ailidh's eyesight was lost to diabetic cataracts and did this happen before or directly after the diabetes diagnosis? I ask because if she lost her vision quickly, there is a good possibility that she could have SARDS. A veterinary opthamologist is the most knowledgable professional to make this diagnosis. Was she seen by an opthamologist?

I would also be very interested to know if Ailidh's cortisol was well controlled with the Vetoryl. Can you please round up copies of all of the ACTH stimulation tests that were done by your vet to make this determination? Cushing's can be a contributory factor in a dog developing diabetes but if it is well controlled with treatment, this usually doesn't happen. Therefore, looking at test results may help a lot in figuring out the progression of Ailidh's issues. If you don't have copies of testing, your vet should be happy to provide copies.
Glynda

Thank you Glynda, Ailidh's blindness is caused by cataracts and happened within a few days of them first being noticed (by me) and almost the same day that she was seen by the vet and blood taken for testing. By the time we got the result confirming she had diabetes she had gone blind, possibly she has some limited vision but it's hard to tell. No she hasn't been seen by an opthamologist.

I don't have any copies of Ailidh's tests but I will get in touch with my vet and ask for them. Testing Ailidh at the vets has been a challenge as she gets extremely stressed in that situation which I am told does affect the results of the blood test. She is now overdue her test for Cushings as it was due towards the end of July but the treatment for diabetes has taken priority.

Thank you so much for your input, very much appreciated!

[Concernedmom]

Welcome
I am treating holistically. Have been since Feb 28th. My dog had all the clinical signs of cushings that are now controlled. I have a thread on the site if you're interested in reading my story. I know of one other member that is treating holistically. Here is a study that might give you some helpful information. It is the one my vet gave me and the remedies talked about is what we use.
http://www.bahvs.com/wp-content/uploads/2012/11/Cushings-Research.pdf

I am very sorry for Ailidh's health problems.
Hugs

[GillH]

Thank you Concernedmom, I have just taken the time to read your thread and found it very interesting. My problem at the moment is how to know what symptoms are caused be her diabetes and what is caused by Cushings. I keep hoping for some improvement in her condition now that her insulin has been upped to 4 units twice a day, but she is still very lethargic, pants a lot and sleeps most of the time. When she does get up to move around she's unsteady on her feet. It doesn't help that the weather here in the UK is hot at the moment which must be affecting her. I am due to do a blood glucose curve on Sunday which will show if she is improving on the insulin and I only started her on the new dose four days ago, which I know is too soon to be seeing any miraculous improvement. I guess I'm just impatient! Without her having another ACTH stimulation test I can't tell if the Vetoryl is doing her more harm than good and as she was fine on it before the diabetes came along (or at least seemed to be) so I'd be reluctant to stop it without very good reason.

At the moment her quality of life is poor, she has nothing to look forward to except to eat and sleep as she can't go for a walk and only walks slowly around the garden when does go outside. I suppose the fact she has a good appetite and does eat her dinner without any problem shows she is hanging in there and I don't feel ready to give up on her just yet. If only I had a crystal ball and could see that in the not too distant future she would show some improvement.

I think I will wait for the results of the curve on Sunday and depending on that and how she is I will consider contacting my Homeopathic vet. One thing I don't want to do is play Russian Roulette with her medication and I do know that getting the insulin right for her is going to take time.

[Jenny & Judi in MN]

Gill: some folks on the diabetes forum had good luck with vitamin B12 bringing back some rear leg strength. I think Antonia's Eddie was one of them.

[frijole]

You are right - you have to be careful not to upset the diabetes. The challenge is that diabetes is hard to control when the cushings is not regulated. Some dogs are easier than others.

To be honest a large percentage of dogs with both cush/diabetes require the aid of internal med specialists (IMS) vs regular vets as it is just too specialized to handle.

Wishing you great success. Kim

[kaibosmom]

Hi and welcome to the forum. I have found it to be an amazing place for information and most importantly support! My dog Kaibo has both Cushing's and diabetes. His story is long and frustrating and too much to go into here! However, I will share the stuff related to diabetes.

At the time he was diagnosed with diabetes, he was not on any Cushing's meds (part of the long story, lol). I had noticed that the last few blood tests began to show high glucose, which had never been an issue before. I brought it up a few times but was told, oh it isn't that high, it is likely due to stress. In April, we finally found a mass on his adrenal gland. Things seemed to be finally making sense. We knew we wanted the surgery but the vets wanted to see if it was a pheochromocytoma. So we did a urine catecholamine test for that and waited and waited for results. It was supposed to be one week and it ended up being three! During this time that we were waiting I noticed he wasn't himself and knew something was going on. We started finding huge wet spots on the area rug when we got home. I put a call in to the internal medicine specialist and through a miscommunication, she thought that I just wanted test results when really I wanted to talk to her about Kaibo's strange behaviour. She emailed me! Wow. I was upset and felt like she was just brushing me off. That was on a Wednesday. By Friday, he had really gone downhill. I contacted our family vet by text message that night and asked if he could come in in the morning. The new vet in the office was the one to see him and I couldn't have been more lucky. She is amazing. I dropped him off, crying because I didn't know what was happening or if this was all from the tumour or whatever. I mentioned I thought perhaps he had diabetes and showed her all of the blood work (it really is good to have copies of all of the tests!!!)...again she said she didn't think that was what was happening. A few hours later, I received a call that said he did have diabetes!

Well, I was told right away that this might help determine if Kaibo's tumour was functional and causing the Cushing's or not as a Cushing's dog is harder to regulate on insulin. Weeks went by with horrible curve results and ever increasing doses of insulin. Also when he was diagnosed, surgery to remove his tumour was put on hold as they wanted to get control of the diabetes first. In the end, Kaibo was not being treated for Cushing's but was getting insulin. He ended up with a dose of 8 units Caninuslin twice a day and he is only 5kg! He had surgery last week to remove the adrenal tumour. He is home now and recovering nicely. His blood glucose was very good in the hospital in the days following the surgery. I have always been (and continue to be) optimistic that the diabetes will also go away now that the tumour has been removed. They did drop him back to 2 units twice daily after the surgery but at home I started getting BG levels in the 30s but also he wasn't eating. He is on 4 units now and I am doing a "mini" curve tomorrow. It has only been a few days but we want to see where he is at.

This long story was not short at all. Sorry! I am not sure it will help you at all either...but I've typed too much to delete it now. :D I guess I just wanted to share that you are not alone in your frustration over getting the blood glucose under control. It is terrible having to wait but it will all sort itself out soon. If the Cushing's isn't well controlled it will take longer for the diabetes to be controlled but it will come. Hang in there!

[kaibosmom]

Judi...I'm interested in learning more about the b12!

[GillH]

I guess I just wanted to share that you are not alone in your frustration over getting the blood glucose under control. It is terrible having to wait but it will all sort itself out soon. If the Cushing's isn't well controlled it will take longer for the diabetes to be controlled but it will come. Hang in there!

Wow! Thank you so much for all the information and your encouraging comment! I can't get enough info at the moment so never apologise for a long post! It does make me feel better to read everyone's stories and to know that other dogs have been in similar situations and have pulled through to carry on living decent lives. Thank you everyone for your comments and suggestions, all this really is helping me and I'll keep on doing what I'm doing.

I took my other dog out for a walk this evening and Ailidh got up and looked for all the world as though she wanted to come too . . . . not possible, but it was good to see her taking an interest and waking up when Brendon (my collie x springer) started barking when the lead appeared. Then when we got back from the walk she came to meet us and yapped a greeting and made quite a fuss of me. That's the most she's done all day so it was very encouraging. Then she ate all her evening meal then went to the other bowl to see what Brendon had left. Asleep again now but I'm feeling much better tonight than I was first thing this morning when she wouldn't stop panting and lying down. Early days I know and . . . . . . . patience is a virtue!! ;)

[Jenny & Judi in MN]

Judi...I'm interested in learning more about the b12!

here is a link to some of the discussion about b12 http://k9diabetes.com/forum/showthread.php?t=4601&highlight=weak

[GillH]

Hi all, it's been a while since I posted on here as any problems I've had have been diabetes related. Ailidh seems to be fine on her present dosage of 40mgs daily of Vetoryl. Diabetes is almost regulated at last, still some fine tuning but we are getting there. She is doing pretty well, she can now go for walks although still a bit slow and not as far as previously (i.e. before July when diabetes was diagnosed) but I'm more than happy with that as at one point I didn't think she was going to be around for much longer. She did have to have her right eye removed a month ago due to complications of the cataract in that eye but has recovered well from the op.

We've been concentrating on getting her diabetes regulated, then this issue with her eye cropped up so Cushings has taken a back seat. It's very fortunate that she was doing well on Vetoryl and was stable well before the diabetes appeared.

But I have been wondering how long she can go without being re-assessed for Cushings as I understood a maximum of three months was advised between tests. She was due this in July, it's now mid October.

My vet telephoned me about another matter yesterday and I mentioned that I was concerned that she had missed the Cushings ACTH test and how long could we go on without it? Now that the diabetes was almost to the point of being regulated should we be considering it? Ailidh is particularly stressed when at the vet (not surprisingly) so I know her readings aren't reliable.

She told me that testing was not an option at the moment because they do not have the drug to do it. They cannot get any new supplies and are not sure if it is going to be available again. At the moment they cannot test new suspected cases of Cushings. I was quite shocked at this revelation so my question is, have any of you in the UK come across this problem?

My apologies if this has already been asked and answered, I have not had time to look at other threads.

[lulusmom]

Hi Gill,

I'm so glad to hear that that Ailidh is doing so well. Maintaining control of cushing's is difficult but when you add diabetes to the mix, it can be a hair pulling experience. You've done a great job!

I did a little research and the stimulating agent used in the UK is called Synacthen and there is a shortage but according to the VMD, it is expected to be back on the market mid month. Also according to the VMD, vets should contact Dechra, the manufacturer, to obtain advice on how to monitor treatment of Vetoryl until that happens. I would be very interested to hear what Dechra has to say. I'm guessing that they might suggest to your vet that he obtain a resting cortisol until Synacthen is available. There is literature about this but not all agree as to how accurate it is, especially if a dog is highly anxious at the vet's office; however, I think it's certainly better than nothing at all. If they suspect a long term delay in getting Synacthen back on the market, they may offer guidance on how to import a like drug from another countery. I'm a nervous nelly so if it were me, I'd probably call the manufacturer myself, using the number the VMD provided in the hopes they would talk to me and give me an update.

See excerpt below from VMD website:


Synacthen

The VMD is aware of a European supply problem with the human authorised product Synacthen, PL16853/0017. Synacthen is a synthetic ACTH, indicated as a diagnostic test for the investigation of adrenocortical insufficiency. It is used for the diagnosis of hyperadrenocorticism (Cushings), hypoadrenocorticism (Addison’s) and for monitoring trilostane therapy in cats and dogs. Normal stock levels are due to return to market from the middle of October 2013.

If veterinary surgeons are aware of any other alternative products, you may submit import certificate applications for these. Each application will be assessed on its individual merits.

If you would like further information on Synacthen, please contact Alliance Pharmaceuticals Limited on 01249 466966.

For further veterinary advice on how to monitor dogs treated with trilostane in the absence of synthetic ACTH, please contact Dechra Veterinary Products on 01939 211200.

Keep up the good work and please keep us posted when you do have Alidh's cortisol levels checked.

[GillH]

I'm guessing that they might suggest to your vet that he obtain a resting cortisol until Synacthen is available. There is literature about this but not all agree as to how accurate it is, especially if a dog is highly anxious at the vet's office; however, I think it's certainly better than nothing at all.
.

Thanks for all the information! I will be in touch with my vet again in a few days so I will pass that on. She did say that because Ailidh gets so highly stressed at the vets the readings are too unreliable in any case, especially now we have diabetes in the mix. I got the impression that she felt it is better to leave Ailidh as she is for the time being rather than cause her too much stress now that she appears to be stabilised. With the drug unavailable for the time being a decision one way or another has been taken out of our hands. I'll see if anything changes with the drug availability and go from there, unless I feel there's any problem that needs attention first then see what the options are. Thanks again for going to so much trouble to investigate.

[rock2avenged]

hello gill
my name is sue and I am a mum to a twelve year old Labrador called ebony. ebony was diagnosed with diabetes in july 2008 her sugar levels were in the 30's. she was put on a insulin starting dose of 10units twice a day which was increased until it was up to 30 units twice a day which did little good. in September 2008 ebony was diagnosed with cushings and put on vetoryl which did help bring down her sugar levels to the lower 20's. in the October ebony was diagnosed with hypothyroidism and was put on forthyron tablets. and within a couple of weeks her sugar levels dropped and the units of insulin she required dropped. ebony went blind from cateracts in December 2008. up until recently she has been on 11 units of insulin twice daily, 60mg vetoryl once a day and 1.5 tablets of forthyrone twice daily. she is currently unstable, found out a couple of weeks ago after acth stim test that her corsisol levels were too low and sodium levels high so was told to stop with the vetoryl. took her for testing as I could tell she wasn't feeling herself and her sugar levels were back in the 20's. although I was told to restart vetoryl after a weeks break but so far I have not done this as she is a lot better in herself.. ebony hates going to the vets now and I really don't want to start with the vetoryl again as the stress from the blood tests seems to make her unwell plus the fact of the latest test results worrid the vetoryl is now doing more harm than good. gonna see how things go. so hard to manage all conditions. the vet gave her a life expectancy of two years and that was five years ago so think we have done pretty well. my thoughts are with you and your dog xx

[molly muffin]

Hi. I just wanted to check in and see what your vet had to say about the testing agent. How is Ailidh doing?

Sharlene and molly muffin

[GillH]

Hi Sharlene, thank you for thinking of us. :) To be honest, the testing agent has completely slipped my mind as we have had another issue to deal with and rightly or wrongly it hasn't seemed a priority. Ailidh had her right eye removed almost six weeks ago and all seemed to be going well until at the beginning of this week I noticed it looked a bit swollen and red, then the next morning I saw a fair amount of blood on her face.

It seemed to me as though perhaps she had an abscess and it had burst so off to the vet we went. It was so painful she wouldn't let anyone near it to examine it and we had to go home with antibiotics and painkillers and return the next day. She was given a GA and a biopsy and swab were taken, and a small lump was also removed.

My vet said that she really didn't like the look of it and that it should be a different shape, and couldn't understand why this had happened after several weeks of apparently healing nicely. She was afraid that something more sinister was going on and that there might be a tumor.

I took her home from the vet in tears, telling my husband and family that things didn't look so good, after the months of getting her back on track after the diagnoses of diabetes, this all seemed too much and so unfair.

But she wolfed down her dinner that evening, no after effects from the GA and seemed happier than she had been for a few days. She was out in the garden barking with my other dog, wandering around and generally looking more alert than she had in a while.

The next day was more of the same, we went for a decent walk and she was fine, a bit slow but that's normal for her as she can't see. On the way home she was ahead of me and I had to walk quickly to keep up. Unheard of!

Back to the vet the next day and she was thrilled with how the eye looked and how well Ailidh was responding. We are now waiting for the results to come back from the lab, but the feeling is that because of her Cushings she is more prone to infection and it wouldn't take too much to set something off. Maybe a small fragment of suture had been left behind and although they dissolve, it could be enough to cause an infection. Thoughts of a tumor have now taken a back seat, not to say it can be completely ruled out, but the chances are that this is unlikely.

Hopefully we will have confirmation of that in the next few days. In the meantime I have an appointment for her at a veterinary hospital next week to investigate whether or not the cataract on her left eye can be removed.

It seems to be one thing after another at the moment, but when all these things have been resolved I may need to bring the focus back to the ACTH test!

[molly muffin]

Oh My Gosh!!! What an ordeal you have been through. Poor baby, to get an infection too. :( Yes, it's true, cushings does do a number on the immune system so infections are possible at any time.

I'm so glad that the whole idea of a possible tumor is not at the forefront any longer and that she is responding so well to the antibiotics and pain killers. That must have hurt like the dickens. Imagine, leading the way home with a pep in her step even. That's great to hear.

Do let us know how things are going, as you know, we consider you all a part of our K9family :)

hugs,
Sharlene and Molly Muffin

[goldengirl88]

God Bless Alidh and you. You have been through a lot and so has she. God bless her for making it through all this and then Cushings on top of all the rest. My heart goes out to you as you are doing a wonderful job with all you have to deal with. Blessings
Patti