Hawthorne (9 y/o shepherd mix) - Diabetic/Lysodren

[hawthorne's_dad]

Hi All,

I was referred here from the k9diabetes site. Hawthorne is a 75 pound Shepard mix who was diagnosed as diabetic in August. He has never been overweight and receives consistent exercise. We have had a very difficult time regulating his blood glucose which led to us taking him to an IMS vet yesterday to run diagnostics, particularly wanting to know if he has Cushing's.

He had a Cushing's stim test run in September which produced an equivocal result. Since, his coat has become dull, his skin is flaking, he has a flaky section around his abdomen, he has been lightly panting when inactive, lays on the tile often, and has excessive thirst. He has a very slight potbelly.

The ultrasound showed no abnormalities or irritation. The blood work showed high triglycerides so he's starting Gemfibrozil tonight for that. We switched to Hills W/D food yesterday as well. We are awaiting cultured urinalysis results early next week. We are also awaiting results of another stim test which will be analyzed for atypical Cushing's as well and should hear back in 7-10 days.

Just wanted to hear from those of you with pets with Cushing's, if Hawthorne's symptoms seem consistent with it, advice, how you've managed it, etc. I'll keep you posted as his results come in.

Thanks in advance!

[Harley PoMMom]

Hi and welcome to you and Hawthorne,

Althiough I'm sorry for the reasons that brought you to us, I'm glad you're part of our family!

Hawthorne does has Cushing's like symptoms but those same symptoms can be attributed to diabetes too. It can be a challenge to diagnose Cushing's under normal circumstances but when diabetes is thrown into the mix it makes diagnosing Cushing's doubley difficult, so it is usually advised to have the diabetes under control before any test for Cushing's are performed. I am surprised that the ultrasound didn't find any abnormalities, especially with the adrenal glands.

I gonna post a link to our Resource thread, that will help you to get up to speed on Cushing's, please feel free to print anything out: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10)

Also here's an excellent read from Dr Peterson's blog:Q & A: Diagnosing Cushing's Disease in Dogs with Diabetes Mellitus (http://endocrinevet.blogspot.com/2012/01/q-diagnosing-cushings-disease-in-dogs.html)

If you have any questions, please do ask. ;)

Hugs, Lori

[hawthorne's_dad]

Thanks for the welcome. Any reason you're surprised there were no abnormalities with the adrenal glands? Is it because Cushing's is suspected?

[frijole]

I'm not Lori but normally with cush dogs you see enlarged adrenal glands. Given the fact you are dealing with a diabetic we are even more cautious before accepting the dx. We get a lot of dogs that have false positives on cushings tests. That said it could be that cushings is new and therefore no enlargement yet.

The symptoms could be from either diabetes or cushings. How much water are we talking a day? Cush dogs are also pretty chubby in the tummy. They have ravenous appetites as in they do not chew their food they inhale it.

It will be interesting to see what the test results are. Please share them. Interesting that they elected to do the full Univ of TN panel to rule in/out atypical cushings.

Glad you found us and welcome aboard! Kim

[hawthorne's_dad]

Well, we had an annual checkup in June with zero issues other than a very slightly elevated liver value. Then in August he had urinated in the house overnight so we assumed it was a UTI and took him to the vet where we found it was diabetes. So he was essentially diagnosed soon after onset.

His thirst is frequent but seems to coincide more with high BG values. We have two dogs so it's hard to gauge volume, but when his BG is high, he'll drink half of a large stainless bowl in one sitting.

We've always controlled his food so we can't say his appetite is any greater, but he's always inhaled his food, so it's really hard to say if that has changed. He has always had a big appetite. I would say he has a slight potbelly. I'm not sure I would have noticed it readily had I not read about Cushing's.

[Squirt's Mom]

Hi and welcome to you and Hawthorne! :)

My Squirt always had a big appetite, in fact one of her nicknames is Miss Piggy! So I felt from the beginning of our journey that appetite would never be a good sign to judge her control by - BOY! was I wrong! :eek: A cush appetite is frightening to see - they literally feel like they are starving 24/7 and will steal food from anywhere - out of your hand as you eat, get in the trash, counter surf, scrounge the ground constantly; they look for food all day and all night until exhausted. They will finish their meal very, very quickly and look up with desperation in their eyes begging for more because they are still starving. Their eyes are pitiful, full of anguish and sadness that we won't give them more; the eyes are haunting to me because they are so terribly desperate. I could literally see that Squirt thought I was mistreating her, causing her to starve. FYI - Squirt started out Atypical then became true cushinoid over time and it was when her cortisol began to rise, constituting the true cushing's, that this gargantuan appetite showed up.

Appetite is one of the main differences in diabetes and Cushing's - most diabetic pups lose their appetite while most cush pups have an unstoppable appetite. Control of the BG or cortisol corrects the appetite for the vast majority of pups. Weight is another - diabetic pups lose, cush pups gain.

As others have said, it becomes doubly difficult to pin down a Cushing's diagnosis in a diabetic pup. I, too, am surprised that nothing abnormal was seen on the US, especially with the adrenal glands. Even in Atypical, the adrenals are typically enlarged.

I'll be watching Hawthorne's thread for updates and the results of the UTK stim - the only place to test for Aypical that we know of. I'm really glad K9D sent you to us and look forward to learning more about the both of you. You both now have another family here whether it turns out Hawthorne has Cushing's or not. BTW I love his name! :)

Hugs,
Leslie and the gang

[hawthorne's_dad]

Hawthorne's stim test came back equivicol again (sorry, didn't get the numbers). We meet with the vet Thursday to discuss possibly starting him on Lysodren and to discuss its side effects.

He responded to an increase from 7.5 units of insulin to 9 units by getting into the 200 range for a day but went right back into the 500-600 range. With Cushing's, is BG typically consistently high, or is it more erratic? I'm wondering if he just needs a higher dose of insulin.

[molly muffin]

hmmm, seems your post was missed in the threads. I apologize for that. With cushings in the mix, it is harder to get the BG to a steady number. Hopefully if you are starting him on lysodren (did you start yet? if not let us know when you do and what the prescribed dosage they are using for loading will be, we have several lysodren people here) anyway, hopefully as the cortisol is controlled, the BG will become more normal and you might even need a lower dose of insulin.

Sharlene and Molly Muffin

[hawthorne's_dad]

Hawthorne's final stim results came back from University of Tennessee and he has been diagnosed with Atypical Cushing's. He begins Lysodren tomorrow. The IMS vet doesn't want to do a loading dose as he is older and diabetic.

Anyone here have experience with atypical Cushing's? Any early advice for us?

[frijole]

I dealt with regular cushings but I've been her 8+ yrs so can help a bit. Usually with atypical you have a nonloading dose and you give melatonin and lignons. Can you get us the test results from the UTK panel sometime?

Meanwhile tell us your dogs weight and the dosage of lysodren you will be on.

I am going to link you to info on lysodren just as an fyi. Even though your dosage is low i want you to read this just so you know what signs of overdose are - you probably will never need this but JUST TO BE SAFE ok? :)

Kim
http://www.k9cushings.com/forum/showthread.php?t=181

[frijole]

Other helpful hints for using lysodren (I have used it):

Give it AFTER a meal wrapped in cream cheese or similar as it coats the tummy

Don't handle it if you have cuts on your hands (wear gloves)

Your dog might be tired at first and may experience gas - this is normal. :eek:;):D Their bodies adjust over time

Did you get prednisone to have on hand?

Thanks, Kim

[hawthorne's_dad]

I do not have the test results but could get them at some point. He will be on one 500mg tablet of Lysodren three times per week. The IMS vet did not want to give him melatonin or lignans as there is some evidence it can lead to insulin resistance and he is already not responding to insulin. He weighs 70 pounds and whe was prescribed prednisone for emergencies.

Thanks for the info and support!

[frijole]

Oops your vet is right - melatonin is a no no for diabetics. Smart vet too. :)

OK that is the dose a dog would have after loading so it is a hefty dose. You should be ok but do pay attention to eating and drinking habits. Vomit and diarrhea are signs of overdose. While starting out don't give any people food or any new foods/treats - that way you know if the tummy is upset it is from the drug and not some new food.

Kim

[Squirt's Mom]

My Squirt started out as Atypical and we did not load - we went straight to maintenance as is recommended by UTK. So your vet is correct with his approach for using Lyso in an Atypical pup, too, as well as correct about the melatonin. Without the melatonin, the lignans will do little so there is no need for them. Good call on your vet's part! :)

At 70 lbs., Hawthorne weighs 34.09 kg. The maintenance dose for Lyso is 25-50mg/kg/week. So at the high end, 31.82 x 50mg = 1590.90mg/week. Each pill is 500mg so at 3 pills a week, Hawthorne is getting 1500mg/week - which is within the range for maintenance dosing. Your vet is doing so good! :):)

AND they gave you pred to have at home! Another kudos for your vet! :):):)

If you have any questions or see anything that concerns you, never hesitate to ask, ok? You're doing a great job, Dad!

Hugs,
Leslie and the gang

[hawthorne's_dad]

For those using Lysodren, how long did it take before your dog's high glucose levels started dropping? It's only been a week since Hawthorne has been on Lysodren, but was curious as he's still in the 500-600 range.

[Jenny & Judi in MN]

I don't keep the best records here at work but it looks like after 10 days jenny dropped from the high 300-low 400's to the 250 range

After a month she was in the 100's, yay, still at the same dose.

Since I wasn't testing at home, didn't notice till 4 months down the road that she was routinely running hypo at less than 100. So glad you are testing Hawthorne's blood sugar at home!

Since Hawthorne didn't load, I wonder if it will take a little longer. When did you last increase his insulin dose?

[hawthorne's_dad]

We increased it just over a week ago from 9 to 10. He hit 690 before dinner so I'm a bit concerned. Plan to do a curve tomorrow and send to vet.

[hawthorne's_dad]

Did a curve yesterday and our vet had us up his insulin dose to 11 units 2x/day. He's consistently been in the 500+ range. :(

[labblab]

It has to be so worrisome and frustrating to see those glucose levels remaining so high. Hopefully both the Lysodren and increased insulin will kick in soon!

Please do keep us updated.
Marianne

[labblab]

P.S. I've added the word Lysodren to your thread title so that others who are also using the drug will be more likely to "see" you. ;)

[hawthorne's_dad]

P.S. I've added the word Lysodren to your thread title so that others who are also using the drug will be more likely to "see" you. ;)

Thank you!

Yes, its rough seeing those numbers elevated for so long. He's handling it decently at least.

[hawthorne's_dad]

Just checking in with a quick update on Hawthorne (Hoffa as we like to call him). Hawthorne has been on Lysodren (no loading dose) for about two weeks now. No reactions or issues with Lysodren which is great to see.

No real change with his blood glucose. He has been on 11 units 2x/day for a week. Will perform another curve next week. Otherwise, he's doing ok. He's handling his elevated BG like a champ.

[lulusmom]

Can you please post the results of the UTK adrenal panel?

[hawthorne's_dad]

Can you please post the results of the UTK adrenal panel?

Whoops, I never did request the results. When I submit the next curve I'll request it.

[hawthorne's_dad]

We just switched from Humulin to Novolin a few days ago. Not sure if it's that, if we had a bad bottle of Humulin, or if the Lysodren is finally working g, but Hawthorne's BG is FINALLY coming down out of the 500-600 range. He was upper 300 this morning and was 208 a bit ago.

Looks like it's back to worrying about him possibly going hypo again. Glad to see him respond finally.

On another note, he has shed quite a few pounds since being on W/D. So much so that I noticed a round bump/mass by his shoulder. He goes to the vet Wednesday to see what it is. Really hoping it's nothing.

[Jenny & Judi in MN]

this is great news! fingers crossed it is just a fatty lump

[hawthorne's_dad]

Well, the good news is Hawthorne's BG has FINALLY started coming down. He was in the 150-250 range for a few days and is now hovering in the mid-300's. He's definitely more active and more peppy which is good to see. He had another stim test Tuesday where the vet increased his Lysodren dosage from 500mg 3x/week to 750mg 3x/week.

We had his lump checked and it was just a really big zit basically. No worries there.

The bad news...he's going blind. His cataracts seemed to get worse in the last few days, despite his BG dropping. He stops at the back door when I call him in to see if the door is open or closed. Just now I gave him his after dinner treat and he went for my pinky finger, missing the treat. Poor guy. :( I expected this so I'm not as upset as I maybe would have been, and I know he'll adjust, I just feel bad that I can't help him more.

[molly muffin]

Awww poor guy. I think though that going blind slower, rather than fast, makes it a bit easier for them to adjust. They start to use their senses more, along with the fading eyesight and by the time they are blind, they have been on that road to adaption for awhile.

I am sorry though.

Good that the BG is getting better though.

Just watch that increase in the lysodren, as even though higher now, you don't want that cortisol to drop too low. I'm not an expert on the lysodren ratios, but others will know. In the mean time, keep an eye out for the regular things with low cortisol, such as lethargy, not eating, wobbly, etc.

Hang in there, it does sound really good about the BG getting under control

hugs,
Sharlene and Molly Muffin

[hawthorne's_dad]

Yeah, I'm a bit concerned only because our new home will be built in a few months. A new house and yard for him to "learn" with restricted eyesight. Oy. He'll manage though. He's a tough cookie.

[Squirt's Mom]

I am mom to three blind babies and one who is blind in one eye. Two of the blind ones have no problems finding their way around by using their other senses - smell, sound, and touch. Both of them came from CA to ARK and adjusted then we moved into a new house (for us) after they had lived almost 2 years in a camper, and they adjusted fine. My new baby is also mostly deaf and has very little sense of smell yet she is learning her way around her space by feel. I use little rugs of differing naps to help her know where she is going - a different nap leading to differing areas - as well as using hand towels under her water/food bowls so she knows they are near. Some folks use different scents in various places to help them orient. I keep TVs going 24/7 just about to help my hearing blind babies orient. For a while I wore bells on my ankles when we went out so they could follow me. Now I talk or sing as we walk and they follow right along - unless Brick gets a whiff of an empty pizza box then the chase is on! :p I swear he can find those things miles away with his nose! :D

Watch Hawthorne and he will help teach you how to help him. For example, with Grace, the one who has very little sensory input, I learned that I need to put my hands very close to her nose by watching her reactions, not quite touching so I don't startle her, but so she gets a scent before I touch her. You will notice things Hawthorne seems to have more difficulty with or you will notice ways to help prepare him for changes like someone touching him or picking him up. ALWAYS say his name before you touch him when he's not aware you are close. Touch, sound, and scent will help you help him.

Most pups adjust to losing their sight much better than humans do...and much better than their caretakers do. ;) We can't help but feel sorry for them and projecting our human emotions and thoughts about this on them - but they don't feel or think about this like we do for the most part. Some take longer to adapt, some experience depression and things like separation anxiety. But you can help him gain confidence by doing little things to help him know where he is, where his things are, and to face new experiences trusting his dad completely.

[hawthorne's_dad]

Hi everyone. Hope you are all well. Wanted to post a brief update on Hawthorne. We moved in March and things are slowly settling down. He has adjusted to the new house incredibly quickly with no eyesight. I think having all tile helps him hear echoes maybe.

His blood glucose is better but still isn't great. He is consistently in the 300-400 range and is due for another curve.

Unfortunately the poor guy woke up yelping yesterday morning and limping on his front left paw. We inspected it and pressed on it with no reaction. About 15 minutes later the same thing happened so we took him to the emergency vet (we were just there last week where we found out our 17 year old Siamese cat has cancer; bad week for us). Turns out he has neck pain which is causing the intermittent limping. Likely due to degenerative discs, but there is a possibility it could be valley fever; they are testing his blood for this. Could also be lesions or cancer. I have a follow up on Wednesday to discuss further, possibly x-ray/MRI, etc. In the meantime he is on Tramadol for pain as the vet didn't want to prescribe a steroid due to Cushing's.

Anyone have any experience with this? I'm curious what treatment options are available. He's doing a lot better today but the Tramadol is making him pant. He didn't whine last night or this morning which was great. We elevated his food and water and are making sure he lying on a bed at all times. Again, a very stressful week for us. I've been sick to my stomach seeing the little ones in pain.

[goldengirl88]

Have you thought about switching the the of diabetes drug you are using. Sometimes you can get a better response by changing the type you are using. I am so sorry for all the things you are going thru, and your poor dear cat having cancer. That is a lot to bear at one time. I hope things get better for you. Do you think acupuncture or laser therapy would help with the disc problem? Maybe when he yelps the disc is pinching a nerve?? Hope things get better for you. Blessings
Patti

[hawthorne's_dad]

We switched from Humulin to Novalin some time ago which has helped. He really is due for another curve as his Lysodren dose has remained consistent.

We did not get x rays at the emergency vet yesterday as he was in a fair amount of pain. When we visit our internal medicine vet Wednesday we will discuss how to evaluate. At this point we don't know the cause of the issue so we need to figure that out. He is doing well today having been on pain meds for 24 hours. He is sluggish and slow to get up and down but looks a lot better. I'm hoping it is just inflammation that can be treated with meds but we will see. We have not had a good run of luck with our pets health lately.

[molly muffin]

I went through a back issue with my dog earlier this year. Interesting to hear that the front paw limp can be caused by neck pain due to the disc issues, as my dog did the front paw limp for a bit too.

Anyway, since I am very nervous about NSAIDS in general and especially cush pups, we ended up using toledine, 20mg tablets, you give 1.5 tablets daily with food for 4 days, stop for 3 days repeat. Limit activity, no jumping or stairs, up or down for a period of about 6 weeks. They took an xray which confirmed, it was inflammation in 2 areas.

Sharlene and molly muffin

[hawthorne's_dad]

I went through a back issue with my dog earlier this year. Interesting to hear that the front paw limp can be caused by neck pain due to the disc issues, as my dog did the front paw limp for a bit too.

Anyway, since I am very nervous about NSAIDS in general and especially cush pups, we ended up using toledine, 20mg tablets, you give 1.5 tablets daily with food for 4 days, stop for 3 days repeat. Limit activity, no jumping or stairs, up or down for a period of about 6 weeks. They took an xray which confirmed, it was inflammation in 2 areas.

Sharlene and molly muffin

Sounds like it was fairly easy to recover from then and easy to treat? How has your pup been since? Any additional flare ups?

[molly muffin]

No nothing since except for that occasional front paw limp and that hasn't happened in a few weeks now so hopefully it is all good now. Oh I also did laser therapy from the first day discovered. That seemed to help he reel better too.

The immobility was the hardest part as my dog isn't one for being constrained from what she wants to do. Even now she will try to evade the lift or pickup as she was carried way too much for her liking during that time. We have a lot of stairs so it was a real issue.

Cross fingers you can get this figured out and corrected soon. You've certainly been through a rough patch lately.

Sharlene and Molly muffin

[hawthorne's_dad]

Thanks for the input. The emergency vet read Hawthorne's file and was like "wow". His glucose rose today, likely from all the stress, and he had his first accident in the new house and first accident since his initial diagnosis period with diabetes.

As concerned as I am for him, I'm more worried about our poor cat. The vet gave him weeks to months to live. I know those odds can be a crap shoot but it is still depressing all the same. He has lost a fair amount of weight, so it is sad to pet him and feel his shoulders and spine. Renal disease with stomach cancer and likely hyperthyroidism and this cat still loves to cuddle and purr. I don't know how cats are as tough as they are. Sheesh.

Sorry for the venting. It has been a very trying few weeks so it feels good to get some of this off my chest. I will keep you posted on Hawthorne especially after his Wednesday appointment. I could really use some promising news here. Thank you for the support.

[molly muffin]

It is incredibly hard when you have one sick, it is double hard when you have two. I know the renal disease in cats, my precious Tipsy passed from it. The changes in their body, their coat, are heart breaking to see, and yet those little purr boxes just continue on.

I hope you get some good news on Wed. You're due for some. They can see via xray, if there are any compressed points along the spine, so that is good and just be careful about any anit-inflammatory's given. Some don't mix will with cushings like metacam. Just seems to be be problems there with cortisol in the mix.

Don't worry, we are here, you can vent any time at all. Hang in there.

hugs
Sharlene and molly muffin

[goldengirl88]

I have to say I am not a fan of NSAIDS especially for Cush dogs either, I try to get the most natural helpful thing I can find to try first so I do not bring on other problems while trying to solve one. I hope your cat can be managed with the renal disease somehow. It is heartbreaking to see your babies go down hill. I am praying you get a break and that your babies turn around and get to feeling well. Blessings
Patti

[hawthorne's_dad]

Hawthorne was checked out today and pretty good news overall. It is likely that it is a disc extrusion not cancer as he is responding to Tramadol. Added Metacam to help with the rest of the pain and will monitor to see how he responds. Vet feels good about giving NSAID due to how well controlled his Cushings is from his last test. Now to get diabetes better controlled.

He was about due to have triglycerides rechecked and they are still high so increased Gemfibrozil from 1/2 tablet 2x/day to 1 tablet 2x/day.

Poor guy is like an old man with all the pills he takes. Lol.

[goldengirl88]

I use salmon oil on Tipper's triglycerides it has done a good job. I would inquire about Adequan if I was you. In a Cushings dog NSAIDS can cause liver issues and their liver is already under stress from the Cushings. I would definitely want that diabetes controlled too. I am just very conservative and ant to use natural things as much as possible. Blessings
Patti