Cushings, Diabeties and now pancreatitis

[Bella's Mum]

Hi everyone,

Hope you have all enjoyed your Christmas break :)

We have a mini dachshund who would be roughly between 9 - 13 ( rescued so not 100% sure) female named Bella. Bella was diagnosed with diabeties back in November 2011 and cushings in September 2012.

Past year or so we have had our ups and downs and most recently today Bella refused to eat, she even turned down her favourite meal - BBQ chicken! Called the vet and went in for check up as she hasn't eaten therefore no medications. (0.20ml caninsulin and 40mg Vetroyl) bloods taken and now are awaiting results, the vet is suspecting pancreatitis. Bella has had pancreatitis about 3/4 times this year so far so it's not unknown but still scary. Bella did have a ACTH test last week, I have not seen the results but vet says its not good and will need to look at increasing medications.

We have noticed the last week hair falling out, very itchy but still happy to walk around the house and yard until today.in the last 6 months or so Bella has developed further cateracts and is running into walls and doors more and more evey day and when in unknown environments (even the vets office) Bella does stress out.

Sorry for the rant but not really sure where to go from here, 1 year of cushings and 2 of diabeties, fundage wise it's estimated over $15,000 in one year alone :( thankfully Bella is insured and we recieve approx 80% back and there has never been any question with spending the money but question is when do you call it quits :(

[doxiesrock912]

Welcome to you and Bella! :)

There is a forum dedicated for dogs that have both since the combination makes treatment more complex.

Someone who has the link, please post asap. Thank you

It's necessary to have the diabetes under control before treating Cushings.
Pancreatitis is common with Cushings unfortunately.

[Bella's Mum]

Well just got of the phone to the vet. It's not pancreatitis as initially thought, although levels are high and we will need to increase her vetroyl although not sure what to as yet. We pick her up tomorrow morning.

[doxiesrock912]

Interesting. Are they sure that there's not an underlying infection? Does she take the Vetotyl once or twice a day?

[Trish]

Hi there

I am presuming they did an ACTH test and all electrolytes to make sure she has not gone low from the vetoryl? Make sure they have done that won't you before you bring her home. I think the general rule is not to give the vetoryl to a sick dog. Although sounds unlikely if her vet said based on last weeks ACTH you may have to increase her vetoryl. I am also presuming they assessed her glucose status with the diabetes.

Sorry I am not Cushings expert (not even close!) but I do know the ones that are will want to see the blood test results, back to diagnosis if possible so they can help you figure this out.

There is a sister canine diabetes site, it focusses on diabetes not cushings but there is a bit of to and fro between the sites for those dogs that have both problems. You can check them out here http://www.k9diabetes.com/forum/

I hope your Bella is feeling better tomorrow, but do remember to pick up copies of all her results while you are there, bloods, urine, ultrasounds included. :)

[frijole]

Trish is correct! In order for us to really help you we need to know results from tests that have been done to diagnose cushings as well as any abnormal blood panel results. (post the high or low enyzmes and the ranges for normal on each)

It is not usual for a dog to NOT eat when they have cushings as they tend to be constantly starved. And it is a sign that cortisol is too low (that the dose should be decreased not increased). I'd hesitate to increase the dose right now if the dog isn't eating - in fact i would withhold meds until appetite is normal.

Please give us more details about the eating issues. Also tell us if there has been vomiting, diarrhea and lethargy.

With everything going on (diabetes and cushings) it can be hard to get a balance. Are you working with a specialist or a regular vet? Sometimes a specialist needs to be brought in to help get things under control.

Glad you found us! Kim

[Bella's Mum]

Trish is correct! In order for us to really help you we need to know results from tests that have been done to diagnose cushings as well as any abnormal blood panel results. (post the high or low enyzmes and the ranges for normal on each)

It is not usual for a dog to NOT eat when they have cushings as they tend to be constantly starved. And it is a sign that cortisol is too low (that the dose should be decreased not increased). I'd hesitate to increase the dose right now if the dog isn't eating - in fact i would withhold meds until appetite is normal.

Please give us more details about the eating issues. Also tell us if there has been vomiting, diarrhea and lethargy.

With everything going on (diabetes and cushings) it can be hard to get a balance. Are you working with a specialist or a regular vet? Sometimes a specialist needs to be brought in to help get things under control.

Glad you found us! Kim


Hi, we picked Bella up this morning. I still don't have the results from the ACTH as both our normal vet and pratice owner vet would like to speak to the pathology specialist as currently Bella is on a 5mg/kg dose - total 80mg daily broken into two 40mg twice daily dose. At this stage no increase as its Sunday here and the two vets are hesitant as stated above.

Bella's eating habits do vary and we have been told to place her on a strict diet yo help maintain cushings/diabeties and lose weight. Previously Bella diet mainly consists of meat only with biscuits during the day. We told to switch to a homemade rice and meat diet and watch the amount given. Luckly the has been no vomiting or diaherra just refusal to eat yesterday, she did put up a fight this morning at the vets but then decided chickens not too bad and ate her dinner.

At present we are working with Bella's regular vet who is currently study small animal medicines and the pratice owner who has previously been named "Small Animal Practitioner of the Year" in Australia numerous times. We are in a smaller regional location in Auustralia and no local vets from my understanding are truly specialists in internal medicines and we would need to travel and even then it's hard to find one that's somewhat close by with google!

Bella's abnormal blood results are
Matter Actual. Range
Plasma glucose. 13.0mmol/L. (3.5-6.7)
Lipase. 97 U/L. (1-70)
Cholesterol. 14.7mmol/L. (3.6-8.8)
Triglyceride. 7.9mmol/L. ( 0.2-1.7)

The remaining are well within the normal ranges, I can post if requested. I will look for her orginal blood results when dignosed as should have it somewhere - she was diagnosed after going into seizure, that was scary :(

Since coming home Bella ate some more and had her vetroyl tablets, and seems to be happy to be home

[flynnandian]

a mini dachshund on 80 mg vetoryl? is she doing fine on such a high dose? you posted 2x40 mg/day, or is this a mistake? my friend has one and she only weighs 8 kg. or is your dog so much heavier?

[frijole]

On the blood results that you posted I noticed you did not post the liver enzymes which are alk phos and alt. Were they within normal ranges? I ask because cush dogs ALWAYS have high liver enzymes, particularly the alk phos.

Also I agree that the dose you are on seems extremely high. Please confirm that your dachsund is on 80 mgs a day. If so please tell us your dog's weight. Normal dosing is more like 1 mg per kg of weight. I find it hard to believe your dachsund is 80 lbs. :)

Kim

[Bella's Mum]

On the blood results that you posted I noticed you did not post the liver enzymes which are alk phos and alt. Were they within normal ranges? I ask because cush dogs ALWAYS have high liver enzymes, particularly the alk phos.

Also I agree that the dose you are on seems extremely high. Please confirm that your dachsund is on 80 mgs a day. If so please tell us your dog's weight. Normal dosing is more like 1 mg per kg of weight. I find it hard to believe your dachsund is 80 lbs. :)

Kim

Hi, yes Bella is only 8kg not sure what that is in lbs, and yes 2x 40mg twice daily on vetroyl. Just abut to take her back to the vet as she is now vomiting with diaherra :(

[Bella's Mum]

On the blood results that you posted I noticed you did not post the liver enzymes which are alk phos and alt. Were they within normal ranges? I ask because cush dogs ALWAYS have high liver enzymes, particularly the alk phos.

Also I agree that the dose you are on seems extremely high. Please confirm that your dachsund is on 80 mgs a day. If so please tell us your dog's weight. Normal dosing is more like 1 mg per kg of weight. I find it hard to believe your dachsund is 80 lbs. :)

Kim

Also yes sorry totally missed the alkaline phoshatase it was 177u/l with normal being 1-120

[molly muffin]

If a dog is vomiting or sick, not feeling well, then with hold the vetroyl.
With vomiting, diarrhea, these are common signs of too low of cortisol. Also, did they mention pancrease episode possibly?
Is there any way at all to get an ultrasound if needed? If this is a possibility both location and financially, then I would probably go for it.
Did they do the ACTH or are they just not giving you the results yet? It is very important that an ACTH be done due to the symptoms Bella is currently experiencing. Electrolytes also.

Sharlene and Molly Muffin

[doxiesrock912]

Stop the Vertoryl.

[labblab]

So we'll all be on the same page regarding Bella's dosing, 8 kg. equals approximately 18 pounds. So at 80 mg. of Vetoryl daily, this equals a formula of 10 mg. per kg. (Dechra recommends an initial range of 2.2 - 6.7 mg. per kg.), or 4.4 mg. per pound (Dechra recommends an initial range of 1 - 3 mg. per pound).

So it is a higher dose than we are accustomed to, but whether or not it has been appropriate really depends upon the results of the previous monitoring ACTH testing during this past year that she's been taking the drug. We'd surely be interested in the actual numerical test results, though.

First things first, though, and I definitely agree that Bella needs to be seen by the vet and her Vetoryl withheld for the moment. But if her cortisol was actually too high last week, it seems to me that you really do have to wonder about pancreatitis as being more likely than low cortisol, though. Just want to warn you that a specialized blood test (cPL) is really necessary to rule out pancreatitis. My own dog is living proof that lipase and amylase may appear normal on lab results even in the midst of an acute pancreatic attack.

Marianne

[Bella's Mum]

Happy new year :)

We took Bella back to the vet as mentioned and she was given maxalon shot to help settle her stomach. Took her home and was back to her happy self again. I wonder if the vomiting and diaherra can be stress related as she typically does this after a visit / overnight stay? The vet on didn't seem to think so, but normal vet agrees with us when she's stress and come homes she 'sick' again.

It's a public holiday here today, but will call the vets in the morning as to what to do regarding vetroyl and try to get copies of the last ACTH test. At this stage yes she is still on it as we are doing what we were told by the vet.

The past week or so Bella has been very itchy, we gave her a soothing bath yesterday but has not helped 100%, is this the cortisol levels playing up?

Hope everyone has a safe and happy new year :)

[Bella's Mum]

Ok got the last ACTH test
0-94
1-194

Still looking for orginal ACTH test will post when find

[Bella's Mum]

Ok got the last ACTH test
0-94
1-194

Still looking for orginal ACTH test will post when find

Found the very first ACTH
0-100
1 -714
:(

[frijole]

Ok got the last ACTH test
0-94
1-194

Still looking for orginal ACTH test will post when find

Translated for US members this is Pre 3.3 and post 6.92. That is improvement! Cortisol previously was 25.5 and now it is 6.92 so it has gone down which is exactly what you want. Kim

[molly muffin]

Okay I am guessing that this is in nmol? is that correct? And do you have the dates for each test?

converting to ug/which most here are use to viewing, it would be as follows

1st ACTH
pre - 100nmol (3.62 ug)
post -714nmol (25.87ug)

2nd ACTH
pre - 94noml (3.4 ug)
post - 194nmol (7.03ug)

If this is correct, and please verify that the unit is nmol and the dates, then this is on the right track. Dechra says that results if symptoms are controlled can be up to 9.0ug, if not controlled then to bring the post number to under 5.4ug.

How is Bella now? Is she still itchy? Any more vomiting or diarhea?

Sharlene and Molly Muffin

[Bella's Mum]

Okay I am guessing that this is in nmol? is that correct? And do you have the dates for each test?

converting to ug/which most here are use to viewing, it would be as follows

1st ACTH
pre - 100nmol (3.62 ug)
post -714nmol (25.87ug)

2nd ACTH
pre - 94noml (3.4 ug)
post - 194nmol (7.03ug)

If this is correct, and please verify that the unit is nmol and the dates, then this is on the right track. Dechra says that results if symptoms are controlled can be up to 9.0ug, if not controlled then to bring the post number to under 5.4ug.

How is Bella now? Is she still itchy? Any more vomiting or diarhea?

Sharlene and Molly Muffin

Hi,
Sorry I don't know how to convert for US :(.
The 1st ACTH with the result 714nmol was at first diagnosis 28 August 2012.
2nd one of 194nmol was 13 December 2013.

I did look at previous results when all was being controlled and the post was around 52nmol which vet told me is excellent control so being on the same dosage doesn't always remain the same :( .

Yes, Bella is still extremely itchy, thankfully no diaherra or vomiting . we have another ACTH test booked for tomorrow as the specialist from the lab wanted to double Bella's medications and I am wary of doing that as last time we went to 65mg twice daily, Bella got really sick.

Fingers cross her levels are back to 'normal' tomorrow

[doxiesrock912]

Please ask them to determine the cause of the itching before increasing anything. Infections can throw off test results.
If there is an infection, I would reschedule the ACTH until it has resolved.

Hope Bella feels better soon.

[molly muffin]

I would definitely ask them to take a look at her skin and maybe even take a scraping to find out what is going on there.

65mg twice daily, Yowser, I can see how that might make her very sick, dropping the cortisol likely. Well, you know that is a no no dosage to go already then.

hugs,
Sharlene and Molly Muffin

[Bella's Mum]

Well retested and ACTH came back as
Post 114, sorry can't recall the pre will check tomorrow.

We slowly increased by 20mg per day so now 50mg twice daily. So far no side effects. Bella is still itchy and scratchy show for the time being but no skin infections

[labblab]

Did you increase the dosage before or after this ACTH test? For our U.S. readers, the result translates into 4.1 ug/dl, which is safely inside Dechra's desired therapeutic range. So if the test was after the increase, it seems to be a very good result. If the increase has come subsequent to the testing, I am confused and worried because you will again be risking a cortisol drop that is too low.

For a post ACTH result between 40 - 150 nmol/L, the Dechra literature very clearly states: "Continue on same dose."

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

So please do let us know about the timing of this increase, OK?

Marianne

[Bella's Mum]

Did you increase the dosage before or after this ACTH test? For our U.S. readers, the result translates into 4.1 ug/dl, which is safely inside Dechra's desired therapeutic range. So if the test was after the increase, it seems to be a very good result. If the increase has come subsequent to the testing, I am confused and worried because you will again be risking a cortisol drop that is too low.

For a post ACTH result between 40 - 150 nmol/L, the Dechra literature very clearly states: "Continue on same dose."

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

So please do let us know about the timing of this increase, OK?

Marianne

Hi, this increase was after the test- both vets and lab specialist recommended it so now I am confused :(
Behaviour wise still happy and barking, but drinking lots of water still and very itchy.

Vet is back next week so perhaps we should re test then.

[labblab]

If I were you, I would print out the Dechra Product Sheet so that you will have it for reference purposes, and then ask your vets why they are wanting to decrease Bella's cortisol even lower than it already is since a dosage increase at this point is contrary to Dechra's recommendation. Perhaps there is something at play of which we are unaware, but it will be important for you to know the specifics of their thinking.

Marianne