Diabetes and cushings - Cortisol Testing ?

[VickeLynne]

Skie, our 12 year old Siberian Husky, was ill for a few weeks when we took her to the vet. The dr. immediately thought diabetes from the smell of her breath. She ran tests and sure enough Skie's sugar levels where off the charts. She also believed she had Cushions. She took x-rays and sent us to a specialist. He did more tests, even an ultrasound. He concluded that Skie did have cushions. He said she had no tumors on her adrenal glands and all organs looked good. He is assuming that she has a tumor on her pituitary gland. He said that the CT Scan would cost over $1,000.00 and that it was not necessary because even is she did have a tumor it could not be removed. They had us start out for a week of 13 until of insulin twice a day with meals. After a few days I noticed she was not nearly as lethargic and was eating better (but not normal yet). Her sugars were tested everyday by our vet and they only would go as low as 450 milligrams. She increased her insulin to 18 units twice a day and started her on Vetoryl (30 mg 2x's a day). Her appetite increased to almost normal by day 2. Last night (day 5) everything seemed to change drastically. All Skie wanted to do is eat. The vet said she can only eat twice a day with insulin. So she barked and whimpered all night long. She paced the floor continually. Started loosing her balance almost as if she where drunk. These seem to me to be side effects from the Vetoryl but its nothing I can find as actual side effects. I have to wait for our vet to come in at 10:00 am. I was hoping someone here understand what my dog is going through and can help me to understand and help her. Maybe some info to go to my vet with or even questions to ask. Thank you so very much.

Vicke

[Squirt's Mom]

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[Squirt's Mom]

Hi and welcome!

I don't typically comment on diabetic threads since I don't know much about it BUT I do know that is it HIGHLY risky to start Cushing's treatments before the diabetes is under control. It is also HIGHLY likely the Cushing's testing done while the diabetes was not controlled will give false positives.

If I were you, I would stop the Vetoryl now. Concentrate on the diabetes only for now. We have a sister site for canine diabetes and I want you to run on over there now and register. They are the experts on this disease and will be able to guide you. You can find them at - http://k9diabetes.com/forum

I am sure others will along soon.
Hugs,
Leslie and the gang

[VickeLynne]

Thank you very much. I will go over and see if they can help me.

[VickeLynne]

My dog Skie's vet does not want to do any testing unless we put her back on the Vertoyl. We chose to take her off because her BG levels were not regulated and still very high. The side effects of Vertoyl far outweighed the lack of benefits of the medication. After being off the Vertoyl for a week and starting her insulin at a lower dose her levels started coming down and she no longer had side effects. We chose to incorporate a more natural treatment (I know alot of people dont agree with this) which has seemed to help tremendously. Her BG levels are down from over 600 to the low 300's since changing things. Anyway we have no answer if Skie really has cushings or not. The ultrasound showed no tumors. They extra showed some haze in her lungs but the specialist said it was just old lungs and nothing of concern. Is there a way that we can test her cortisol at home? It seems like the vet does not agree with our way of treating Skie and wont do any testing to see if she is truly doing better unless we put her back on the meds. I dont want to do that unless I absolutely have to.

Thank you so much for you help,
Vicke

[Renee]

Why not just get a different vet? I know that seems simplistic, and many here will have a lot more questions.... but, really, a new vet seems in order if you and your current vet cannot come to an agreement.

[goldengirl88]

Welcome to you. Glad that you and Skie found us. I think anyone on here will tell you that you are using good judgment getting the diabetes until control. That is paramount to treating Cushing's. Any other health issues going on when your dogs cortisol is tested, could skew the numbers. That being said, Cushing's is a slow progressing disease. No rush to treat in other words. Once the diabetes is controlled, then you would proceed with Cushing's. Just know up front there are no other methods to manage this disease or there would be no need for this forum. Cushing's is not curable, but is manageable with Lysodren, or Trilostane brand name Vetoryl. There is nothing else that manages the cortisol. We will support you in your choice of treating or not, just know the long term affects of cortisol on your dogs organs will be the consequences of no treatment. Your vet surely knows there is no natural treatment, and sounds like he is not wanting to cost you money on tests that he knows will show high cortisol from not using the proper drugs to control it. It is a futile exercise in other words. Believe me my dog would not be here today if she was not on Vetoryl. You may feel differently when your dogs symptoms return, and they will without proper control of the cortisol. If you start out with a low dose, and tweak it when necessary, you dog will be safer than starting out at a high dose and the dogs cortisol goes low. We are here for you to support you through this journey, so you are not alone in this.You are at the very best place you can be to help your dog. This forum has alot of experienced people on it, who will be on to greet you. Could you get copies of the tests and post the abnormal numbers along with the scale the lab gave for normals, as they are all different. Please give us a brief history of your dog, any illnesses, or other issues, and what your dog weighs. To stay on the low side with Vetoryl you will want no more than 1 mg per pound. You will want to make sure to feed the dog, give the Vetoryl and have the ACTH completed within 4-6 Hours of the Vetoryl dose. Do not fast the dog, this will skew the numbers and can over dose the dog. No matter what you decide, know we are here to listen and help. We do have a sister diabetes site too. There are many on here who manage both diabetes and Cushing's. I hope Skie will soon be on the road to feeling better. Blessings
Patti

[Harley PoMMom]

Hi Vicke,

Welcome to you and Skie, sorry for the reasons that brought you here but glad you found us.

First thing, I highly recommend that you join our sister site that deals with canine diabetes. The loving and knowledgeable folks there can help immensely with Skie's diabetes. Here's the link: K9diabetes.com (http://k9diabetes.com/) Now for some questions :eek: :) Could you get copies of the tests that were done on Skie and post any abnormal results, also, if any Cushing's diagnostic or monitoring tests were performed we are very interested in seeing those results too. How much does Skie weigh and what was the dose of Vetoryl she was taking?

Cushing's is one of the most difficult diseases to diagnose and unfortunately, it is also one of the most misdiagnosed. There isn't just one test that is conclusive, so a vet has to rely on more than one diagnostic and validation test. Strong symptoms do play a huge part in a Cushing's diagnosis, could you tell us what symptoms Skie displayed that led the vet to test for Cushing's in the first place?.

Also, any non-adrenal illness can cause false positive results, like Skie's diabetes, and therefore the diabetes should have been under control before any testing or treatment for Cushing's was started.

If this were me I would stop the Vetoryl, as you have already done, and concentrate on getting Skie's diabetes under control. Since her BG is doing better that tells me that her Cushing's diagnosis is questionable.

Please know we will help in any way we can so do not hesitate to ask all the questions you want. ;)

Hugs, Lori

[labblab]

In addition to all the good info you've gotten, I just want to tell you that there is no home test for cortisol. Laboratory analysis is required. If you are willing to pay for the test, though, I don't see why your vet should refuse. Bear in mind, nonadrenal diseases such as diabetes can elevate cortisol readings even when Cushing's is not involved.

[VickeLynne]

I have been looking for a new vet. I live pretty far out from the nearest city and it seems the vets that are available are not knowledgeable with cushings. But its not stopping me from my search to find a new one.

[Renee]

Yes, many people here have that exact same issue and I sympathize with you on that. When your choices are limited, try finding a vet that is willing to learn / work with you, rather than one that is experienced in cushings, since that can be harder to find. I chose an 'inexperienced' vet over an experienced one because I trust her judgement and she has been willing to learn right along with me. I hope you can find a vet like that!

[VickeLynne]

Our vet did not do any blood testing for cortisol. We took her to the vets because she was not eating. The vet said her breath smelled as though she was diabetic. She checked her BG levels and they where over 600. She then did an xray and there was some haze in her lungs. Said she believed she had cushings. She sent us to the nearest vet hospital to have an ultrasound done. The ultrasound came back normal. The vet there said the haze in her lungs was just from her being old. He said that without doing a very expensive CT scan that he can only guess that she has a small tumor on her pituitary and that would be why she has cushings. That is why I am so skeptical. I never heard of a doctor guessing that someone or an animal had something with out testing. I dont have the $1200.00 for the CT scan but I would think a blood test would tell us something. So when we went back to our local vet she only wanted to do a blood test after 10 days of being on the Vetoryl. But she did not want to get her blood sugar under control before starting the Vetoryl. That is when I came here and the diabetes forum to learn all I could. We ended up stopping everything the vet was doing and start over. No more cushings treatment and slowly increasing the insulin by 10% a week. Since we did that Skie's sugars have come down over 200 points (or however they are measured) and have started to stabilize. I still dont know if she truly has cushings or if it just seemed that way because her sugar was crazy high for so long.

[Harley PoMMom]

In our Resource Thread we have a link to the American College of Veterinary Internal Medicine (ACVIM) in which one can search for an IMS in their area. Here's the link: http://www.acvim.org/PetOwners/FindaSpecialist.aspx

You just need to type in the State you reside, no other info is required, and then hit search.

[Iraklis]

If you are willing to pay for the test, though, I don't see why your vet should refuse.

Because some vets have huge EGO issues...happened to us too...

I'd change vet before its too late...

[Harley PoMMom]

Since we did that Skie's sugars have come down over 200 points (or however they are measured) and have started to stabilize. I still dont know if she truly has cushings or if it just seemed that way because her sugar was crazy high for so long.

When a dog is diabetic it can be really difficult to diagnose Cushing's. If the diabetes is starting to stablize without any treatment for Cushing's than I question the diagnosis for Cushing's.

Here's a link to Dr Peterson's blog in which this is discussed. Dr Peterson, is a renown Cushing's expert and who also is a contributor to Dechra's continuing education site: Q & A: Diagnosing Cushing's Disease in Dogs with Diabetes Mellitus (http://endocrinevet.blogspot.com/2012/01/q-diagnosing-cushings-disease-in-dogs.html)

An excerpt from his blog:
The problem with diabetic dogs is that it's very difficult to make a diagnosis of Cushing's with certainty unless we see cutaneous changes. PU/PD, polyphagia, and high liver values all could be secondary to the diabetes. False-positive test results on a LDDST are very common in dogs with nonadrenal illness, such as diabetes

Hugs, Lori

[molly muffin]

Hi Vicki,
I merged your other thread and this one so that all the information about Skie is in one thread.
I am also going to add Diabetes to the thread title, so that any of our other members with both cushings and diabetes will see the thread readily.

Sharlene and molly muffin

[goldengirl88]

Just checking in today to see how things are going? Hope we were able to help you. Blessings
Patti