10 year old chihuahua diagnosed cushings Disease

[sebarflin]

Hello, I have a 10 year old female chihuahua, Kricket, who was diagnosed Cushings disease approximately 8 months ago. She is currently prescribed Vetryl 10mg 1x per day and was doing well. After about 2 months of the diagnosis I took her back to vet to have blood test again to ensure medication was doing it's job. It was. I've also researched proper diet for cushings and found that "hi protein, grain free" food is recommended. She is now (approximately 3 weeks) eating Blue Wilderness Grain Free kibble. She really seemed to enjoy the food and even ate it at a slower pace. Actually chewing and not swallowing food whole.

Kricket's weight has always ranged around 12lb. She is Chihuahua breed that has longer legs and more stout body so her Vet was never concerned because her weight was consistent. A couple of months ago, I took Kricket to the vet due to a seeping cyst (hot spot) on her leg. This is a reoccurring issue at least every couple of months since being diagnosed. Anyway, she weighed 13.4 (of course due to stomach weight).

It was about 2 weeks ago when I began noticing muscle weakness and sudden weight loss. Kricket started urinating under the kitchen table near her water bowl which was new behavior.

Because we were concerned about Kricket's sudden behavior changes my husband took her to the vet this past Wednesday. Another blood test was completed and we should find out results tomorrow. We also found out that Kricket has lost 2lbs in 2 months.

This past Friday is the first time she has shown no interest in food or eating. I have attempted to add water to her food to entice her to drink flavored liquid and then hopefully begin eating the food. That lasted for about a day and now nothing. I'm concerned about her not eating and was wondering if chicken broth can be added to her food which might entice her to eat. Is this a good idea or should I try something else? I really need to ensure that she eats because the medication is not as effective on an empty stomach. Medication is hard enough on a full stomach.

Thank you for your time and I appreciate any advice you can give.

[labblab]

I apologize that I have only a moment to post, but please do not give Kricket any more trilostane until you get the test results back. I am hoping you had another ACTH done to check her cortisol levels, because the behavior you are describing could very well be due to her cortisol dropping too low and/or imbalances in her blood chemistries as a result of overdosing. Over time, it is not unusual for the dosing to require alteration. I will try to come back a little later on to add some more, but I am very worried that her cortisol may be too low. Do you have any prednisone on hand in case of emergency?

Marianne

[sebarflin]

Hi Marianne,

Thank you for your quick reply. I was also wondering if I should continue medication until I find out results. Thank you for easing my worry about that. The blood test was conducted to find out cortisol levels. I do not have any prednisone. What do you mean by "in case of emergency". What behaviors do I need to look for for prednisone purposes? Reply when you can.

[labblab]

Hi again. Cortisol levels that have dropped too low can cause acute symptoms such as vomiting, diarrhea, severe lethargy, even physical collapse. Prednisone can be given as a rescue medication in order to supplement cortisol levels that have tanked.

I encourage you to call your vet first thing tomorrow to report Kricket's inappetance. Hydration is likely the more important issue than food over the short run. But for a dog weighing only ten pounds, this issue needs to be addressed ASAP and the cause investigated. Those cortisol levels tomorrow will be really important. In the meantime, you can try using things like broth or tuna water to try to tempt appetite. Just make sure that any product you use does not contain onions in any form since they are toxic to dogs.

Marianne

[sebarflin]

Thank you for the information. I will contact Kricket's vet tomorrow morning. I'm sure they're expecting me to call anyway :) I'll ask about the prednisone. I gave her rice and mixed in some chicken broth tonight. She ate some of it but I'm happy she has a little something in her stomach anyway. I truly appreciate this page. I've been looking for a support group that supplies information for a while. I've learned so much just by reading other posts and experiences. This disease is ruthless and I hate it! I feel so helpless at times. Kricket looks at me as if she's saying, "Please help me" and I feel so sad and frustrated because at times I don't know what to do to make her feel better. She's so precious and has been such a good girl. She doesn't deserve this. Thank you so much for your support.

[Squirt's Mom]

I've also researched proper diet for cushings and found that "hi protein, grain free" food is recommended.

I was taught that the correct diet for a cush pup was low fats and moderate proteins. High proteins are not usually recommended for dogs unless they are working dogs - agility, sled, herding, etc.

How is your baby this morning?

[molly muffin]

Hello I just want to welcome you to the forum and see if you found out the results from the ACTH today. You should have a pre number and a post number. With high protein, I worry about pancreatis as cushing dogs are prone to it. Moderate fat and moderate protein is what I have always been told for cushing pups.

If they do a full blood test, then you can check things like the lipase levels and also check glucose as diabetes can also come on quickly with cushing pups.

Let us know. We'll be anxiously awaiting.

[sebarflin]

Hello ladies!

Dr. called around 1:00 p.m. Kricket's Cortisol levels are through the roof. Before the injection Kricket leveled at 10 1/2 which the norm is 1-5. After injection Kricket level was 17.4 and the norm is 8-17.

Also she now has secondary diabetes. I can't imagine what she is going through right now. I just want my baby feeling like herself again. Anyway, Dr. wants to focus on Cushings and lower the cortisol levels first. We are going to increase Vetryl to 20mg a day. We will take Kricket to vet next week for check up. If Kricket's spirits have lifted and she's eating better, then we will wait a couple more weeks to let medication do it's thing, have another blood test to see where the levels are at that time. If all comes back the way we hope, then we can begin working on levels for insilin shots to take care of diabetes.

She also had signs of infection as well. That explains the sore, seepage and blood near her vaginal area this saturday. We call dr. on call and he said it sounded like an anal glad burst and the infection was coming out of small whole. My husband and I doctored it over the weekend. It's still a bit swollen but not red and bloody like Saturday.

My husband is being so brave through all of this. We both have our days of tears. I'm cheering him up one day and then he's cheering me up the next. We love her so much. I know my husband's heart is breaking as well. He keeps motivating me to think positive and that Kricket is going to kick this thing. I'm just having a hard time being as optimistic. I've read many things about Cushings and Diabetes working against eachother. I'm just so glad that we have doctors who care that we care. They don't take us for every penny we own and give us breaks here and there. I asked about Blue Wilderness Grain Free kibble and dr. said that would be a good choice because Kricket will not need to have any grain or carbs in her diet due to the diabetes. Any other suggestion on dog food. My schedule is very tight but if I have to boil chicken every day....I will. I just want to make sure she eats healthy and gets vitamins she needs. She's losing muscle mass in front legs and no longer jumps on the couch. We have to take her up the 4 steps from the doggy yard up to the deck because she has difficulty lunging forward to get up the stairs.

Well, that's probably more info than you needed but it feels good to speak to people who understand my pain and Kricket's pain.

Blessed Thanksgiving my friends!!!!

God is my refuge and I depend on him for my strength. He knows my every weakness and also knows that I'm struggling trying to find my strength in all of this.

[Squirt's Mom]

Also she now has secondary diabetes. I can't imagine what she is going through right now. I just want my baby feeling like herself again. Anyway, Dr. wants to focus on Cushings and lower the cortisol levels first. We are going to increase Vetryl to 20mg a day.

I got this far and couldn't read any more. Your vet is so wrong! Diabetes is LIFE threatening, immediately life threatening. Cushing's is NOT. Take care of the diabetes first then worry about the Cushing's. I think you need a new vet asap based solely on this advise alone.

Please, please, please do NOT wait to address the diabetes. Please.

Go now and register at our sister site, K9Diabetes, ok? That doesn't mean you get to leave us but they are the experts on diabetes so get with them asap. Here is a link - http://www.k9diabetes.com/forum/

[Renee]

I second Leslie. Please, take the advice here.

Take care of the diabetes first. And, find a new vet ASAP!

I am sad your vet is so very, very wrong, risking your pup's life, and wasting your money.

[doxiesrock912]

Diabetes is just as dangerous for dogs left untreated as it is for people.
Please find an IMS specialist and definitely a new vet.

Having both makes treatment a little more complex, but the diabetes and any infections must be taken care of first.

[Harley PoMMom]

Hello ladies!

Dr. called around 1:00 p.m. Kricket's Cortisol levels are through the roof. Before the injection Kricket leveled at 10 1/2 which the norm is 1-5. After injection Kricket level was 17.4 and the norm is 8-17.

Those reference ranges (8ug/dl-17ug/dl) are for a dog that does not have Cushing's.

For a dog with Cushing's and being treated with Trilostane the post reference ranges are 1.5ug/dl - 5.4ug/dl, the post number can go as high as 9.1ug/dl as long as the clinical signs are controlled. You can find this information here: Dechra's U.S. Product Insert (http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf)




Also she now has secondary diabetes. I can't imagine what she is going through right now. I just want my baby feeling like herself again. Anyway, Dr. wants to focus on Cushings and lower the cortisol levels first. We are going to increase Vetryl to 20mg a day. We will take Kricket to vet next week for check up. If Kricket's spirits have lifted and she's eating better, then we will wait a couple more weeks to let medication do it's thing, have another blood test to see where the levels are at that time. If all comes back the way we hope, then we can begin working on levels for insilin shots to take care of diabetes.

I totally agree with Leslie, getting the diabetes under control should take priority over the Cushing's. Could you post her glucose numbers for us? Thanks!

Hugs, Lori

[addy]

a few links for you:

Therapy of Concurrent Diabetes Mellitus and Cushing's Syndrome
Canine and Feline Endocrinology and Reproduction
Edward C. Feldman and Richard W. Nelson, 2004
http://books.google.com/books?id=elP...ldman&f=false"

Q & A: Diagnosing Cushing's Disease in Dogs with Diabetes Mellitus
Insights into Veterinary Endocrinology (January 22, 2012)
Dr. Mark E. Peterson
http://endocrinevet.blogspot.com/201...edium=facebook

[Spencersmom]

I too have a chihuahua with cushings and different complications than what you are dealing with. I can't encourage you enough to heed the advice given here and even share with your Vet that you have tapped into this forum! I did this when my Spencer was diagnosed and in spite of his many challenges, he's fought long past what we all expected thanks to the advice given here that allowed me to go to my appointments informed and ready with the right kinds of questions that needed to be asked!!!

[sebarflin]

I really appreciate all of the help and advice. I will heed your warning and take Kricket to vet tomorrow. However, is there a possibility that increase in Vetryl (20mg) could help lower blood sugar level? I''m just worried that too much too fast (adding insulin with increased Vetryl) will lower blood sugar too quickly and cause more problems for her. Kricket is currently taking antibiotic for infection as well.

[molly muffin]

A dog with diabetes needs to be dosed twice a day with trilostane, am and pm, the dosage so, if you give 10mg, you would give 5mg in the morning and 5mg in the evening. Dr. Peterson is a strong advocate of this and he is one of the leading vet specialists in the field, world wide.

Will getting the cushings under control help the diabetes and help to get the blood sugar under control, sure it helps, but diabetes is much more important and life threatening so has to be addressed. I would definitely see a specialist that is familiar with both and with the current Up to date treatment protocols of both. Many GP vets are not up to date on what the latest guidelines are and it is very important. Often a specialist is, but even then, I'd ask them how many have they treated with both, what are the protocols they follow, etc. This is how you know if you have a vet who Is up to date or not. You can always ask on here too, as we deal with this so often, every single day for years, we often will be able to provide you with documentation to back up what we advise.
As we aren't vets, we follow what the specialist in the fields put out very closely.
So, get that diabetes under control, treat the infection, find a specialist. Would I go from 10 to 20mg of vetroyl. No I personally would not as the acth still showed high readings I would go to compounded trilostane, 10 mg and add in 4mg at night for example. But I wouldn't just double as that can get you in trouble.

[sebarflin]

Hello,

Kricket's appetite has improved just a bit. She no longer wants to eat Blue Wilderness chicken flavored food for some reason. Maybe she knows its too high in protein and fat and not a good recommendation for her. LOL She was eating it fine until we found out about diabetes. Then she turned her nose to it. I gave her some Raw Instinct chicken the other night and she looked at me like I was crazy. How dare I give her raw meat! So we've boiled some chicken, gave that to her this morning. She ate some of it; but when added some "thanksgiving" turkey she at a bit more. I put some green beans in the mix and she ate all around them. So....guess she doesn't like green beans. Guess I'll have to get a turkey breast because she really seemed to enjoy that. I've been researching foods for cushings/diabetes and found that no grain, medium protein/low fat is preferred so I guess it's back to petsmart tomorrow.

We also have another chihuahua (Hershee - 15yrs) and she is LOVING Kricket's diet change because she is also getting chicken and turkey in her food. She's at normal weight and only health issue at this time is slight cataracts and minor heart issue. She takes medication for that and doing fine. Still as spry as ever.

Anyway, didn't mean to get off subject. Kricket seems to be doing better and gaining a bit more strength back. She actually came up our 4 deck stairs on her own a couple times these past two days which is a huge improvement! Last week we were lifting her onto the deck because she was struggling with stairs. Antibiotic appears to be working well too. Going to take her to the vet tomorrow to check out insulin levels. I'm heeding your warning and going to discuss with vet about reasons to wait or move forward to address the diabetes. You guys kinda scared me a bit about not addressing diabetes sooner. I definitely do not want to neglect Kricket or cause any harm to my baby girl.

My family has been going to these vets for over 30 years and they have always had our babies best interests at heart. We have great relationships with each one and they actually know our babies health history. They know that we've had several pets through the years and know the sacrifices we've made to keep them as healthy as possible. They know how much we love our pets and they help us work hard to deal with issues quickly. I trust them with my babies because they've never given me reason not to. However, I'm a bit nervous about comments you all made about waiting too long to address diabetes so I'm taking Kricket to vet tomorrow morning.

I'll keep you posted. HAPPY THANKSGIVING!!!!!

[molly muffin]

The reason we worry so about diabetes and take it seriously is because we've seen dogs start to throw ketones in their urine when it goes for too long without treatment. Now I know that your vet is a family friend, but here you have the worry wart aunts.

Dr. Peterson, who is one the world authorities, has written a paper, stating that twice daily dosing with trilostane is better for dogs that also have diabetes. You want to keep everything level for the entire day, with as little bounce as possible, which makes it easier to keep the glucose in check too.


In diabetic dogs with concurrent Cushing’s disease, twice-daily administration is essential in avoiding large fluctuations in serum cortisol concentrations during the day (1,2). With once-daily trilostane administration, adequate diabetic control will be next to impossible in many dogs with concurrent Cushing's syndrome.
http://endocrinevet.blogspot.ca/2012/12/low-dose-twice-daily-trilostane.html

There are a lot of what might seem to be small things with cushings and diabetes that regular GP vets while very good vets, might not be as updated on.

You can print this out and take to your vet if you'd like. My IMS and vet are both open to discussions of what I have read and their opinions on it, etc. In the end though, it is my decision on which way to go on the treatment road.

Happy Thanksgiving!
hugs

[Squirt's Mom]

Sweetheart, many have learned a hard, very sad lesson about their long time, trusted vet when it comes to Cushing's. Please don't let your baby be the lesson for you. :( Never, ever blindly trust a vet, any vet.

[Spencersmom]

Just a little suggestion about home cooked meals. My Hubs & I cook our Chihuahua's food. His name is Spencer, diagnosed with Cushings early this year. Anyway, if you boil chicken first then use that broth to cook a little rice with greenbeans, peas, carrots and a tbls of cannned pumpkin I think your baby will eat it! What we do is dish up a plate with a little rice/veggie mix, with a little shredded chicken...heat it up in the microwave then add about a tsp of canned food (we use weight control) smashing it all together with a fork so there's no definite bits to be culled out.....Spencer cleans his plate!

Don't know if your baby will enjoy this, but hoped the suggestion worth sharing!!:D

[Renee]

Even a very trusted and loved vet can make mistakes, so please do not feel that any suggestions here are a personal attack on your vet. General practice vets don't and can't know everything. With such a close relationship with your vets, they should welcome your active participation in the treatment plan and not let ego get in the way.