Bichon - Diabetes and possible PDH?

[bmarra]

Hello, I found your forum yesterday as I was researching all that I could about Cushings. My 8 yr. old Bichon Frise had the low dose Cushings test and there was no suppression but actually increases at both the 4 & 8 hr. testing. Her baseline was 8.83, 4 hr - 9.76 and 8 hr. 15.0. My first concern is the very high levels including the baseline. Vet told me that wasn't unusual.

3 weeks ago by girl, Lacie, had a few accidents in the house which is not like her at all so took to vets and he found bladder infection and she was treated with 7 days of antibiotics. One week after finishing the med, she got the runs and vet found bacteria and gave her a 10 day dose of Metronadezole.

After the 1st infection, vet suggested doing a total blood work up which we did. I don't have the results of that to post but will get and post later if needed. I do know the liver enzymes were higher than normal, and there was signs of hypothyroidism. Cortisol level high enough to suspect Cushings so test was given.

Only symptoms Lacie is experiencing is excessive drinking and urinating. She does also have a little pot belly. Appetite is good but not ravenous. No hair loss and no bad skin, although she did have dry scaley dark patches all over her back side about two years ago which was treated topically. Since then I've been adding Salmon Oil to her meal and the skin has improved greatly.

The vet that did the Cushings test and the same vet I've been seeing for years as I had another Bichon before this one who lived to just under 16, indicated test was positive but I had to do my own research and then ask what type she has. I was extremely disappointed with the way he treated this situation as I never did get to talk to him directly but only his assistant who tried to answer my questions. He was ready to start her on 30 mg Vetoryl immediately.

I wanted a 2nd opinion so went to a vet I've used for emergency in the past. They got results of test and said it looks positive but to determine what type they needed to do an ultrasound which is scheduled for this coming Thursday.

From the information I shared, do you all think this really is a case of Cushings? Also, I'm being told that it looks like the adrenal dependent type which I am very concerned about knowing that is much rarer than the pituitary dependent and may involved a cancerous tumor. Even though Lacie is only 8 I can't see putting her through a delicate surgery to remove the adrenal so would like to know if anyone has had experience with treating the adrenal dependent Cushings with Vetoryl.

I am very scared and worried about this as, again my girl is only in the middle of her life and this is just so unexpected. She seemed fine just 4 weeks ago!

We will see what the ultrasound reveals but if it is in fact Cushings I am praying it is the more common type.

Any advise would be appreciated and helpful.

Thanks!
Brenda

[Harley PoMMom]

Hi Brenda,

Welcome to you and Lacie! So glad you and Lacie have joined the forum but sorry for the circumstances that brought you here.

Getting those test results and posting the abnormal levels here will be a big help. Was an urinalysis done, and if so, does Lacie have a low urine specific gravity? And when you say "Cortisol level high enough to suspect Cushings so test was given" what exactly was this test?

Yep, those results you posted are from a low-dose dexamethasone suppression (LDDS) test and since there was no suppression that does point to the adrenal type of Cushing's.

I agree that an ultrasound should be the next step as it gives a vet an opportunity to check surrounding internal organs for abnormalities and hopefully both of the adrenal glands will be visualized. If an adrenal tumor is involved, one adrenal gland will be larger than the other and the other gland will be much smaller or even atrophied from lack of use.

Adrenal tumors can be functional, meaning they secrete cortisol and/or other adrenal hormones, or they are nonfunctional and don't secrete cortisol. Another adrenal tumor type is known as a Pheochromocytoma, this kind does not secrete cortisol but rather catecholamines, primarily epinephrine and nor-epinephrin. The first line of treatment for an adrenal gland tumor is adrenalectomy. It is a risky surgery; however, the risks are much lower if the tumor has not spread into the vena cava, and/or the surgeon is a seasoned veteran in performing this surgery.

Hypertension is a concern in Cushing's but is greater concern with adrenal tumors and pheochromocytomas. Did your vet check Lacie's blood pressure?

Please know we will help in any way we can, and feel free to ask all the questions you want.

Hugs, Lori

[labblab]

Hi Brenda, and wecome from me, too! Lori has already given you a lot of great info, so I mainly just want to reconfirm how glad we are that you've joined us.

I absolutely agree that the ultrasound is an excellent "next step." It is true that the majority of dogs showing lack of suppression on the LDDS have the adrenal form of the disease. But we are told that up to 30% of dogs with that pattern do have pituitary Cushing's instead. So that is still a definite possibility for Lacey, too. Either way, Vetoryl can be used to treat the symptoms with success. It is specifically approved for adrenal Cushing's.

So we will look forward to learning more about Lacey, and good luck with that ultrasound!

Marianne

[bmarra]

Hello Lori - Thank you for replying so quickly. I will get a copy of Lacie's work up and post as soon as possible. Yes, she did have the low dose dex test but that has been the only thing so far. From a chart I saw that someone had posted on the forums for how to interpret the low dose results, I saw that if both the 4 hr & 8 hr don't suppress then further testing is recommended to determine the type. I hope that is right as I am so afraid that she may have an adrenal tumor. My vet also indicated that the result of the low dose test wasn't conclusive.

I don't believe blood pressure was checked but I will certainly look into that.

Do you know of other posters who have had to deal with the adrenal dependent Cushings?

Thank again.

Brenda

[bmarra]

Thank you Marianne - I truly appreciate your response and offering hope. I am praying that if she in fact has Cushings that is the pituitary type as I would think the Vetoryl has been more widely used for that since it is much more common.

Also, can you or any other posters tell me if the symptoms can come & go or are they pretty much consistent? And, would the adrenal type act differently than the pituitary?

The only real symptoms Lacie is showing is the drinking much more than normal and, of course, the urinating and having some accidents. Yesterday she didn't have a very good day with that but she rests peacefully during the night and doesn't bother us to go out. My husband takes her out in the middle of the night just to prevent any accidents but I also noticed that her drinking was much less, at least last night.

Today, she seems more like herself. She is still drinking more but isn't always looking for water or food and that is very confusing to me. Also, she normally wants to come up on our bed toward the morning but lately hasn't done so as she likes the tile or laminate floor. But, this morning she came over to come up to the bed and layed with me for a belly rub. I was pleased about that!

Any advice is obviously appreciated.

Thanks again,
Brenda

[Amanda's Mom]

Hello Brenda,
First don't panic! There are wonderful, supportive people here who can provide a wealth of information. I am also Mom to a bichon and two poodles. My old, blind poodle girl was diagnosed with an adrenal tumor last fall. I do regular ultrasounds and it showed up as a small node and then began to grow. Amanda had no symptoms of Cushings yet. But over half adrenal tumors are malignant and even if they are not secreting tumors or malignant they can still become locally invasive.

I felt the only way to give Amanda a good shot at beating this was surgery. It was a frightening and difficult decision but I believed it was the only decision. Her story is already posted here as well as recently to Aggie's mom. Amanda was 12 yrs 8 months when she had her surgery. She is blind, has high blood pressure and a Grade 3-4 heart murmur. Her internist and surgeon were incredible and she came through the surgery with flying colors. We caught it before it had become invasive, treated her pre surgery with some medications and she had great post op care...home in two days. Amanda's tumor was functional and growing but fortunately not malignant. Still, she would have experienced Cushings symptoms soon enough as well as the tumor becoming locally invasive. She is cured, happy, doing great and I do not regret my decision one bit. BUT we did catch it early and I had a terrific very experienced surgeon. I have photos posted under the Community section if you want to see how the surgery went. I know you are leaning towards treating with medication and you will read much that is negative about adrenalectomy. But I like to post Amanda's story because she was a high risk case (right adrenalectomy, old with heart murmur) and she sailed through this and was just fine within a few days. So there are success stories too with wonderful results! Meanwhile you will be learning and researching and this is a great site with great people!good luck and we are all here for you!

[Harley PoMMom]

Also, can you or any other posters tell me if the symptoms can come & go or are they pretty much consistent? And, would the adrenal type act differently than the pituitary?


With a pheochromocytoma tumor symptoms do wax and wane, increased drinking/urinating, loss of appetite and panting are some of the symptoms with a pheochromocytoma tumor.

Lori

[bmarra]

Amanda's Mom - Wow, that is so great that your baby came through that surgery. Right now I just have to wait for the results of the ultrasound then go from there I guess. Thank you for replying and giving me that information. Just makes you wonder why such things happen to our furry babies...seems so unfair. Will keep all posted on results.

[Harley PoMMom]

Here are links to other member's threads whose dogs have an adrenal tumor or have had an adrenalectomy:

Hi-New Memeber- PHEO - Need Info and Advice Please (http://www.k9cushings.com/forum/showthread.php?t=5904)

Flynn 11 y/o Foxie Cross - Right adrenalectomy, 3rd Dec 2012 for Pheochromocytoma (http://www.k9cushings.com/forum/showthread.php?t=4242)

adrenalectomy scheduled Nov 4 (http://www.k9cushings.com/forum/showthread.php?t=6731)

Meet Kaibo :) 7 y/o toy poodle - Diabetes, adrenalectomy; now PDH and CC (http://www.k9cushings.com/forum/showthread.php?t=4648)

Just found out Aggie has cushings (http://www.k9cushings.com/forum/showthread.php?t=7094)

[bmarra]

Lori, thank you. I will check those out for sure.

I was able to get a copy of Lacie's lab work that was done last month.

When she first went to the vet for what turned out to be a slight bladder infection, her urinalysis results were:
SP.GR. 1.010
PH 7.0
LEU +
PRO +
Everything else NEG

After medicating, 2nd urinalysis was:
SP.GR. 1.004
PH 6.0
Everything else NEG

But, with those two positive results, the vet recommended testing for Cushings, so she had the low dose dex test done.

Before that however we had a complete blood work up done and these are the abnormal results:

Sample Lipemia - Slight
ALK Phosphatase - 2,475 (very high)
ALT (SGPT) - 339 (high)
Triglycerides - 534 (high)
Thyroid (T4) <0.5 (low)
Seg Neutrophils - 85 (high)
Lymphocytes - 9 (low)

So, I've read where high liver enzymes can be caused by Cushings but am wondering if hypothyroidism can cause same and also if it can increase cortisol levels? Another concern is that within the 3 weeks prior to having the low dose dex test she was on two different antibiotics - could that alter the outcome? I was told that it could not but I am skeptical. I was told to just skip giving her a pill the morning of the test which would have been her 9th day taking it.

Thank you all again.

[bmarra]

Hello Everyone. I was just reading more info on Cushings and came across a write-up about it on Vetinfo.com. Link http://www.vetinfo.com/dcushing2.html.
What I found very interesting that I haven't read from anyone posting here is this bit of information:
"While it is unusual, there have been some well documented cases of spontaneous remission from Cushing’s disease. This makes sense as spontaneous remission seems to occur with a number of cancers. It isn’t something you can count on, but if your pet seems to recover from previously diagnosed Cushing’s disease it is really possible that recovery is truly happening."

This just makes one wonder if meds should even be given since the meds don't cure the disease. Has anyone heard of this happening?

Also, last night I posted my Lacie's lab results so if anyone would take time to please review and offer their opinion as to whether or not these are indicative of possible Cushings I would greatly appreciate it.

My other questions are:

Can hypothyroidism cause Cushing like symptoms and raise cortisol levels?

Since Lacie was being treated for a bacterial infection when the blood work was done could that have altered the results? To backtrack, she was given a 7 day dose of antibiotics for what appeared to be a higher than normal white cell count in her urine. After she finished, her urine was tested again and it was clear and she also, at that time, had blood drawn for the workup. A week after finishing that medication, however, she developed bad diarrhea and was put on another antibiotic for 10 days as they found bacteria in her stool. On Day 9 of her med treatment she was scheduled for the low dose dex test and I was told to just withhold her med for that morning. So, could it be possible that the infection was not totally cleared up and caused increased cortisol levels?

Thank you all for taking time to read this and for any advice/info you offer!

Brenda

[Harley PoMMom]

Hello Everyone. I was just reading more info on Cushings and came across a write-up about it on Vetinfo.com. Link http://www.vetinfo.com/dcushing2.html.
What I found very interesting that I haven't read from anyone posting here is this bit of information:
"While it is unusual, there have been some well documented cases of spontaneous remission from Cushing’s disease. This makes sense as spontaneous remission seems to occur with a number of cancers. It isn’t something you can count on, but if your pet seems to recover from previously diagnosed Cushing’s disease it is really possible that recovery is truly happening."

This just makes one wonder if meds should even be given since the meds don't cure the disease. Has anyone heard of this happening?

I've been a member of this forum for 6 years and I have never seen a member's dog go into spontaneous remission. I have seen dogs that have had their cortisol drop too low on medication and it took a while for their adrenal glands to start producing cortisol again.


Also, last night I posted my Lacie's lab results so if anyone would take time to please review and offer their opinion as to whether or not these are indicative of possible Cushings I would greatly appreciate it.

I am so sorry that it has taken this long for us to reply to you, we are usually on the ball but sometimes it gets away from us. :(:o



Can hypothyroidism cause Cushing like symptoms and raise cortisol levels?

Yes to both questions. Any kind of non-adrenal illness and even stress has the ability to raise cortisol levels, enlarge the adrenal glands, yield false positive results on the Cushing's tests, and cause similar abnormalities of Cushing's on CBC/chemistry panel blood work. This is one reason why Cushing's is difficult to accurately diagnose.


Since Lacie was being treated for a bacterial infection when the blood work was done could that have altered the results? To backtrack, she was given a 7 day dose of antibiotics for what appeared to be a higher than normal white cell count in her urine. After she finished, her urine was tested again and it was clear and she also, at that time, had blood drawn for the workup. A week after finishing that medication, however, she developed bad diarrhea and was put on another antibiotic for 10 days as they found bacteria in her stool. On Day 9 of her med treatment she was scheduled for the low dose dex test and I was told to just withhold her med for that morning. So, could it be possible that the infection was not totally cleared up and caused increased cortisol levels?

Thank you all for taking time to read this and for any advice/info you offer!

Brenda

I see that Lacie has a low specific gravity (SP.GR. 1.010 & SP.GR. 1.004), which means her urine is diluted. When a dog has diluted urine a regular urinalysis may not pick up the bacteria in the urine, so that 2nd urinalysis that shows no infection could be false. With diluted urine an urine culture and sensitivity test should be performed. This type of test will be able to show exactly what bacteria is in the urine so the appropriate antibiotic will be given.

And most definitely a urine infection can cause a false positive result for Cushing's, and with the LDDS test the odds are higher that this can happen.

Hugs, Lori

[bmarra]

Lori, thank you for your reply...you've given me much hope. And please no apology necessary for not responding right away as I don't know how you can keep up with everyone as I see there are many new posters daily. Makes one wonder as to why so many dogs are being diagnosed with Cushings, doesn't it?

You've given me much insight as to the urinary infection and I am truly wondering now if Lacie was clear of it when the Cushing's test was done...as I said she hadn't yet finished the 2nd antibiotic yet they said it was ok to give her the test when I questioned them about it.

My girl was absolutely not herself the past few weeks but I have seen an improvement in her today so it could be that she is finally getting over the infection.

I am going to go ahead with the ultrasound this week even though it is a huge expense but if it gives me a clear picture of what may be going on it will be worth it. If it is not definitive of Cushings then I am going to ask this new vet who did not administer the low dose dex test what else can be done to confirm if she has it or not.

I have many questions for this vet so hopefully I will have many answers soon.

Thank you again!

Sincerely,
Brenda

[Harley PoMMom]

I think an ultrasound is a great next step. Ultrasounds can be a very useful diagnostic tool, they may be able to find abnormalities on the internal organs, such as gallbladder mucocele, kidney issues, pancreatitis...etc. Our motto here is you get a lot of bang for your buck with an ultrasound. However not all ultrasounds are created equal. A good quality ultrasound/interpretation depends on a few things; the tool used, the technician performing it, and the physician interpreting it. Usually a Board Certified Veterinary Specialist is the best choice to perform an ultrasound.

Hugs, Lori

[molly muffin]

Hello and welcome from me too.

Absolutely infections can play havoc with diagnostic testing for other issues.

So, I'd see what an ultrasound shows. If it's an adrenal you'll have one noticeably larger adrenal gland than the other. If it is pituitary then you'll have probably a mildly enlarged liver and both adrenal gland mildly enlarged also. With that really super high ALKP, I think you want them to take a look at the gall bladder to for an sludge, as that can happen also.

Thyroid can cause some similar symptoms as cushings, such as the drinking and peeing, but then cushings can also cause the thyroid numbers to be a bit off too. Confusing isn't it.

As was also already mentioned, we've seen remission, but it usually happens after the dogs have been on medication and it isn't necessarily the norm, as much as the abnormal.

Welcome again!

[labblab]

When she first went to the vet for what turned out to be a slight bladder infection, her urinalysis results were:
SP.GR. 1.010
PH 7.0
LEU +
PRO +
Everything else NEG

After medicating, 2nd urinalysis was:
SP.GR. 1.004
PH 6.0
Everything else NEG

But, with those two positive results, the vet recommended testing for Cushings, so she had the low dose dex test done.

Before that however we had a complete blood work up done and these are the abnormal results:

Sample Lipemia - Slight
ALK Phosphatase - 2,475 (very high)
ALT (SGPT) - 339 (high)
Triglycerides - 534 (high)
Thyroid (T4) <0.5 (low)
Seg Neutrophils - 85 (high)
Lymphocytes - 9 (low)

My 8 yr. old Bichon Frise had the low dose Cushings test and there was no suppression but actually increases at both the 4 & 8 hr. testing. Her baseline was 8.83, 4 hr - 9.76 and 8 hr. 15.0. My first concern is the very high levels including the baseline. Vet told me that wasn't unusual.

Hi again, Brenda. I just want to reconfirm the benefit I think you'll gain by proceeding with the ultrasound. Since you don't see many overt symptoms of Cushing's in Lacie, every piece of diagnostic information can be really helpful.

In looking back over her lab results, however, I have to say that she really does exhibit a classic collection of Cushing's abnormalities. And I will disagree a bit with your vet by saying that I think YOU are right -- her LDDS results are really highly elevated. We've seen a lot of LDDS tests reported here, and Lacie's levels are really high across the board.

And just to clarify, were you wondering whether a lingering infection might be affecting the LDDS, or was it instead a possible drug interaction with the antibiotics that you are asking about? If you are wondering whether the antibiotics themselves might have skewed the test, I have never heard of that being the case. Also, it sounds as though the LDDS was performed after the second urinalysis at which time she appeared to be clear of infection, so it makes it less likely that the bladder infection would have affected the results to a significant extent.

Given this overall pattern of results, if I was being asked to place a bet, I would put my money on Cushing's being the underlying factor that is causing the other abnormalities (including the low thyroid reading). The wild card, however, is the lack of consistent overt symptoms. So I'll be really interested in seeing what that ultrasound reveals.

Marianne

[bmarra]

Hello Sharlene - thank you for your reply and, from what my vet said about the ultrasound, it will be thorough and look at all organs. I've been so nervous about this and can't wait until the test is done this Thursday.

Hello Marianne - thank you so much for taking time to review Lacie's test results again and offering more advice. I guess my first question, since you agreed her cortisol levels were very high, is if you've ever heard of any other cases where the levels were that high? I was told by my vet that took the test and the new vet I'm seeing to do the ultrasound that they have seen levels like that before. It causes me to be alarmed however.

Lacie had two episodes of infection - she started to have accidents in the house and going more frequently so I took her to get checked. I was told to bring a urine sample and they did a test right in the office and told me it showed a somewhat higher than normal level of white cells so they gave me an antibiotic for 7 days. I was asked by the new vet today if a culture was done to find out what type of bacteria was found and, of course, one was not. So, not sure how they knew what med to give her.

Vet also suggested we do a blood workup so one week later we had that done. Also brought in another urine sample and they said it was clear.

About a week after finishing the antibiotic, Lacie got the diarrhea that went on a couple of days so back to vet with sample. They found bacteria so gave her another antibiotic for 10 days.

So, since she got either another infection or the same one that affected her bladder ended up in her intestinal tract, I question whether or not the infection was cleared up when the low dose dex test was done. She still had one pill to go when the test was done so med treatment wasn't completely finished. For that reason, I question how accurate the test was as I don't believe the infection was totally cleared.

Of course she started with the excessive drinking and urinating which hasn't abated. I do notice her panting more than usual so guess that is not good.

I've already asked the new vet what else can be done to confirm a Cushing's diagnosis but I guess we'll know much more with the ultrasound then proceed from there.

Once I get the results I will post.

Thanks again!
Brenda

[labblab]

I guess my first question, since you agreed her cortisol levels were very high, is if you've ever heard of any other cases where the levels were that high? I was told by my vet that took the test and the new vet I'm seeing to do the ultrasound that they have seen levels like that before. It causes me to be alarmed however.
Yes, I do believe we have seen other dogs with levels that high, but they are higher than average. Now I don't mean for you to feel alarmed by that, but instead just to indicate that Lacie's 4 and 8-hour results were not just slightly out-of-range, but instead significantly out-of-range which does make the Cushing's diagnosis more likely in my own mind. For the sake of argument, even if her infection had not totally cleared, you are still left with several abnormalities that a bladder or GI infection would not explain, but Cushing's would. And now we have panting to add to the symptom list in addition to thirst/urination, pot belly, and history of skin issues.

I am not saying the diagnosis is a "done deal," but there is really nothing about Lacie's lab profile that is not consistent with Cushing's. Yes, there could be other explanations for individual pieces. But when you look at the picture as a whole, I can see why your vet thinks Cushing's is likely because it is one thing that could account for all the lab abnormalities.

But having said that the LDDS results were high, that does not mean Lacie is any less likely to respond favorably to treatment if and when it should seem warranted. It is just a matter of adjusting the medication dose to arrive at the point at which the cortisol level is satisfactorily controlled, and that is really more a result of the way in which each dog individually metabolizes the drug as opposed to how high the cortisol level was to begin with.

Let's see how the ultrasound looks. And if you are interested, there is another diagnostic blood test that can be administered: the ACTH stimulation test. That is the same test that is used to monitor cortisol levels after treatment has begun, so there would be value in running it as a pre-treatment baseline as well as an additional diagnostic.

Marianne

[bmarra]

Hello All - Well, I thought I wouldn't be writing again until after Lacie's ultrasound tomorrow, however the unexpected happened last night and it was off to vets this morning.

Lacie was acting very off last night, she was restless, breathing heavily and drinking like there was no tomorrow. She hasn't been like that up to then so first thing this morning I called the vet and took her in. After 2 hrs of consult and very thorough testing and, of course, $$$ (I believe everything that could be done was except for a ACTH Stim test) he diagnosed her with diabetes. He still believes the chance is very high that she also has Cushings but will know more tomorrow after the ultrasound.

Diabetes - now that was unexpected! He gave her a shot of insulin and it seemed to make a difference right away. She's calmer and is drinking less. X-rays showed an enlarged liver which was expected but nothing else, other than bad hips, of concern. He also gave her Denamarin for the liver which I start tomorrow evening.

My head was absolutely swimming this morning trying to take it all in and grasping the reality of what's going on with Lacie. The vet said that the diabetes could have resulted from the Cushings which we know may well be the case.

However, is it possible that the diabetes caused her symptoms and not Cushings? I told vet I really want to be SURE she has Cushings before starting any treatment. He did do a Cortisol Baseline test today so that will tell more.

Also, since she's now having to take insulin, is it safe to start her on Vetoryl soon after or should there be a fair amount of time until her body is adjusted to the insulin?

Thanks again everyone - will post additional results when received.

Brenda

[molly muffin]

oh my goodness

So first thing first, lets see if once the diabetes is regulated successfully if cushings is still an possibility. It might not be, or it could be, it rather depends, but diabetes symptoms are much the same and for some once insulin is regulated successfully, cushings diagnosis is no longer in the picture.

To help you with the diabetes, we have a sister forum here: www.k9diabetes.com wonderful folks and very knowledgeable. We have members on both forums as sometimes you do end up with both disease.

Pop over and join them. They will be immensely helpful during this time.

[Harley PoMMom]

My goodness, when it rains it pours, huh? I'm going to copy and paste a reply of mine that I posted in another members thread today regarding diagnosing Cushing's in a dog that has uncontrolled diabetes:


Diagnosing Cushing's is difficult in itself and when diabetes is thrown in the mixture it makes it even more challenging. When a dog is diagnosed with diabetes it is important to get that blood sugar regulated before any tests for Cushing's are performed. Diagnosing Cushing's in an uncontrolled diabetic dog is next to impossible as diabetes can cause the same organ abnormalities on imaging, overlapping symptoms that are also associated with Cushing's and diabetes can cause false positives LDDS and ACTH stimulation test results.

I'm providing a link below to Dr. Peterson's blog entitled Q & A: Diagnosing Cushing's Disease in Dogs with Diabetes Mellitus. http://endocrinevet.blogspot.com/201...e-in-dogs.html It has some pertinent information so I do recommend that you read it.

Sharlene is correct, definitely getting that blood sugar regulated takes top priority, just put any thought of Cushing's on the back burner for right now and let's focus on the diabetes...please do join our sister site too~ http://www.k9diabetes.com/forum/ They can help with the diabetes immensely.

Hugs, Lori

[labblab]

Wow, for sure this is a shocker! I think you've already been given some great advice, but I do have just one thing I'd add re: the Cushing's. If both adrenal glands are enlarged, then I agree that the waters may remain murky right now as to whether diabetes or pituitary Cushing's is the cause of the adrenal abnormality as well as other symptoms in question. Although having said that, was Lacie's glucose level within normal range in all previous blood panels including at the time of the onset of symptoms and also the LDDS? If so, I do think that makes it more likely that Cushing's is truly involved because if Lacie's glucose levels were always normal prior to last night, then diabetes would not be the cause of the previously seen abnormalities. It seems to me that it would be harder to unravel the two disorders if the elevated glucose level and "positive" Cushing's testing (elevated cortisol) had instead presented simultaneously.

If an adrenal mass is visualized, I think it becomes a different story and it is really likely that the Cushing's preceded (and precipitated) the diabetes. In that event, I think there is even less doubt the Cushing's will likely need to be addressed in conjunction with the diabetes. So I do think the ultrasound remains really important.

Also, I do not think there is any particular value to a baseline cortisol in this situation. Cushing's or no Cushing's, you would not be surprised to see it elevated in this type of stressful situation. Baseline cortisols are simply of no diagnostic value in determining whether or not a dog is suffering from Cushing's because there can be a very wide range of baseline values even in normal dogs.


Resting cortisol concentrations are not useful for diagnosing Cushing’s Syndrome. In fact, resting cortisol levels in dogs with known Cushing’s Syndrome overlap 50% of the time with normal dogs.

Marianne

[bmarra]

Getting ready to take Lacie for ultrasound but wanted to post quick reply to Marianne.

Her lab work that was done last month, before the LDDS, showed glucose at 125 which was in normal range. Yesterday it was over 300. Guess that then is a concern.

I do know that after getting the insulin yesterday she spent a much more restful night and didn't drink as much. Hubby took her out about every 2 hrs just in case but she was never in a hurry to go.

Also of concern is what you said about the baseline cortisol and makes me wonder what that will really confirm if in fact it's high due to stress and the diabetes. UGH!!! This is so confusing, isn't it?

Will let you all know results of ultrasound and, of course, I am hoping & praying the adrenals look good with no tumor involved.

Thank you all for your support and replies.

Brenda

[bmarra]

Got Lacie's results from the ultrasound and the great news is that the adrenal glands were normal - so, no Cushings, right??

My vet wasn't in the office today but the radiology specialist that did the ultrasound consulted with him over the phone. What she did find was enlarged intestines, kidneys and pancreas. This apparently was more than would be found in determining pancreatitis so they are going to do another test to find the cause. The test is called a PLI/TLI/COB/Folate Panel and it is done by sending blood to Texas A&M (why there I'm not sure) but the results should come in fairly quickly.

They said this could all be caused by the diabetes or an infection which, of course, she did have.

Until I hear directly from my vet and not the tech that Cushings has been ruled out I will not celebrate just yet.

What I do know is that since giving Lacie insulin she has been more herself - resting peacefully, not drinking as much and not having accidents. If this is just a diabetes issue I guess I will be spending time on your sister site for diabetes.

Thank you all for your support and information. If I hadn't found this sight I probably would have been giving Lacie Vetoryl for no reason since that was what my "regular" vet prescribed without doing any further testing. That is certainly worrisome and I don't believe Lacie will be seeing him again.

Also, if it is just diabetes then that means the LDDS was a false positive so it certainly can happen.

Again, until I hear it directly from my new vet I will not jump to that conclusion but, from what I've learned, normal adrenals would not be present with Cushings. If I'm wrong on that please advise.

So, I may be back still but, if not, I wish you and your furbabies all the best!

Sincerely,
Brenda

[labblab]

Brenda, thanks so much for updating us so quickly, and I am so very glad that Lacie is more comfortable now!

In answer to your question about the appearance of the adrenals, it sounds as though an adrenal tumor has definitely been ruled out, and I know you are feeling very grateful for that. As far as pituitary Cushing's, however, these results make the disease less likely but it does not rule it out entirely. We have read that approximately 30% of dogs suffering from pituitary Cushing's do not exhibit enlargement of their adrenal glands, especially when the disease is at an early stage. So I'm afraid the lack of bilaterally enlarged adrenals is not a 100% rule-out of a pituitary tumor. However, it is certainly important info to consider when looking at the overall picture.

I'll try to find an actual research citation for that statistic and add it later on.

Marianne

[labblab]

OK, I'm back with that research citation. I am just gonna go ahead and include a quote from a reply I had written to another member. Once again, however, if Lacie's adrenals looked totally normal, that info makes Cushing's of either type much less likely. And no matter what, attention to the diabetes remains the first priority.


It is true that a dog with adrenal Cushing's will typically exhibit abnormalities on an ultrasound image (one adrenal gland swollen with the presence of a tumor or mass, and the other gland often shrunken or atrophied). The majority of dogs with pituitary Cushing's will exhibit enlargement of both of their adrenal glands. But not infrequently, the adrenal glands of dogs with pituitary Cushing's will be of normal size -- in fact, up to 30% of the time. Here's a quote from an article by Dr. Claudia Reusch: (http://www.k9cushings.com/forum/showthread.php?t=230)


In the typical case of a dog with PDH the adrenal glands have a bilateral symmetrical appearance. They may be enlarged (increase in thickness), or normal-sized. Normal-sized adrenal glands are relatively frequent (about 30% of cases with PDH) and we assume that they are mostly seen in dogs with short term or mild disease. In dogs with PDH the shape of the adrenals is usually preserved, a plump appearance is sometimes seen. With regard to echogenicity adrenal glands in dogs with PDH are most often hypoechoic and homogenous. However, the parenchyma may also appear irregular, show focal areas of increased echogenicity or a nodular appearance.

Dr. Reusch does state that most dogs with pituitary Cushing's do exhibit abnormalities in the manner in which the ultrasound waves are reflected back ("hypoechoic"). But once again, it sounds as though this is not ALWAYS the case.

[Harley PoMMom]

The test is called a PLI/TLI/COB/Folate Panel and it is done by sending blood to Texas A&M (why there I'm not sure) but the results should come in fairly quickly.
Brenda

They did mention that there is a 12 hour fast required for that PLI test?

Dr. Jörg M. Steiner may be the reason why it is going to Texas A&M, as he is a Professor with the Department of Small Animal Medicine and Surgery and the Department of Veterinary Pathobiology at Texas A&M, he is also one of the developers of that PLI test, so he know his stuff when it comes to Gastrointestinal issues.

For an explanation of the tests use this link: http://vetmed.tamu.edu/gilab/service/assays

Dr. Jörg M. Steiner info: http://vetmed.tamu.edu/gilab/staff/dr-joerg-steiner

Lori

[bmarra]

Marianne - wow, thank you so much for all that information. I had second thoughts about the adrenals and Cushings after I wrote and did more research also. I did find that the adrenals could be normal sized with it but the description I got from the tech was the adrenals were "normal" so I will have to get clarification on what that really means.

I also found info that indicates Diabetes symptoms can be much like Cushings particularly the ones Lacie had and thankfully doesn't have currently. She slept through the night with no issues and hardly any drinking. We got some needed rest ourselves!!

She did in fact fast for that long as she couldn't eat after 10:00 pm Wed. night to have the ultrasound. That is interesting about the Dr. at Texas A&M - will have to research him.

So, we are not completely out of the woods yet as still need the results from that test and, again, I want 100% confirmation that Cushings isn't in the picture.

Bichons are very prone to diabetes so that is why I'm thinking & hoping that alone is the culprit.

Have a great day,
Brenda

[bmarra]

Hi again all - well, my hopes have just been shattered to bits! Vet called and told me Lacie does, in fact, have Cushings and that the adrenals were enlarged - that is not what the tech told me yesterday. Also, he's going by the fact her glucose level was normal when LDDS was taken and now, of course is high, the fact her liver enzymes were very high and he told me her baseline cortisol was 16 and a normal is 5.

Other bad news is that she may still have infection so he's putting her on an antibiotic and also something for pancreatitis (mind you, we don't yet have the results of the test sent to Texas A&M). But, the worst news of all is they found a small shadow on the bladder which could be a cancerous tumor but they aren't 100% on that and we are going to do a wait & see approach for now (I think).

There is so much going on to wrap my head around. I can't understand why with the insulin her outward symptoms are all but gone. Wouldn't they still be there with the cortisol pumping through her body?

If we start her on Vetoryl how would I even know it was working if the symptoms don't return?

Any advice at this point, knowing all this, would surely be very appreciated. Should I hold off on treatment for Cushings until all these other issues are stable? I can't see doing Vetoryl and insulin at the same time.

I am so sad learning that my poor puppy has been so sick and not knowing. As we all agree - if only they could talk?

Sad Mom today,
Brenda

[labblab]

Oh gosh, Brenda. :o

What a rollercoaster you're on, and such a NOT fun ride. :(

It is so incredibly frustrating that there is no single definitive test for Cushing's -- we have to keep filling in puzzle pieces one by one. Perhaps what the tech meant by telling you that the adrenals were "normal" was that no adrenal tumors nor masses were seen. We know how worried you have been about that, so at least that fear can be removed. But I do understand why your vet is still suspecting Cushing's based on these additional findings from the imaging. It still remains true that other diseases could be causing various problems, but Cushing's is one disease that could account for all these abnormalities, even the new ones including diabetes and pancreatitis, so we still have to suspect that it may be at the bottom of everything.

But as far as what to do now, it is a very complex situation and I hope your vet can consult with somebody with specialized training in complicated cases like this. Setting aside the worry about the shadow on the bladder, it still seems to me that trying to gain control of the diabetes remains the first priority because it can cause urgent problems quickly. Whether or not you are able to gain good control of Lacie's glucose levels may actually be another diagnostic indicator as to whether Cushing's is present -- diabetic dogs with Cushing's may not ever reach good, stable glucose levels unless the cortisol levels come under control as well.

In this situation, I honestly don't know what an endocrinologist would recommend in terms of beginning insulin and trilostane simultaneously vs. first attempting to stabilize glucose levels with insulin alone. For what it's worth if and when you do start the Vetoryl, for diabetic dogs treated with insulin, most specialists recommend breaking the daily trilostane total into two parts given at 12-hour intervals, and the initial dosing formula equals a daily total of no more than 1 mg. per pound.

I am just so sorry you are being hammered with so many worries in such a short time. I am really just in the brain-storming stage here, myself. So please keep talking to us and updating us as the additional test results come in, OK?

Marianne

[molly muffin]

I agree with Marianne, I hope they will talk to a specialist, but I'd try to get the glucose stable and then see what the cortisol levels are like. It could be cushings at the bottom, but I'd start the insulin first I think, if it was me and monitor the dark area, which hopefully won't turn out to be anything at all.

If the cortisol remains high and glucose won't regulate, or symptoms show up again, then I'd start the vetroyl. I do like the idea of one thing at a time, so you know what the reaction is rather than starting multiple things at the same time.

So sorry you are going through all this with your baby. :(

[bmarra]

Thank you both for your replies and input. I had to pick up some meds for Lace today - she is already taking insulin as I mentioned and the Denamarin. Since evaluating the results of the ultrasound the vet has given us another antibiotic just in hopes to control any possible infection for the time being. We are still waiting on a culture to come back which will identify the bacteria if there is any then she may be put on a different antibiotic. He also gave her PanaKare Plus tablets for pancreatic support. Besides the culture we are still waiting the results of the PLI/TLI/COB/Folate Panel.

Once the results of those two tests are back, hopefully at the beginning of next week, I am going to meet the vet for another consultation on the path forward. Lace is still doing better than she was so I have to take this a step at a time and see how it plays out. I also know her blood test indicated she is hypothyroid which is another common ailment of Bichons but the vet hasn't even discussed that possibility with me as far as treatment and what that may cause.

I believe we're on a pretty long journey but I am grateful I found your forum and of the support and information you have given us so far. You all have been extremely helpful in getting us to this point.

Thanks much!

Brenda

[Harley PoMMom]

They did mention that there is a 12 hour fast required for that PLI test?


I know I am being a pest, but this is very important, Lacie was fasted for 12 hours before the blood was taken for the PLI test, right?

[labblab]

Hey Lori, I think we're OK re: the fast.


She did in fact fast for that long as she couldn't eat after 10:00 pm Wed. night to have the ultrasound.

And Brenda, low thyroid levels can be yet another common consequence of Cushing's. However, often the thyroid level will normalize again all on its own once the cortisol is controlled. So your vet may or may not feel as though independent thyroid supplementation is actually necessary at this time. If so, it is very simple and inexpensive -- you just give pills.

Marianne

[bmarra]

Lori, thank you for questioning the fasting for the test and I see that Marianne responded. The test wasn't done until after 12:00 on Thursday so it was over 12 hours fasting.

Lacie had a very normal night last night and even wanted to come up on our bed this morning which she hasn't done in weeks. The change in her since the insulin is quite remarkable.

We are still waiting on two test results and then I will consult with the vet. I'm really hoping he doesn't push me on the Cushings as I would really like to make sure all infection is clear and diabetes is under control before making a decision on treating for Cushings.

Does anyone know if the adrenals can be enlarged by diabetes or infection?

Today we are taking Lace for a glucose test so we'll see how she's doing with that.

More to come....

Thanks as always,
Brenda

[Harley PoMMom]

The findings of enlarged adrenal gland can be caused by a non-adrenal illness such as diabetes.

[labblab]

Yes, any illness or issue that places chronic stress on the body can result in hyperadrenal function and appearance.

Like your vet, though, I do question whether diabetes is the source of Lacie's issues, however, since her glucose level was not abnormally elevated at the time her first symptoms, lab irregularities, and positive LDDS appeared.

Since she is outwardly responding so well to the insulin, though, I surely understand why you are wondering whether additional treatment is necessary, at least right at the moment. I would be wondering the same thing.

Marianne

[Harley PoMMom]

I knew Dr Peterson had written in blog regarding enlarged adrenal glands with illness...took me a while to find it!
One should never make a diagnosis of hyperadrenocorticism based on the finding of large adrenal gland size alone. Remember that the stress of any nonadrenal illness commonly leads to an overactive hypothalmic-pituitary-adrenal axis. Therefore, any dog with chronic stress or illness can develop bilateral adrenocortical hyperplasia as a physiological response. I

http://endocrinevet.blogspot.com/2014/01/seizures-and-bilateral-adrenal.html

[bmarra]

Lacie's glucose was 216 today which is still high but I was told to just continue on the same dose of insulin for the time being (I guess until the other test results come back).

In doing more research, I came across a case that was submitted to Dr. Peterson which sounds very similar to Lacie's situation. The dog, an 8 yr. old Schnoodle, was presenting with PU/PD and polyphagia and had a bit of a pendulous belly. Marked hepatomegaly was found verified by abdominal radiography. No other outward signs.

The dog had high alkaline phosphatase, high glucose, high triglycerides, SP.GR. of 1.029 and negative ketones.

They started the dog on low dose of insulin with moderate decrease in PU/PD but thirst remained excessive (Lacie's has decreased considerably particularly during the night).

Two weeks later they did a serial blood glucose cure and there was persistant hyperglycemia so they diagnosed insulin resistance and did an LDDS test which was positive. The vet wanted to start the dog on Vetoryl but wrote to Dr. Peterson to see if he was on the right course.

Dr. Peterson's response was interesting! He said the problem with diabetic dogs is that it's very difficult to make a diagnosis of Cushings with certainly unless seeing cutaneous changes. PU/PD, polyphagia and high liver values could be secondary to the diabetes. False positive results on the LDDS test are very common in dogs with nonadrenal illness (which you all have shared with me).

Dr. Peterson said the insulin dose given wasn't high enough to say that the dog was insulin resistant and recommended that the dog continued to be monitored and to slowly raise the dosage to see if that helps control the signs. He said this is sometimes the best course to follow in these type cases.

He said they define insulin resistance as doses greater than 2.2 U/kg/injection (Lacie is at .5 currently and symptoms have greatly subsided) so in this case they weren't even close to the doses required to diagnose resistance. Dr. Peterson also said that diabetic dogs can get marked hepatomegaly secondary to fat accumulation in the liver. That can lead to a mild-moderate "pot-bellied" appearance. He says that if Cushing's is present, it will be progressive and other signs will develop to make the diagnosis easier to confirm.

I am taking information on Dr. Peterson and a copy of this case to my vet and ask him to read it. This is precisely why I want to wait this out and see how she does with the insulin before jumping into Cushings treatment.

I know this is common knowledge for most of you but maybe someone else reading the posts will find this very interesting and help with their dilemma also.

Brenda

[labblab]

Brenda, that article by Dr. Peterson is one that we believe is super helpful, and we usually do provide the link to folks whenever they are confronted with both diabetes and Cushing's. I'm sorry if we neglected to point you towards it earlier :o. But for anybody else who's interested, here's the link to the article itself:

http://endocrinevet.blogspot.com/2012/01/q-diagnosing-cushings-disease-in-dogs.html

One difference between Lacie and the dog in the article, however, is the order in which the abnormalities were noted. For the dog in the article, the LDDS was not performed until after it was already known that the dog had diabetes. For Lacie, there was a reverse progression in the abnormalities: apparently her glucose was not elevated originally, but did elevate after the LDDS returned a positive result for adrenal abnormality and symptoms first emerged. I suspect that may be an important distinction that makes Lacie's situation different from the dog in the article. If both glucose and cortisol are elevated when a vet first sees a dog or when symptoms first emerge, it is difficult to know whether the cortisol would have been elevated independently or whether it (and the other symptoms) resulted from the diabetes. But in Lacie's case, apparently the elevated cortisol (and other abnormalities) preceded the diabetic crisis. So that would lead one to believe that the elevated cortisol may be the "egg" that hatched the diabetic "chicken." Lacie's cortisol levels are really high, not just kinda high :o. Her LDDS response was highly elevated, and even after what I wrote earlier about discounting resting cortisols for diagnostic purposes, a resting cortisol of 16 seems really high to me. It would have been interesting to know how much higher a stimulated ACTH response might have been.

But I may be totally missing the boat about this. And that's why I'm hoping that your vet may have a specialist with whom he may be able to consult since this is definitely a complicated case presentation.

For what it's worth and perhaps to ease your mind a bit, even if Lacie does have Cushing's, I think you will be able to handle the treatment just fine. It is actually much easier than insulin shots, because it only involves giving her oral meds. An adrenal tumor has been ruled out, so you no longer have the worries about a possible malignancy that could be invading her abdominal area. In no way way do I want to minimize your concern about Cushing's and your hope that she does not suffer from it. But really and truly, it can be managed just as successfully as can the diabetes, and shouldn't be any more disruptive to your lives together. So please take heart in knowing that, OK?

Marianne

[Harley PoMMom]

I did supply that link:


My goodness, when it rains it pours, huh? I'm going to copy and paste a reply of mine that I posted in another members thread today regarding diagnosing Cushing's in a dog that has uncontrolled diabetes:


Diagnosing Cushing's is difficult in itself and when diabetes is thrown in the mixture it makes it even more challenging. When a dog is diagnosed with diabetes it is important to get that blood sugar regulated before any tests for Cushing's are performed. Diagnosing Cushing's in an uncontrolled diabetic dog is next to impossible as diabetes can cause the same organ abnormalities on imaging, overlapping symptoms that are also associated with Cushing's and diabetes can cause false positives LDDS and ACTH stimulation test results.

I'm providing a link below to Dr. Peterson's blog entitled Q & A: Diagnosing Cushing's Disease in Dogs with Diabetes Mellitus. http://endocrinevet.blogspot.com/201...e-in-dogs.html It has some pertinent information so I do recommend that you read it.

Sharlene is correct, definitely getting that blood sugar regulated takes top priority, just put any thought of Cushing's on the back burner for right now and let's focus on the diabetes...please do join our sister site too~ http://www.k9diabetes.com/forum/ They can help with the diabetes immensely.

Hugs, Lori

[labblab]

Thanks, Lori. Then that's probably how Brenda found it in the first place.

Marianne

[bmarra]

Thank you Marianne - I certainly understand why you feel Cushings is still the underlying culprit and chances are very high you are right.

Obviously I am very concerned about such high cortisol levels yet I also know my Lacie was put into a very stressful situation when given the LDDS test...they took her from me promptly and then put her in a crate and may have taken her out once or twice during that 8 hr timeframe but that would have made her extremely nervous. If I had known what all could affect the results of the LDDST I would have waited until I knew that any infection was clear at least.

The diabetes is a puzzle since just 3 weeks ago her glucose was in normal range - now, the question there is, was it really as labs could make errors. Also, there was no fasting for the blood workup done by my original vet that produced that result - whether that matters I don't know.

I'm probably just wishful thinking about the Cushings but you've given me encouragement that it may not be so bad since I'm dealing now with diabetes. Frankly, as I know many others have concerns about also, it's the treatment that worries me. How will Lacie tolerate it and how long will it take to get the proper dosage, and most importantly, how can we keep a close watch when my husband and I both work outside the home? Also, will we be able to board her? (We're not ones to board her at the vets but at a place where she can play and socialize with other pups)

Well, maybe I'm getting ahead of myself. I'm sure I'll know much more in a day or two.

Brenda

[bmarra]

Hello All - Just got results of the two tests we were waiting on. Some good news for once: the urine culture came back clean so no more infection and the only problem detected from the test that was done at Texas A&M is pancreatitis which isn't surprising. Dr. seems to think the pancreatitis caused the diabetes? Does that make sense or is it usually the other way around?

One thing he said that surprised me was that her glucose level of 216 taken on Saturday was good. I thought that was still high. What do you all think about that? He is going to do a glucose curve test probably next week.

This week he also wants to take more urine to test for ketones.

I haven't hopped over to the diabetes forum yet but certainly will do so very soon as I'm sure I will learn a great deal there also.

As always, thank you for your support.
Brenda

[labblab]

That's great that the urine culture came back clean. YAY!!!! We definitely take happy news whenever we can. :) ;)

As far as the pancreatitis, I wish I knew a bunch more about diabetes but I'm afraid I am not very knowledgeable. What I think is true is that it's another one of those chicken-n-egg things. I do think that pancreatitis can cause damage that can lead to either temporary or permanent diabetes. But I also think that diabetes and Cushing's are both diseases that can leave dogs more vulnerable to developing pancreatitis.

Acknowledging that I really know nothing about this :o, it does make sense to me that an acute attack of pancreatitis could have led to Lacie's diabetes. But then we are still left with the possibility that Cushing's may have made her more vulnerable to the pancreatitis in the first place. So now we maybe have two chickens and one egg, or one chicken and two eggs, or who knows???????

Anyway, I'm really glad her urine is clear and I'm glad your vet is happy with her glucose level. For sure, the k9diabetes crew will be able to help you evaluate that side of things. (BUT DON'T STOP CHECKING IN WITH US, TOO, OK????). We are happy to share you with them, but you cannot leave us. That is an order! :cool:

Marianne

[bmarra]

Marianne, thank you for your kind words. Yes, this really is quite a puzzle and I hope we can get it solved. My new vet is working well with me so far in answering all my questions and addressing my concerns.

He still wants Lacie on Baytril antibiotic as, even though there's no infection, there was still the issue of thickened intestines and some bacteria so he wants to prevent anything developing. I really didn't think antibiotic would be effective in that case but I'm putting my faith in him even though I was hesitant to give Lace a 3rd antibiotic in a month. I may be surprising him with all I'm throwing at him but like I told him tonight, "I know my dog".

Take care and I will be checking in..you haven't gotten rid of me yet!

Brenda

[molly muffin]

I don't know about the pancreatis causing the diabetes, but they are all tied together.

This might help to explain it all better than I can.

http://diabetesindogs.wikia.com/wiki/Cushing%27s_disease

[Harley PoMMom]

The pancreas has 2 jobs: producing digestive enzymes to break down food, and producing the hormones insulin and glucagon to control sugar levels in your body.

When the pancreas becomes inflamed the cells that aid in the production of insulin/glucagon may get damaged, and if they do this turns into diabetes.

[bmarra]

Hello All - thank you for your replies.

Sharlene - that article was very helpful and timely as I am writing on that very issue to get some more advice.

We had a consult with the vet last evening and, although I understand where he's coming from, I feel more confused and frustrated than ever. He most definitely is still focusing on Cushings being the underlying problem - he even brought in test results from a dog he is currently treating to show us how much improvement it's had since taking medication for it. He called the trilostane a "miracle drug" that saves lives.

Here's where we are - still waiting on results from urine test to see if ketones are still present - on 4/15/15 the result of ketones was 3+.

A glucose curve will be done sometime next week.

So, he definitely wants to make sure the pancreatitis is gone and the diabetes is under control before treating for the Cushings which is a good thing.

He's again going by the numbers on the cortisol levels, the ALKP (3582 -off the charts!) and ultrasound showing enlarged liver and renal area. Don't forget the glucose level was showing normal a month ago also.

Here's my confusion/concern - Lacie's drinking/urinating has subsided greatly since taking insulin. Her appetite is still very good and I feel on the new food he has her on that's she's not getting satisfied but for now that's all she is getting plus some carrot pieces for snacks. Again, she has no outward signs of Cushings. So, if the cortisol was the culprit causing the diabetic symptoms why would insulin seem to be controlling those symptoms - wouldn't the cortisol still be pumping through her body?

I told him I still wanted to be sure about the diagnosis and he said he would do an ACHT Stim test once other issues under control and that would confirm Cushings if level was high. Is this the way to go or should another LDDS test be done?

I asked if hypothyroidism could be an issue as her T4 level was below normal and again he said treating Cushings would help that.

One bit of encouragement from him was that he said he would start Lacie on low doses of Vetoryl so I'm assuming he's going by the new guidelines which I was happy to hear.

I had that article from Dr. Peterson about diabetes and not treating for Cushings unless outward signs to give to him but he is so convinced of Cushings I backed off. Sometimes I wonder if these vets are getting kickbacks from the med companies as it seems Cushings diagnosis is becoming more & more prevalent!

As always, any advise/info is greatly appreciated.

Thanks much!!
Brenda

[labblab]

Hi again, Brenda. Glad to get your update!

If you do decide to retest for Cushing's, I agree that the ACTH would be better than the LDDS this time around. Although both blood tests are vulnerable to being skewed by nonadrenal illness, the ACTH is less likely than the LDDS to return a "false positive" for Cushing's in the event a dog does not really have the disease.

As far as the low thyroid reading, it is indeed the case that Cushing's can affect thyroid testing results and sometimes the only treatment necessary to normalize the thyroid is effective control of elevated cortisol levels. Not as though you want to spend yet more money on testing :o, but it is possible to request more specialized analysis of Lacie's thyroid function via additional blood testing. Depending on the results of the more comprehensive testing, you can sometimes judge whether it seems likely that low thyroid readings are a primary problem in their own right vs. being secondary to another issue such as Cushing's. But not infrequently, vets take a wait-and-see approach when Cushing's dogs start treatment -- hoping they will see improvement in the thyroid level as cortisol levels decline. If not, thyroid supplementation may be necessary.

I am so glad that Lacie's thirst and urination have improved so much! Just to double-check other symptoms you mentioned previously: panting, history of skin problems, pot belly (I think?), and recently seeking out the cool tile floor rather than coming to bed. What is the situation with any or all of those issues? Since starting the insulin, does Lacie basically seem back to normal in all regards?

Thanks again for checking back in, and for being so patient as to keep answering all our questions!

Marianne

[Bonnie0420]

Good Morning,

Im Bonnie, Aggies mom, we just went through this and Aggie had her surgery yesterday. I just posted everything that we went through yesterday so please if you have any questions Ill be happy to answer anything that I can. This was all way above my head and Im not as "versed" in all the test results what they mean etc etc but will share anything with you that helps!!

The one thing that I can say, while its all a personal choice, I as others would not change the decision we made to have the surgery done for anything. Aggie is going to be 8 in Oct so Im right there with you on the age factor. Being very honest, we knew that would could possible lose her yesterday, however, her symptoms from the cushings was horrible and getting worse. Her quality of Life was not going to be good and honestly I dont think the Meds would have done anything for her. While there was no way I wanted to put her down, we chose to do the surgery to try and help her, again, knowing we could lose her. One of the hardest decisions I have had to make in a long long time! and it scared the &*^%$*( out of me!!

Everyone on here is AWESOME. They will get you through this, giving encouragement, support and anything else you can think of.

thoughts, and prayers to you and your fur baby

Bonnie

[bmarra]

Hi Marianne, in answer to your question about Lacie's current "symptoms":

She does still have a very good appetite but it is difficult to gauge now whether or not there is any difference as she is on the Hills R/D canned food twice a day with just a few carrot pieces as treats in between. She was used to eating a dried sweet potatoe treat, a salmon stick, a small carrot piece and sometimes a couple other small treats in the am, another carrot piece and a Dentastix in the afternoon and then a mix of kibble and canned food in the evening. I'm not sure how much this new diet is filling her up especially when it makes her defacate more.

The skin issue she had has been cleared up for well over a year and I attribute that to giving her salmon oil in her dinner. I do still find one or two dark, dry spots on occassion but use a topical on them. Her belly was shaved for the ultrasound so I can see that skin clearly and it looks pretty close to perfect to me.

Since on the new food she has already dropped about 2 lbs in a week so her belly seems to be going down also. I know she feels lighter when I pick her up. Hoping she doesn't lose too much weight as she is now a bit over 19 lbs.

She does still like the tile floors and that has been pretty consistent for the last few years. The one difference still is that she has not slept in her cushiony bed at night for over a month.

Panting was never really a big issue - we only noticed it somewhat the night she seemed very uncomfortable over a week ago. Since then no panting.

So, there you have it - to me the typical Cushings symptoms just aren't there but, again, she could just be one to not show them (at least yet), right?

Happy to hear that you would recommend the ACHT over the LDDS too.

So, what would happen if we give her Vetoryl and she doesn't have Cushings - what harm will that cause? Has there been any information from the manufacturer on giving to those misdiagnosed?

As always, thanks for your support and advice.

Brenda

[bmarra]

Hi Bonnie, I just saw your post to me and I thank you very much for your support.

I probably should change my subject line as my girl had an ultrasound subsequently and it ruled out the adrenal dependent Cushings. My original vet went strictly by the LDDS which showed no suppression and he concluded she had adrenal Cushings. I got a second opinion and the new vet did an ultrasound to confirm (which at this point has actually just ruled out adrenal).

I can't imagine the emotional roller coaster you went through deciding on surgery or not but I'm sure you did the absolute right thing. My prayers to your sweet baby for a full and quick recovery and that she'll live a happy and full life. And of course to her Mom for taking such great care!!

Thank you again for your support.

Sincerely,
Brenda

[labblab]

Hey Brenda, I am being so "forward" as to edit your thread title to reflect Lacie's current status. Just let me know if you want the title to read differently, though, and I will change it again to anything you wish.

Thanks for all the additional info, and I am so glad Lacie isn't suffering from a bunch of other symptoms. I definitely understand why all these test results are leaving you scratching your head when she outwardly is doing well!

Re: effects of giving trilo to a dog who does not have Cushing's...obviously it is a powerful drug that never should be given without good reason. However, I have found it interesting that it has been given experimentally and apparently without problem to non-Cushpups suffering from a hair loss condition known as Alopecia X. So of course depending upon dosage and duration of administration, I'm sure effects would be variable. But on the face of these studies, apparently normal dogs can tolerate the drug within certain parameters with no significant problems.

http://www.ncbi.nlm.nih.gov/pubmed/15500480

http://www.researchgate.net/publication/7620490_The_use_of_trilostane_for_the_treatment_of _alopecia_X_in_Alaskan_malamutes

http://www.vetbook.org/wiki/dog/index.php/Alopecia_X

Marianne

[bmarra]

Hi Marianne - thank you for changing the title...no further changes needed.

So, can I ask you, if you were in my shoes, would you have your vet convince you that she has Cushings and needs meds, or would you wait it out to see if she develops any other symptoms?

I still would greatly appreciate an answer from anyone if they know why the insulin has seemed to control the symptoms she was having if there is excess cortisol pumping through her that would cause these symptoms also? Wouldn't she still be drinking/urinating excessively if Cushings was present?

She hardly touches the water bowl during the night now and, like I said, there is no panting whatsoever. And, Marianne, she actually popped into her little bed yesterday albeit for a very short time but she had abandoned it for the last month.

I just don't want the vet to push me on the Cushings and so far that is definitely what he's doing. The sad thing is that if I hadn't gotten the 2nd opinion from this vet, my original vet would have already had her on 30 mg of the Vetoryl, and I know from the new dosage requirements she would have been overdosed.

Also, and I will be asking this on the diabetes forum also, have you known of any cases where subsequently treating for Cushings helped the diabetes and then no insulin was needed? My vet indicated that could happen.

Thanks to your forum I believe you saved us from making a huge mistake and may have saved Lacie's life. You all are the best!!:)

Brenda

[Squirt's Mom]

Cortisol is the bodies natural response to any stressor - internal or external. So diabetes itself, the stress of the disease on the body, could cause the cortisol to rise showing positive for the disease on testing. Example - my Squirt was diagnosed with the pituitary form based on 5 different tests - the LDDS, HDDS, ACTH, UTK panel and 2 ultrasounds. After the second US I was told about a tumor on her spleen. Once the tumor and half her spleen were removed, her cortisol level returned to normal. The stress of that tumor caused all those tests to return as positive when it was the tumor, not Cushing's. ;)

[labblab]

Brenda, over these last several days, I have thought long and hard as to what I would do if Lacie were mine. As you can tell from my replies, I do have suspicions/concerns that Cushing's may be at the bottom of the low thyroid, the pancreatitis, the diabetes, and the other lab abnormalities. We keep going back to the fact that the high glucose did not appear until after the cortisol was already elevated, rather than vice versa. I cannot explain why her thirst/urination has now improved so significantly just with the insulin control alone. However, not all Cushing's dogs display even this most common symptom. Some dogs are initially suspected of Cushing's based solely on certain characteristic skin/coat disorders even when no other outward symptoms are seen.

However, after having said all the above...I believe I would want to first wait and see whether Lacie's glucose level can be satisfactorily stabilized on insulin alone. If so, I would then move ahead with the ACTH at that point in order to see how it turns out with the diabetes under control. If it is still highly elevated even when the glucose is normal, I do think that would be more diagnostic evidence that Cushing's is truly at play. If it turns out that you are not able to control Lacie's glucose satisfactorily with insulin alone, on the face of it, that would point the finger back to Cushing's, too.

Marianne

[bmarra]

I am very anxious to find out her glucose levels when the curve is done. Haven't yet scheduled it as I'm waiting to hear back from vet regarding last urine test. In the back of my mind I'm still thinking hypothyroidism is involved but it may be all 3 diseases, who knows?

One thing I would hate to do though is rock the boat if she's doing well getting the diabetes under control. Guess I'll know much more soon and then will update you all.

Thanks again & have a great weekend.

Brenda

[bmarra]

Hello everyone - wanted to give update on Lacie. She is still being treated for pancreatitis and diabetes. The pancreatitis seems to be healing but we need to have her tested again next week.

The diabetes is a bit tough to get under control as her glucose levels still go into the 300 & 400's. Had a vet visit this past weekend and he increased her insulin for the 3rd time...she is now on 7 units 2x/day.

This morning I tood a glucose reading and it was 223 which is great. So hoping the insulin increase will work this time.

However, since starting her on insulin, her symptoms of increased thirst, urination & restlessness have abated. She sleeps through the night now which is wonderful.

So, back to questions about Cushings which vet still insists she has.

First off, she has lost weight...was 21 lbs and now 18.5. She obviously is eating differently and not being given any dog treats but would a Cushings dog lose weight like that?

Her fur on her shaved belly for the ultrasound is growing back nicely and there is still no loss of fur.

Her appetite is still very good and she seems hungry but I feel I can attribute that to either Cushings or fact that she is being given less food which is also bland with low protein and low fat.

There is still the issue of the thickened bladder wall finding from the ultrasound and vet says that there are a number of tests that can be done to determine tumor and if cancer but all carry risk and I'm not willing to do that. We're taking a wait & see approach for now.

So, as things stand now, if this was your pup, would you move ahead with treating Cushings or just wait and see if symptoms return once the diabetes is controlled?

Thanks!
Brenda

[Squirt's Mom]

Sounds like things are looking up! If it were me, I would forget about Cushing's for now, especially in light of the improved signs. If, IF, the diabetes is just impossible to control, then you have a very good indicator that Cushing's could be in play. But many of the signs are shared by both diseases so I would continue to focus on the diabetes for now, watching for increased cushing's/diabetes signs and an inability to control the BG. As long as the signs are good and the BG is controlled, I wouldn't worry overly much about Cushing's. But that's me. ;)

[labblab]

Great to see you again, Bonnie!

Given this new update, I believe I'd still hold off on treating Cushing's until you see whether or not you can get Lacie's glucose level stabilized on insulin alone. So I guess I'm still pretty much of the same opinion as when I wrote to you last.

As far as the weight loss, it is true that dogs with only Cushing's tend to gain weight rather than lose it. But the diabetes is definitely a factor since we know that Lacie suffers from elevated glucose levels and that can account for weight loss. Also, for what it is worth, it is not impossible for untreated Cushpups to lose weight because that was what happened with my own dog. Even though he had a ravenous appetite, we did not give him access to any additional food or treats before he was diagnosed and he ended up losing weight. There is just never an "always" with any individual Cushing's symptom. I do think, however, the fact that Lacie's fur is filling in and you are seeing such improvement in overt symptoms does continue to throw the diagnosis into some question.

So I'd still take a wait-and-see approach, and still hold off on any more diagnostic Cushing's testing until you see what finally happens with her glucose levels.

Marianne

[molly muffin]

I too would see if the glucose can be stabilized first and that pancreatis is completely cleared up before moving to cushings diagnosis and meds.

Hopefully things will continue to improve.

[bmarra]

Hello everyone - back again!! UGH!!!

So, the latest with Lacie is that she's gone from 5 units of insulin to 9 in 2 1/2 months. With the last increase to 9, which was a few weeks ago, it seemed her glucose levels were going down to good range and she was doing quite well but I am only able to test her morning & evening unless on a weekend. However, yesterday I was able to do a glucose curve testing her every 2 hrs. and her levels were all over the place with big swings...ranging from very high to quite low then back to extremely high. Needless to say I was very concerned and disappointed.

Some on the diabetes forum think she may be getting too high a dose of insulin but obviously she is where she is now due to not getting good numbers at lower levels.

Anyway, my vet is back to the Cushings and maintains that is why she has diabetes that isn't being controlled well and that she needs treatment for Cushings. Again, I am still very skeptical and worried about starting meds.

Ok, as for symptoms, as I've indicated in the past, drinking/urinating normal since starting insulin. She still seems always hungry but she gets very little now and none of her favorite treats. Poor thing. Her fur is all in tact but it does seem thinner as there isn't an undercoat per se and her tail has definitely thinned out. Fur on belly has grown back from the ultrasound in April.

Had a fungal & bacterial skin issue last month so they gave her a Convenia shot which helped. She still has a little of it on her private areas but nothing else that would be the typical Cushings skin.

Belly is a little distended but less so and softened since pancreatitis has healed.

Had her tested for hypothyroidism and it was negative.

Vet said that those physical symptoms happen in the later stages of Cushings and, if we wait to treat until then, more internal damage will be done.

He said we can do the ACHT to see if that confirms it or just start her on low dose of Vetoryl then test in 3 weeks and see where she is.

What do I do? I am so concerned about doing this and also having to monitor her insulin. I work and can't be home with her during the week. Hubby is home but I am her caretaker for the most part and he unfortunately won't test her for the glucose level so I have to hope she'll be ok until I get home.

Thanks!
Brenda

[Squirt's Mom]

Since this has been going on since May, her diabetes is not easy to control, and she is still showing some signs, I would rerun the ACTH just for my own peace of mind. ;)

[bmarra]

Thank you. I really want to exhaust all possibilities before treating for Cushings.

I was told by one of your members whose pup had diabetes and Cushings that she never saw fairly low glucose level until the meds were given for Cushings and, since Lacie has had low levels she is dubious about the Cushings also.

I am really seeking an answer as to why, if she has excessive levels of cortisol pumping thru her, she wouldn't be panting and still drinking/urinating heavily. She also sleeps on a blanket at night so not always on cool floor.

I would also like to contact Dr. Peterson and any other expert you may know of on this. Could you please send me contact information?

Thanks so much!
Brenda

[labblab]

Hi Brenda,

Here's some contact info for you. If you want to direct a question to Dr. Peterson, I think adding a comment/question at the end of this blog article would be the best route to take (article regarding the challenges of diagnosing Cushing's in diabetic dogs):

http://www.endocrinevet.info/2012/01/q-diagnosing-cushings-disease-in-dogs.html

Dr. David Bruyette is another endocrinological expert; he is located in Los Angeles and is very responsive to direct email questions:

David.Bruyette@vca.com

One of our other members has satisfactorily corresponded with both these specialists just during this past week. :)

Marianne

[judymaggie]

One of our other members has satisfactorily corresponded with both these specialists just during this past week. :)



Brenda -- that would be me! :D At the end of the blog article you will see "Post a Comment" right above "Links to this post". Click on "Post a Comment" and a box will pop up for you to enter your questions. You need to give Dr. Peterson the specific information about your dog that relates to your questions. You will need a Google userid and password to submit your post to Dr. Peterson. I would also suggest that you have comments e-mailed to you (you will get an e-mail with your post and a separate e-mail with Dr. Peterson's reply). Dr. Peterson usually responds in a day or two. If you need to clarify anything or ask another question, just follow the same steps.

Dr. Bruyette answered my e-mail to him in just a couple of hours. I expect the weekend may alter response times for both.

[bmarra]

Thank you both so much for this information.

I will definitely contact them and if I have any issues in doing so will let you know.

I did find one case submitted by a vet to Dr. Peterson about this subject where the vet was ready to start Cushings med as he thought the dog was insulin resistant, and the test for Cushings was positive. Dr. Peterson said that the dose of insulin given was no where near the maximum that would determine resistance and that diabetes can also cause a lot of the same symptoms as Cushings, even the pot belly. So, he recommended not treating for Cushings unless others signs develop that would make it easier to diagnose Cushings. This particular dog had consistent high glucose levels but my dog doesn't have that, she does go down so hoping my vet is wrong, at least for now.

Thanks again,
Brenda

[kaibosmom]

Hi Brenda! I'm Nikki, owner of one of the pups someone provided a link for. Kaibo is a very complex little guy who doesn't follow the rules. I can help you with questions about the adrenalectomy and diabetes and now Kaibo has pituitary dependent cushing's. So, we've seen it all and then some. Having both Cushing's and diabetes at the same time sucks. Plain and simple. It isn't easy to treat when they are together. I was trying to read all of the posts but just skipped to the end now to see what the latest info was. For us, the diabetes has been extremely hard to control. However, when we started treating for Cushing's this time around with Trilostane/Vetoryl we finally have control of his diabetes. We were able to go off of one type of insulin all together in fact. So, we have seen great improvement since adding the Cushing's treatment. I didn't see anything about a diabetes curve in what I read so far. I can check back for that. I saw a brief comment about thinking the insulin dose is too high. I have learned that the dose may need to be higher and what you need to focus on is the disappearance of diabetic symptoms. That being said, too high of a dose can lead to Symogyi effect and that makes things even more fun to sort out. Remember that insulin should not be increased until the same dose has been given for at least 10 days and a curve has been done. I understand the frustration with the waiting. Trust me. Everything takes time…the diabetes, the Cushing's. Kaibo has had diabetes for 2 years now and we are finally experiencing consistent diabetes control. I'm not sure if any of this helped you! If you have any other questions, let me know.
Nikki

[kaibosmom]

Oh, I should say that we were trying to treat his adrenal cushing's with lisodrene. We were not able to keep him in therapeutic range due to the fact that it was an adrenal tumour. Because Kaibo is was only 6 at the time, we took the risk of the surgery. We knew that we could lose him but because his tumour was on the right side, invading the vena cava was going to happen at some point. We decided that it was worth the surgery risk since if he made it through surgery he would no longer have Cushing's disease (which happened for awhile; getting pituitary Cushing's was just, well, I have no words for what it is) and it would make his diabetes easier to control (which also happened for awhile). The decision to do the adrenalectomy is only one that you can make. You have to follow your heart and know that no matter what the outcome is, you made the best choices you could on behalf of your dog.

Nikki

[bmarra]

Nikki, thank you for your replies. Please let me clarify...Lacie's ultrasound indicated two slightly enlarged adrenals so, if Cushings, it is the pituitary type. As far as getting the diabetes symptoms (drinking/urinating excessively) under control, that happened as soon as she was given insulin. The only issue we are having now is that she gets big swings in the levels and goes very high at times.

I wrote to Dr. Peterson over the weekend and he responded almost immediately. He told me that, with the information I gave him, it was difficult to say whether or not Lacie definitely has Cushings, but, even if she does, the swings in the glucose levels would not be caused by Cushings especially since she's seen numbers in the 100's. He said Cushings would cause insulin resistance and high numbers continually.

So, currently I am at a place where I am just trying to get her numbers more in range and stable throughout most of the day.
I've decided to see another vet who hopefully is more knowledgeable with diabetes and can help me with food, dosage, etc. My current vet just kept raising the dose over the past 2 1/2 months and I'm not sure that is the answer for Lacie.

Brenda

[bmarra]

Hello Everyone -

I was hoping I wouldn't have to return to this forum but here I am again!! :o
My 9 yr. old Bichon had the LDDST last year which indicated Cushings then 3 weeks later she was diagnosed with diabetes. Since then I've only been treating the diabetes but her bg has not been well controlled. Her numbers are all over the place...some lows and some very highs but more highs than "normal" range numbers. Went to vet today and he wants to do the ACTH this Friday.
I have so many concerns. First of all, besides the crazy bg numbers the only other possible symptoms she has are brown/black spots on her skin which vet says are an overproduction of oil from skin glands which could be caused by Cushings (is this true?) and a thinning tail. Her fur overall is thinner than it used to be but still all in tact. No panting, pot belly, excessive urinating, hunger etc.

With the test, since she has to eat at 6:00 am then have insulin, he plans to have her fast as he's also doing full blood panel, then giving the solution for the ACTH test, then feeding her & giving insulin which will be at least 3 hrs after her usual time. I'm wondering if the feeding will affect the result of the ACTH? Can anyone tell me? He says that it won't affect it of course.

Also, she will be stressed I'm sure and that may affect the result. Do you all think since the 8 hr test she had last year was positive and this ACTH comes out positive that should definitely confirm Cushings?

Have you heard of treating for Cushings helping to get the diabetes under better control?

Thank you,
Brenda

[Harley PoMMom]

The feeding should not skew the ACTH stimulation results, and since her BG is not that well controlled the ACTH stim test is the one that should be done.

Once that elevated cortisol is under control it should make it easier to get her BG normalized.

BUT Has a thyroid problem been ruled out? I have read where people with diabetes are more prone to a thyroid issue and thyroid disease complicates blood glucose control.

Hugs, Lori

[bmarra]

Thanks Lori,

She was tested for hypothyroidism last year but they said it was negative. The blood panel she's having done this week may indicate more although not specifically testing for that.

I am frightened by all of this as my girl, besides having the crazy bg numbers, doesn't have any other symptoms that seem to be affecting her quality of life. I am more afraid of the medicine than the disease especially since I won't be able to tell if it's actually doing what's it's supposed to since those "usual" symptoms aren't there. :(

[Harley PoMMom]

It does make it very difficult to judge how the treatment for Cushing's is working if there are no symptoms to control.

Have other types of insulin been tried? I wonder if a change in food, feeding schedule, or amount of food would make a difference. :confused:

[labblab]

Hi again, Brenda! I'm so sorry you're having to worry about the possibility of Cushing's again. But after going back and reading through your whole thread, I'm reminded of all the reasons why Cushing's has been suspected for quite some time. And since you are still having problems with the BG regulation, I do think it makes sense to go forward with an ACTH at this point. If it comes out "positive," I do think I'd bite the bullet and give the trilostane a try. I know you're worried as to how you'll judge treatment issues, but if Lacie's BG comes under better control, I think that'll be your big and most important clue that you're seeing success. And of course the signs of overdosing are the same for every dog: vomiting, diarrhea, unusual lethargy, etc.

If you do end up proceeding with treatment, here are a couple of points to discuss with your vet. First, it is strongly recommended that diabetic dogs be dosed twice daily instead of only once in the morning. Second, the initial total daily dose should not exceed a formula of 1 mg. per pound (or 2.2 mg. per kg.). It's ideal but not necessary to split the daily total in half. But if unequal doses are given, it is best to give the larger dose in the morning. So for instance, if you're giving a daily total of 40 mg., you could either give 20 mg. twice daily, or give 30 mg. in the morning and 10 mg. in the evening.

Just bear in mind that if Lacie does not improve after taking the trilostane, you can always stop the treatment. But at this point, I do understand why Cushing's remains a possible underlying issue.

Marianne

[bmarra]

Thank you for your replies.

I emailed Dr. Peterson yesterday to find out if Cushings would, in fact, cause lows in bg. He said that it would cause insulin resistance so more & more insulin would be needed for control. Lacie does not have resistance as insulin does take her down. Also asked him if excessive oil on skin is symptom as my vet indicated and he said he's never seen it but couldn't be sure.

Anyway, the vet that I've been seeing for about 6 months (maybe 5 times total) got an attitude yesterday and actually yelled in my face. I wanted to walk away right then but didn't and went ahead and made appt for testing on Friday. Since then I could not get past what he did and how awful that was so decided I'm not going back as he hasn't been much help anyway.

Seeing a new vet next week and will proceed from there. Hoping to find a good "partner" in Lacie's care that will listen to the pet owner since we know our pups best. This vet apparently goes by the book and where he thinks her numbers should be but every dog is different.

If I end up having to have the test again for Cushings I will be back.:(

[labblab]

Oh Brenda, sounds like you've made the right decision without a doubt! How awful that your vet yelled at you! Good riddance to him, and let's see how the new vet wants to proceed. Please keep us in the loop -- we are always here if you need us! ;)

Marianne

[molly muffin]

Oh my gosh! How absolutely awful and unacceptable!
I hope the vet you have the appt with is a better partner for you. That is so very important to have that partnership (exactly the right word) between you and your vet and your dog. I personally really like it if the vets bond with my dog, so I feel like they have a vested interest in doing all they can for her because they love her too.
It's just so not acceptable to yell. sheezzz