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[Jax]

I have a ten year old pitbull mix. (spike) My vet diagnosed him with diabetes and is on insulin. Ever since he has started the insulin he has gotten worse. He can barely walk now and gets tired just going out to use the restroom. I have taken him back to the vet several times and finally to a specialist. They think he may have Cushings but wanted to hospitalize him and wanted several thousand dollars to make sure. I can't afford that so I don't know what else if anything there is I can do. I returned to my vet and they said with the diabetes there probably wasn't much that could be done anyway and suggested euthanizing him to stop his suffering. I've been reading a lot about cushings. Spike hasn't lost any hair, his coat hasn't dulled. He can barely walk all he does Is lay around and moan. He only gets up to eat or go to the restroom. Does anyone have any advise? Has anyone used cushex?

[Harley PoMMom]

Hi and welcome to you and Spike!

I have manually approved your membership so now all your posts will be seen right away. Also, please just disregard the validation email that was sent to you from k9cushings. :)

The first thing I am going to recommend is that you join the k9diabetes forum which is our sister site. The wonderful people there are extremely knowledgeable in dealing with dogs with diabetes. We do have members here with dogs that have both Cushing's and diabetes and they belong to both forums, in this way you have the best of both worlds. Here is the link: http://www.k9diabetes.com/forum/

Is your boy's diabetes under control? If not, it is extremely difficult to diagnose Cushing's in a dog with uncontrolled diabetes, and in our experience, a good number of dogs are misdiagnosed. What insulin is he on and the dose? Is he eating and drinking normally? Was his urine checked for ketones?

Could you get copies of all tests that were done on Spike and post those results here? With respect to the blood chemistry and complete blood count (CBC), you need only post the highs and lows and please include the normal reference ranges. Was an urinalysis done and what were those findings? What symptoms is he displaying that leads the vet to think Spike has Cushing's? How much does he weigh?

I am sorry for all these questions but the more we know about your sweet boy the better our feedback can be. Please know we are here for you and Spike and we will help in any way we can.

Hugs, Lori

[DoxieMama]

Welcome to you and Spike, though I'm so sorry for the reasons you've joined. I look forward to learning more about your boy.

Hugs,
Shana

[judymaggie]

Hi! I wanted to also welcome you and Spike. I had to read the "several thousands of dollars" more than once to make sure that I read it correctly. Yes, it can be costly during the initial diagnostic phase but nowhere close to thousands of dollars. After we have gotten the results of any recent lab tests along with more information about Spike's symptoms, we can help guide you.

Hang in there and don't get discouraged!

[molly muffin]

Hello I want to welcome you to the forum and second Lori's suggestion of joining our sister k9diabetes site.

It's important to know if the diabetes is under control or now. How are his curves?

Some dogs do have both but it sounds right now like it is the diabtes and perhaps his insulin that might be the issue and need to be addressed first.

Once you can get back to us with the further information, then we can go from thee, but thousand and thousands of dollars. That seems beyond ridiculous.

[Renee]

I think I'll jump in here with Judy and question your vet's quote for several thousands of dollars worth of testing.

Yes, the testing is expensive, but you should not get up to several thousands of dollars. The ACTH is usually $200-350, the LDDS should be $150-200. Even an ultrasound should be less than $700. In addition, testing for cushings usually does not involve hospitalization, unless you just mean he will be spending the day at the vet?

My suggestion would be to get an itemized break down of the tests they would like to run and their costs. It may be they are including unnecessary tests that you can eliminate.

[Jax]

Assessment:
diabetic ketosis
Plan:
CBC - leukocytosis (22,680) with neutrophilia (20,410)/eosinopenia (30)
Chem6 - ALT 219 U/L, AST 146 U/L, AlkPhos 1148 U/L, otherwise normal
EC8 - hyperglycemia (436 mg/dL)
ketone (urine) - moderate
inpatient treatment plan including 2-4 days hospitalization with assessments, IV catheter, IV fluid therapy, insulin therapy with serial
glucose monitoring, urinalysis with urine MIC (Antech), abdominal ultrasound, +- oral anti-inflammatory therapy - DECLINED
outpatient monitoring using Alpha Trak2 Glucometer; recommended insulin dose is 20 units twice daily however client has expressed
that patient acted abnormal after initial injection at this dose and starting at 15 units twice daily until monitoring can occur has been
discussed
Diagnostics:
DATE/TIME TEST RESULT REFERENCE RANGE
6/16/2016 PCV = 44 % 37 - 55
TS = 8.2 g/dL (H) 5.4 - 7.1
DATE/TIME TEST RESULT REFERENCE RANGE
6/16/2016 ANGAP = 15 mmol/L 8 - 21
BE = -5 mmol/L (-5) - +2
BUN = 10 mg/dL 5 - 30
CL = 114 mEq/L 109 - 120
GLU = 436 mg/dL (H) 65 - 112
HB = 15.3 g/dL 13.3 - 20.5
HCO3 = 18.6 mmol/L (L) 20 - 24
HCT = 45 % 40.3 - 60.3
K = 4.4 mEq/L 3.9 - 4.9
NA = 143 mEq/L 140 - 150
PCO2 = 25.9 mmHg (L) 32 - 43
PH = 7.464 (H) 7.35 - 7.46
TCO2 = 19 mmol/L (L) 20 - 26
DATE/TIME TEST RESULT REFERENCE RANGE
6/16/2016 ALKP = 1148 U/L (H) 23 - 212
ALT = 219 U/L (H) 10 - 125
AST = 146 U/L (H) 0 - 50
BUN/CREA = 18
BUN/UREA = 11 mg/dL 7 - 27
CREA = 0.6 mg/dL 0.5 - 1.8
DATE/TIME TEST RESULT REFERENCE RANGE
6/16/2016 %BASO = 0.0 %
%EOS = 0.1 %
%LYMPHS = 6.5 %
%MONOS = 3.4 %
%NEUT = 90.0 %
%Retics = 0.7 %
BASO = 0.01 K/uL 0.00 - 0.10
EOS = 0.03 K/uL (L) 0.06 - 1.23
HCT = 44.8 % 37.3 - 61.7
HGB = 16.0 g/dL 13.1 - 20.5
LYMPHS = 1.47 K/uL 1.05 - 5.10
MCH = 21.0 pg (L) 21.2 - 25.9
MCHC = 35.7 g/dL 32.0 - 37.9
MCV = 58.9 fL (L) 61.6 - 73.5
MONOS = 0.76 K/uL 0.16 - 1.12
MPV = 10.6 fL 8.7 - 13.2
NEUT = 20.41 K/uL (H) 2.95 - 11.64
PCT = 0.42 % 0.14 - 0.46
PDW = 13.8 fL 9.1 - 19.4
PLT = 397 K/uL 148 - 484
RBC = 7.61 M/uL 5.65 - 8.87
RDW = 21.3 % 13.6 - 21.7
Retics = 52.5 K/uL 10.0 - 110.0
WBC = 22.68 K/uL (H) 5.05 - 16.76
Medication:
ITEM DESCRIPTION DIRECTIONS QUANTITY
Tramadol 50mg tablets Give 4 tablets by mouth twice
daily for pain.
120.00
ADDITIONAL INSTRUCTIONS/COMMENTS:
Spike has been recently diagnosed with diabetes. Regulation of his blood glucose has been unsuccessful to this point and he has
developed ketones in his urine in a condition called diabetic ketosis. This form of Diabetes Mellitus results in severe blood changes.
Diabetes mellitus (DM) is a chronic condition in which a deficiency of the hormone insulin impairs the body's ability to metabolize
sugar. DK is a life-threatening condition caused by insulin deficiency that leads to excess production of ketones by the liver which
causes changes in the blood that include metabolic acidosis and electrolyte abnormalities that results in severe systemic illness. DK
can occur in pets with new diabetes or in current diabetics that decompensate. Secondary diseases and/or infections can cause
diabetics to decompensate and develop DK.
Signs and symptoms associated with DK depend on the individual pet and the length of time of illness. Some symptoms to watch for
include increased thirst, increased frequency of urination, weight loss despite a good appetite, sudden blindness, lethargy, vomiting,
weakness, dehydration, rapid breathing, and a strong smell of acetone from their breath.
Patients with uncomplicated diabetes are generally managed on an outpatient basis, but those experiencing complications such as
diabetic ketosis require hospitalization and stabilization.
In-hospital therapy generally includes insulin administration with frequent dose adjustment, intravenous fluids, administration of
electrolytes, treatment of secondary problems, nutrition support, and often antibiotics. Long term management of diabetes will
likely include insulin injections at home and possible antibiotics to treat infectious complications. You should be prepared for
frequent adjustments to therapy (especially insulin doses) early in the course of treatment.
The prognosis depends upon the severity of the illness, the pet's response to therapy, overall health of the pet, concurrent diseases
(ex: Cushing's Disease), and secondary complications from diabetes. With proper management, many diabetics can have a good
quality of life for years to come.
At this time, we understand that you are unable to hospitalize Spike and have elected to attempt at home regulation of his blood
sugar with the AlphaTrak2 monitor. Further diagnostics, including urinalysis with urine culture and abdominal ultrasound, should be
performed as soon as possible. As you have expressed that Spike had problems when 20 units of insulin was administered, please
start at 15 units twice daily until monitoring is possible.
Thank you for trusting us to care for Spike. If you have any questions or concerns please do not hesitate to contact us. We are
available 24 hours a day.
Sincerely,
Suzanne Caruso, DVM
Oklahoma Veterinary Specialists ER
I have read and understand the discharge instructions in their entirety:
Client Signature Tech/assist initials

[Jax]

This is what I got from the specialist

[lulusmom]

Hi and welcome to you and Spike,

From the looks of those labs and the vet's report, your boy is in some serious trouble if you don't get his blood sugars under control. Ketoacidosis is a life threatening emergency. If Spike is failing and you cannot afford to have a vet get Spike through this very dangerous time and are trying to do it on your own, please, please join our sister site, k9diabetes.com and let the members there help you. I am very, very concerned for Spike and it sounds like your vet thinks he's a lost cause which raises my concern about his current condition. The folks at k9diabetes will help guide you on what to do and they will teach you how to home test. As long as Spike's blood sugars are out of control, it is impossible to test for cushing's as every diagnostic test is very likely to yield a false positive due to the extreme stress of out of control diabetes.

I believe the estimates of thousands of dollars the vet gave you included a lot more than just testing for cushing's. I'm fairly certain that estimate included a few days to try to get his diabetes somewhat regulated. Are you experienced with canine diabetes?

[Harley PoMMom]

I, too, am very concerned about your boy. As Glynda mentioned Ketoacidosis is a very serious complication of diabetes and needs to be addressed.

Please do keep us posted.

Hugs, Lori

[molly muffin]

Oh dear, those labs definitely make diabetes the priority and getting the sugar regulated a must. Please do join our sister site, k9diabtes.com/forum they are very experienced with diabtes and will give you straight answers.

[kanga]

Welcome to the forum, sad to hear about what happen to your poor boy! Hope you find the best treatment for him. Sending my thoughts and prayers.