Ziggy

[aligale]

Hi! My baby's name is Ziggy. He's a 13.5 year old, 35 pound, Heinz 57.

He was diagnosed with Diabetes about a year ago, then Cushing's in December. It seemed like immediately after finding out about the Cushing's, he went blind. He's dealt with the blindness extremely well, and sometimes, if you didn't know it, you wouldn't think he was. I think he can probably still tell the differences between light and dark.

We've been to the vet countless times since last July. When I first took him in, it was because he was panting all the time and had stopped jumping up on the couch and bed. (The jumping was actually the first thing I noticed, but I figured it was just because he had gotten old.) They almost sent us to the emergency vet, but instead kept us there with him hooked up to an IV. It was a Saturday and we were there about an hour after they closed, but they were so calm and didn't rush us. They were there just for us. Of course I broke down and cried when the vet told me; I didn't know the first thing about what we were getting into.

His BG was over 600 and had a high level of ketones. They started him out on 3 units of Vetsulin twice a day and quickly knew it was going to need to be way higher to make any difference. He was so stressed when I tried leaving him at the vet for a BG Curve, they said they probably wouldn't be able to get an accurate reading and suggested that I bring him in in the afternoon and the evening. After many trips, twice a day three or four days a week, then less often, he stayed on 20 units twice a day for quite some time. Finally he seemed to be regulated. Then sometime in December, I could tell he had gone downhill again, right after they told us we didn't have to come back for a month (I thought my wallet was going to get a little break).

It was then that he was diagnosed with Cushing's. He was drinking a lot, having a lot of accidents, waking me up multiple times throughout the night, and panting constantly. We started him on one 60mg Trilostane in the morning, but he wouldn't eat. So they changed it to a half of one twice a day.

The last time I took him to the vet was almost two months ago, and he's going back on Monday. For about the past week, he's been panting a lot and drinking a lot of water again. He's been on 16 units in the morning, 15 a night, 1/2 a trilostane twice a day, and an 81mg aspirin twice a day for a while now. It's still hard to get him to eat sometimes, which sometimes means I can't give him all of his meds. He's had one seizure, which scared the crap out me. He first woke me up whining in his bed. I tried to get him up, but he just layed there panting and wouldn't move. So I dragged him over to the couch in his bed, gave him a Prednisone, and went to sleep. A couple hours later he woke me up making a strange sounding bark. I turned on the light and he was kicking his legs. I had never actually seen a seizure, but I knew what it was right away. I feel like it woke me up almost immediately. I was glad to be there with him through the whole thing. When I got back up that morning, I noticed the Prednisone was in his bed. I took him to the vet and his BG was 69.

I think I was able to actually stop one from happening since then. He had been moving very slow one day, started shaking, layed down in the yard, and I had to pick him up to take him back inside. I gave him a treat with some Karo on it, and then almost instantly he perked up. So thankful for that.

This is my first time on a forum. I'm hoping to get some advice on how I can help him when I can tell he doesn't feel good. The panting worries me.... is his sugar too high? too low? Does he just not feel good and it's not related to either disease? What can I do to help him without the risk of making it higher if it happens to be too high, or lower if it happens to be too low? Are there different symptoms for high and low? It's been a year and still not where he needs to be. Is it normal for it to take this long to regulate?

If you made it all the way through my post.... THANK YOU! I appreciate your time, interest, and empathy. I'm looking forward to finding someone to talk to who is going through the same thing.

[judymaggie]

Hi and welcome to you and Ziggy!

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/

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.

Could you get copies of all tests that were done on Ziggy 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? We would also be interested in seeing the results of all of the tests that led to a Cushing's diagnosis (ACTH, LDDS, ultrasound).

Ziggy was started on almost twice the recommended dose of trilostane for his weight so I am not surprised that he didn't handle it well. We have a great resource forum with lots of excellent articles -- I would suggest that you do some reading to help you better understand Cushing's. Here is the link to the Resources forum:

http://www.k9cushings.com/forum/forumdisplay.php?f=10

and a link to the section in that forum about Cushing's and diabetes:

http://www.k9cushings.com/forum/showthread.php?t=190

I am sorry for all these questions but the more we know about Ziggy the better our feedback can be. Please know we are here for you and Ziggy and we will help in any way we can. I will be back in a while and others will be along as well.

[aligale]

Thank you so much for your quick response. Ziggy will be boarding next week at the vet while I'm on vacation. They'll be doing some more tests, and hopefully getting a better understanding of what's going on with him since he'll be with them the whole week. I won't have access to scanning until I get back to work the next Monday. I'll get copies when I pick him up Saturday and post them as soon as I can. Thanks again!

[AvileeG]

Hi, and I'm so glad you wrote here...

I also have a dog who is both diabetic and Cushing's. My first thought on reading this was -- why didn't your vet advise you how to do blood sugar testing yourself? The thought that he had a seizure overnight (a symptom of severe hypoglycemia) and was still as low as 69 by the time you were able to get him to the doctor in the morning would be terrifying to me.

We were lucky enough to have a doctor who was very experienced with diabetes, and she immediately advised us on getting a BG test kit. I would strongly encourage you to do the same... Daphne's BG varies so widely that we could never get by with only testing her at the doctor -- she has had days when she has had readings as far apart as 454 (pre-breakfast) down to 72 (nighttime nadir). [for any non-diabetic-doggie-parents reading this, normal is about 80-120 but target range is more like 90-150.] She has gone as low as 50 on some days, but even when that low she has never shown any physical symptoms we can see -- since severe hypoglycemia can be life-threatening, if we were not able to test her at home we would be terrified all the time!

Our test kit is one specifically made for dogs and cats (the Alpha Trak 2) but with some expert advice you might be able to get by with a human BG tester. (I just looked, and I can't get Alpha Trak's website to pull up -- but you can find some information about it from American Diabetes Wholesale, where we get a lot of our supplies -- http://www.adwdiabetes.com/alphatrak.aspx . Of course the testing supplies are a bit of an expense, but very little compared to the insulin -- and certainly better than all those trips to the doctor!)

I definitely second the suggestion of joining the canine diabetes forum, as the folks over there will be able to give you lots of tips on testing and such. I'll admit I haven't been on that forum too frequently, since we are lucky enough to not only have had a great vet who got us started, but also to have a neighbor who is himself a type 1 diabetic and diabetes geek -- but we would be going crazy without getting lots of advice from folks who have had experience in this. Diabetes can truly drive you crazy -- blood sugar can be affected by so many little things that even keeping an absolutely consistent routine can't prevent wild swings. Being able to talk to someone with experience in this has been invaluable for us.

In case you do have another severe hypoglycemia event -- we have been advised with a very low BG reading we should rub some Karo syrup directly on the gums, as it gets into the blood stream much faster that way than going through the digestive system. If Daphne is below 60 we usually do that as well as giving her a "sugar cookie" (dog treat with syrup on it).

I certainly understand your frustration with the Cushing's complicating the diabetes... We had Daphne pretty well-regulated for almost three years (we were able to get by with spot-testing her only once every day or two, at her afternoon nadir, and found her in target range more than half the time); but since she was finally definitively diagnosed with Cushing's last summer and had a brief, disastrous trial with trilostane, her BG (as well as all her Cushing's symptoms) went crazy and we now have to test her at least 3x/day just to keep some peace of mind (we check her before each meal and at her afternoon nadir -- more often if any of those tests is way too high or too low).

If Ziggy's going to be boarded at the vet's next week, obviously they will be able to keep an eye on his blood sugar -- but when you get back, if I were you I would definitely ask about a BG test kit so you can have some peace of mind.

Good luck to you and Ziggy!
Avilee

[Harley PoMMom]

Hi and welcome to you and Ziggy from me as well!

Judy and Avilee have gotten you off to a really good start so I just have a few thoughts of my own :eek::D



This is my first time on a forum. I'm hoping to get some advice on how I can help him when I can tell he doesn't feel good. The panting worries me.... is his sugar too high? too low?

Dogs with Cushing's pant for a number of reasons; muscle wasting, redeposition of fat to the thoracic area, an enlarged liver and sensitivity to heat are all contributing factors.

I have found that spritzing some water on the bottom of their foot and getting into those cracks and crevices around a dog's foot pads helps a bit in keeping them cooler.

Regarding his Vetoryl starting dose, as Judy commented, that is a hefty dose for a 35 lb dog. Ziggy's lack of appetite could be from a too high of a dose of Vetoryl. Dechra, the makers of Vetoryl, recommend a starting does of 1mg per pound, so for Ziggy's weight of 35lb his dose should not have exceeded 35mg. Have any monitoring ACTH stimulation tests been preformed, and if so, could you post those results here?

Sudden blindness is dogs with Cushing's can be attributed to SARDS, I'm including this post from one of Administrators regarding SARDS:


Hello and welcome to you and your sweet boy. I'm surely sorry for the problems that have brought you to us, but also really glad that you've found us.

As soon as you mentioned sudden blindness, my mind turns to the possible diagnosis of SARDS. It is a syndrome of unknown origin that causes sudden blindness in dogs, along with certain other symptoms that overlap with (and can be confused for) Cushing's, including excessive thirst, urination and hunger. One thing I am uncertain about is whether or not the dog's pupils become totally nonreactive to light with SARDS. However, if SARDS is suspected for Leo, it is possible that he does indeed also have Cushing's, but it is also possible that the diagnostic blood tests for conventional Cushing's may be negative. Of course, it is also possible that his blindness has not been caused by SARDS, but instead by some other issue which may or may not be Cushing's-related (e.g., high blood pressure leading to retinal bleeding, etc.).

Can you tell us more about the other symptoms that are leading you to test Leo for Cushing's? Also, SARDS can be ruled in or out by an eye examination conducted by a vision specialist. So I don't know how extensive Leo's eye diagnostics have been so far.

Regardless of the cause of blindness, I surely understand why you are feeling so worried and protective of your little boy. We do have members with dogs who have gone blind for a variety of reasons, and I'm hopeful they will be stopping by to give you some tips. Also, in the event that Leo might indeed have SARDS, here's a reply that I posted some time ago to another member. I'm hopeful it will make you feel better about Leo's future, regardless.


Also, I just came across this 2013 article from the Journal of the American Veterinary Association that I found to be very interesting, and you may, too.

Long-term outcome of sudden acquired retinal degeneration syndrome in dogs (http://avmajournals.avma.org/doi/abs/10.2460/javma.243.10.1426)

100 dogs with SARDS were examined at five different vet schools between 2005 and 2010, and these were the main results.


Results—Age at diagnosis was significantly correlated with positive outcome measures; dogs in which SARDS was diagnosed at a younger age were more likely to have alleged partial vision and higher owner-perceived quality of life. Polyphagia was the only associated systemic sign found to increase in severity over time. Medical treatment was attempted in 22% of dogs; visual improvement was not detected in any. Thirty-seven percent of respondents reported an improved relationship with their dog after diagnosis, and 95% indicated they would discourage euthanasia of dogs with SARDS.
Although some pieces were discouraging: medical treatment did not improve vision for any dogs, and the other overt symptoms did tend to persist over time. But excessive hunger was the only systemic symptom that increased, and I found it very interesting that so many owners reported an improved relationship with their dogs afterwards, and the overwhelming majority -- 95% -- did not perceive SARDS to be a reason for euthanasia. I found that to be a very positive indicator of quality of life after diagnosis.

Here is another article that summarizes this research in much greater detail. Once again, I felt as though the overall conclusions were quite positive.

http://speakingforspot.com/blog/2014/07/13/sudden-acquired-retinal-degeneration-syndrome-sards/



I see I've already written a book here, so I'll stop for now! But once again, welcome to you and Leo, and we'll be very interested to read any additional info you care to share with us.

Marianne

I am sorry for the reason that brought you here but glad you found us and we will help in any way we can.

HUgs, Lori

[aligale]

Thank you all for your replies. I have Ziggy's test results to post today, although I'm not sure that all of them are applicable (they're in an album). After being boarded at the vet last week, I've stopped the trilostane until he starts eating better, and his insulin dosage has been decreased to 10 units twice a day. He's still panting constantly though.:( I joined the diabetes forum this afternoon, so hopefully I'll get some feedback from there soon, too :)

[aligale]

I thought Ziggy was getting back on track with eating well, but again this morning, he didn't want to eat. I spoke with the vet yesterday and they will probably hold off and not do the ACTH Stim test on Friday, but wait until he's back on his normal schedule on the trilostane. I'm so frustrated. :(

[judymaggie]

Hi! It has been a while since we have heard from you. Please let us know how Ziggy is doing when you get a chance. We are worry-warts!

[aligale]

Sorry I disappeared! Ziggy's doing ok - still panting a lot, but not drinking as much as he had been. We haven't done another ACTH stim test yet and right now I just can't afford it. He's eating good, for the most part, and I am now able to do home monitoring for the diabetes - so that gives me so much peace of mind. Thank you for reaching out!