Apollo (Diabetes and maybe also Cushing's?)

[Debbie & Apollo]

Hi -

My name is Debbie and my dogs name is Apollo. We were fairly active on this site a little over a year ago when we first suspected and had Apollo tested for Cushings. Last June the tests came back boardline, and inconclusive. The Cushings web site got changed around and I lost touch with you... it is necessity that made me hunt you all down again.

Apollo is having a rough time again (he has been having days where he throws up and his tummy is extended). We just finished a full blood work up - his Cholesterol was 456 (387 previous test) and his triglycerides were 1858 (previous test 1427). Both of these numbers are up even though he is on a very restrictive diet. It appears that retesting for Cushings should be our next step. The vet is recommending a full adrenal panel this time. For now we are treating him with antibiodics just is case an infection is the problem. He is almost 10 years and has had diabetes for the last 4 years, bladder stones, hyperlipidemia, and pancreatitis twice (where we had to do the 3 days of IV fluids only).

At this point I really do not have any questions - I just wanted to get back in touch with you all - knowing you all are here is very comforting. My husband and I are looking at each other wonder how much more we put Apollo through.

I don't remember if it was ever mentioned but I wondered: the meds for Cushing - could someone please give me an estimate on the cost? Also an estimate on the cost for the full adrenal panel -- it would be sent to UT -- our vet even said if we wanted go straight there (UT) that was an option (we live about 1 1/2 hrs) from Knoxville.

thanks,
Debbie & Apollo

--------------------------------
*** Admin note:

Here is a link to Apollo's thread at the k9diabetes message board, just in case anyone here wants to read it to get a better understanding of Apollo's story from June 2008 up to now.

http://www.k9diabetes.com/forum/showthread.php?t=185

[StarDeb55]

Debbie, I'm glad you found us, but am awfully sorry to hear that Apollo is having a rough go of things, again. I will give you a link for the full panel information, check section G. I almost sure that UTK is charging $155, then you would have to pay your vet for the cost of the injection, 2 blood draws, processing & sending the samples.

My Harley weighs about 12.5 lbs. He is currently taking 200 mg of lysodren weekly. I have his lyso compounded by Diamondback Drugs, & I believe for the 100 mg. capsules, they charge me about $28 for 20 capsules. A lot of members do use diamondback as they have on-line ordering, & I believe a standard shipping fee anywhere in the country. The beauty of using a compounding pharmacy is that they can make up any dosage you might need. I keep both 75 mg & 100 mg capsules on hand.
For these little guys like we have, it's a lot easier than trying to split those standard 500 mg. capsules.

I second your vet's opinion that the UTK panel is the way to go. Could you refresh our memories as to what if any Cushing's diagnostic may have been done a year ago? If you can post those numbers that would be great. Was an abdominal ultrasound done a year ago? If so, what did it show about the adrenal glands. If you didn't have the ultrasound done, IMHO, the 2 things that need to be done are the full panel & the ultrasound.

Please let us know how you proceed.

Debbie

http://www.vet.utk.edu/diagnostic/endocrinology/general.php
http://www.diamondbackdrugs.com/

[acushdogsmom]

I second your vet's opinion that the UTK panel is the way to go. Could you refresh our memories as to what if any Cushing's diagnostic may have been done a year ago? If you can post those numbers that would be great. Was an abdominal ultrasound done a year ago? If so, what did it show about the adrenal glands. If you didn't have the ultrasound done, IMHO, the 2 things that need to be done are the full panel & the ultrasound.I'm not Debbie ;) but I have the link to Debbie's ACTH stim test results post (at the diabetes board) from last year:

http://www.k9diabetes.com/forum/showthread.php?p=1644#post1644


The Vet called yesterday and the Cushings results were basically "numbers too low to be conclusive"

His Cortisil baseline was 38.09 (2-56 is the normal range)
His Post admin of the shot was 163 (70-151 normal range) (Those results are from June 2008. Not sure if the results are in nmol/L or if the results are in UTenn units, but it looks like UTenn units to me, and if they are in UTenn units, the "translation" to ug/dl would be pre: 3.8 and post: 16.3)

I don't know if Apollo has had an ultrasound.

[StarDeb55]

Need the reporting units as I don't think those numbers are reported in ug/dl.

Debbie

[Debbie & Apollo]

I will go back into Apollos folder and find the #'s from last year. If memory serves me it was not what was called the FULL adrenal panel. At that time an ultrasound was not done.

Apollo is listless at the moment - I am going to try and encourage him to eat so I can give him his 5 PM insulin shot.

Out vet was saying 'their' ultrasound might not show the adrenal glands. But it would show if there was something going on for some of the other organs.

Debbie, thanks for the $ info - that is very helpful.

thanks
Debbie & Apollo

[acushdogsmom]

Need the reporting units as I don't think those numbers are reported in ug/dl.

DebbieI'm sure Debbie can clarify if the stim test was sent to UTenn, but it does look to me as iif the units are whatever it is that UTenn uses.

[Debbie & Apollo]

Thanks for getting the old info :)

yes those were done at UT.

Debbie & Apollo

and thanks for adding my little mans photo:)

[acushdogsmom]

Thanks for getting the old info :) That's what's so cool about having a "sister board". Easy to find previously posted information! :)


and thanks for adding my little mans photo:)You're welcome! :D

[StarDeb55]

Thanks for the clarification. Yep, those are not glaringly positive results. To get the kind of results you need on the ultrasound, you will have to have it done on a high resolution machine.

Debbie

[BestBuddy]

Hi Debbie and Apollo.
Welcome back, sorry you needed to. Apollo has hit the cushings bump about the same time as Buddy did, he had also been diabetic for 4 years. Our problems were discovered when we couldn't get good BG numbers after so many years of good regulation. Has Apollo been tested for thyroid problems?
Jenny

[Debbie & Apollo]

Well eating was not his big thing tonight - he has been a pest about food....
I gave him some of the canned food (SCI DIET lite) that our Maltese gets and he did eat some of that for me -- I felt confident enough to give him his insulin shot, but I did reduce it to 5 1/2 units as he didn't eat as much as usual.

Jenny to address you question about the thyroid - I believe this blood workup, we just got back, did not show anything elevated there.
It was called a "Superchem". I am not sure what letters would be for the thyroid part.
{I think I just discovered that T4 would be for the thyroid -- Apollo was 1.9}

the only high marks were on:

glucose 166
cholesterol 456
triglycerides 1858
Lipase 789

underBlood Count:
MCH 29.9
MCHC 38.7
Platelet Count 587

Last year we had a problem getting his glucose steady and that was the reason we did the testing. At that time we also changed his food and started some supplements (Milk Thistle and Denosyl).

He is resting right now -- breathing a bit heavy but he appears comfortable.

Debbie - glad to know about the high resolution ultrasound machine. I believe if we do that test I will ask for a place that has that type of machine. If I'm going to pay I may as well try and get the best images for the money.
Would anyone have a access to list of vet clinics that have a high resolution ultrasound machine? maybe I will google that :)


Debbie & Apollo

[StarDeb55]

Thyroid testing may be abbreviated using one of the following T4, T3, or TSH. As far as I know, most vet superchem panels do not include any thyroid tests, but I could be mistaken.

Debbie

[MiniSchnauzerMom]

Hi Debbie,

I remember you and Apollo. Hey, where's his shades?? Sorry that Apollo is having problems. I posted to your thread back in '08. Your Apollo and my Munchie had hyperlipidemia and bladder stones in common. :(

If I'm understanding correctly, your vet thinks Apollo is having intermittent Pancreatitis? Poor guy. His triglycerides and cholesterol are definitely elevated.

Since Apollo seems to have several things going on have you considered taking him to an Internal Medicine Doctor? They would have the high resolution ultrasound equipment. Sometimes our furkids who have several conditions tend to go beyond a gp vet's expertise and that's where the IMS with the extra training comes in.

If you are interested, here's the link to the American College of Veterinary Internal Medicine where you can locate a board certified veterinary specialist in your area.

http://www.acvim.org/websites/acvim/index.php?p=3


I've got no experience with canine diabetes but the hyperlipidemia is another story. Of course, Munchie is a MiniSchnauzer which is a breed that is predisposed to hyperlipidemia - but low fat diet and all, it's been a battle keeping him in the safe zone.

Hope Apollo is feeling better.

Louise

[Debbie & Apollo]

Louise I went to the site you gave, thanks! As for the picture with his shades - I'll have to hunt it down again and post :D
-- I found one vet - in Colorodo - now it's a beautiful state but I think that would be a bit far:)
I am going to get a referal from my vet and head to UT asap.

Does anyone have a name suggestion to ask for at UT.
If you don't want to post a name here you could send a private message.

As for now - Apollo is resting. He did hold down a small breakfast and also a snack at 10 AM. So far the 'runs' have calmed down.

Thanks
Debbie & Apollo

[gpgscott]

Does anyone have a name suggestion to ask for at UT.
If you don't want to post a name here you could send a private message.

Thanks
Debbie & Apollo

Debbie,

You will find reference to a Dr. Oliver frequently on this site, he heads up the lab, I am not sure what his title is.

If you are going to be seen in the clinic that will be a different group of Drs.

Here is a link to the UTK website, I would supply your Dr. with this and let him make the referral.

Scott

http://www.vet.utk.edu/clinical/index.php

[Debbie & Apollo]

Thanks Scott ! I recognize the name Dr Oliver from other posts.
Yes I think I would be seeing someone in the clinic area.
Good to have all the forms -- also I am starting to get a joural together - under stress it might comein handy.

now to just get an appt.

Apollo ate his mid meal.... he did look for grass, which I wouldn't let him have. Right now resting... I think I am going to take a nap, it may be another long evening.

thanks again everyone!
I posted a few pictures.

Debbie & Apollo

[Debbie & Apollo]

Just got a call from my vet :D
we have an appointment at UT on July 27th -
I am going over to pick up Apollos records just in case they have a cancelation and we can get in sooner.
He's doing better today.
I'll keep you posted.

Debbie & Apollo

[Squirt's Mom]

Hi Debbie!

Good to see you and Apollo again but sorry it has to be under these circumstances.

I hope you will be pleased with the UTK clinic and if I were you, I would go ahead and have the full adrenal panel done on Apollo. It will check the cortisol levels and the intermediate/sex hormones which can cause some of the same signs as elevated cortisol.

Welcome home!
Hugs,
Leslie and the girls

[MiniSchnauzerMom]

Hi Debbie,

Glad that Apollo is doing better today and that you have an appointment for him at UT. Good thinking getting all of Apollo's records together from your vet to have on hand. Wish for you there would be a cancellation and he could go to UT sooner. If not, I'll be waiting and watching for an update after his appointment on the 27th.

Thanks for posting the pictures in the gallery. Love those shades! :cool:

Louise

[Debbie & Apollo]

hi

Well everything is sitting by the car ready (but not the insulin:) to load it up to head to UT. No call yet for an early appointment.

At the moment Apollo is feeling better.
I am thinking//wondering.....
if given a choice should they run the high resolution ultrasound first, then do the cushings test??

I have packed an overnight bag -- just in case they want to do any other tests that have to be done 1st thing in the morning.

?'s I have for them is:
1) anything to give him to help lower the triglycerides and chl. and
2) any alternative to antiobiodics since he 'runs' SO BAD from what he has been given.

well bye for now -- I'll keep you posted and THANKS AGAIN!

Debbie and Apollo

[gpgscott]

Hi Debbie,

Well one week from today unless you get a phone call.

I suspect they will want an ultrasound due to his advancing age and the previous history of stones.

Waiting here with you to see what the clinic @UTK has to say.

Scott

[Harley PoMMom]

Hi Debbie,

Waiting here with you to see what the clinic @UTK has to say.

Scott

Me too!

Lori

[StarDeb55]

I'm sure you're on the road now, Debbie, so I hope yo will see this. I think the ultrasound needs to be done regardless, as the vets will be able to get a look at all of Apollo's internal organs, & perhaps get a better idea on what is going on with his pancreatitis, along with his adrenals.

Debbie

[MiniSchnauzerMom]

Hi Debbie,

Waiting here with the rest of the group.....:D

Louise

[Debbie & Apollo]

Hi! (for all spelling errors I am sorry)

Well we made the trip to UT and found out lots of things about Apollo, along with waiting for some test results to come back. All in all the UT experience was very well worth the time and effort.
It’s hard to know where to start.
It has been determined that Apollos diabetes is NOT under good control, using a fructosamine test he was 473 which is high (normal is between 250 – 350). There appears to be underlining conditions which are throwing things off and will continue to hinder good diabetic control.
1) Apollo has bladder stones and also kidney stones in both kidneys. Two years ago he underwent surgery for this same condition (calcium oxalate stones – which cannot be dissolved). At the moment Apollo shows no outward signs of unariry tract infection or difficulty going potty. We are keeping a super close watch on him … what goes in and what comes out. Also I am starting to test urine samples at least once a day.
2) Apollo triglycerides were 1870, even after fasting… he is going to start a drug for this (not sure how to spell it) …gemfibrozil.
3) There appears, from the ultrasound and radiology tests, to be a spot on his pancreases and also a thickening of the walls of his intestines. Not sure about the spot on the pancreases but the intestines could mean an IBS…since he has diabetes yes there are a few drugs to help this that are not steroid based.
4) They drew a small amount of fluid from his gall bladder – tests results won’t be in for 5 days.
5) They did a urine culture – tests results in 3 days.
6) We are waiting on suggestions on diet from the nutritionists. I am going to start reading back in these threads for ideas on home food prep. I need to watch out for fat, and protein…right now I don’t remember if protein is a concern. I know it has to be low fat.
7) Recommendation to stop the Potassium Citrate, stop the Denosyl, and stop the Milk Thistle since there appears to be no advantage to him to continue these supplements.
8) Recommendation to do surgery to remove the stones in the bladder… the ones in the kidney can not be removed safely. During this time also take biopsies samples.

The situation is complex – one attempt to help Apollo tends to mess things up for something else.
He is like a scale that seems we cannot get a balance. Right now he is on W/D as it is low fat. He could use being on U/D for the help with the stones… however the fat is way too high for him.

It seems surgery will eventually be necessary to remove the stones… but if the stones are only going to RETURN… we can’t cut open this poor guy every year!
They would like to do biopsies on the two areas (the spot on the pancreases and the area in the intestines)
All of this would require him to be in the hospital for about 3 – 4 days. As you can imagine the cost is up there.

Right now we are unsure on how to proceed. 1) We are going to start the meds to try to lower the triglycerides. 2) keep an eye on the pee :p & 3) PLAY AND LOVE ON HIM!

Thanks for all you input, care and support!!!! There is a great deal to absorb. Oh yeah! -- they don't think it's Cushings.

Debbie and Apollo

[gpgscott]

Debbie,

Even if it is not Cushing's you are part of our family and we want to hear from you.

I can see you have a lot to deal with. I think one of my first issues would be the kidney stones, if they cannot be removed I think the prognosis in this area would direct what other treatments I might consider.

The good thing about these clinics is you get a very thourough review. The other side of that is that you need some direction on what is best for Apollo from a less clinical point of view.

Please rest and absorb it all and please continue to muse it over here with us.

Hugs. Scott

[Debbie & Apollo]

Thanks Scott !

We are still absorbing info... doing research and we have a few more days before the rest of the results come in.
I have a call into our local vet and I am anxious to hear their opinions.
He started the Triglyceride med this morning... Apollo takes it a 1/2 hour before eating. We paid $11. for 10 pills.... the real kicker is that my hubby just threw out the same drug (he had a poor reaction to it) a few months ago! weird...
Still trying to make sense out of what to feed him...We tried a little sugar free cranberry juice... Apollo will take a lick, but that's about it.
I will definately continue to post here as there may be other dogs that have some of the same symptoms and can benifit from our journey.
thanks guys

Debbie and Apollo

[Squirt's Mom]

Hi Debbie,

As Scott said, ya'll are family and have been for some time now so don't get any ideas about leaving! ;) The stories of non-adrenal, non-Cushing's illnesses that have mimicked the condition so strongly, are as important to share as are those of dealing with a positive, unquestionable diagnosis of Cushing's. The more light we can shed on the complexities of this illness, the better for all.

This really is a lot to absorb, but I know you will make the right choices for Apollo as you always have done.

Let us know when the rest of the results come in! Any time you need us, we are here.

Hugs,
Leslie and the girls