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Lady is a Jack Russell Terrier who was 8 yrs old when she was dx with cushing's in Sept. 06. She was also diabetic at that time but the vet that was treating her missed the diabetes. Her story begins in May 06 when she started with what sounded like congestion. She was put on antibiotics and a steroid but the congestion wasn't going away. The vet thought maybe it was coming from her teeth - she had a lot of plaque. Routine blood work on the day of the cleaning showed her alk/phos was so high they couldn't measure it and the alt was also high. Vet said she might have cushing's. Lady had to have 11 teeth pulled that day and it took awhile for her mouth to heal. The congestion continued - she had been gaining weight - had a pot belly - could no longer jump on the furniture - and had a sore on her front paw that she would constantly lick. In Sept. she started drinking a lot of water and was having accidents in the house. She had an acth test done that showed she had cushing's. More blood work was done and they still couldn't measure her alk/phos and her alt was even higher. Also her bg was 413. When I questioned the vet about it he said it was from the cushing's. She was started on lysodren for the cushing's and after 2 1/2 days on it she became very sick. She started vomiting so vet had us stop the lyso and give her prednisone. We took her in to have her electrolytes checked and they were fine. The next day she had more vomiting and bloody diarrhea. Took her right to the vet's The vet who saw her that day dx her with diabetes - her bg was 450 - she also had a large amount of ketones. She weighed 15.08 lbs down from 17.48 lbs in the beginning of Sept. She was put on 3 units of Humulin N. We were devistated, worried and scared. I couldn't stop crying - was so scared we were going to lose her. Vet told us we had to get the diabetes under control first - she wasn't sure that Lady even had cushing's - said unregulated diabetes could give false positive on acth test and Lady had been on prednisone that summer. We could not get her bg's down - had to keep increasing the insulin. She was going for curves every couple of weeks. She continued to loose weight and in January 07 she was on 10 units of Humulin N and weighed 14 lbs. She was not herself. You could see just by looking at her how awful she felt. Would just lay in her bed all the time. She was retested for cushing's and all tests were positive. Her vet wanted us to see an IMS - she told us she had treated many patients with cushing's and many with diabetes but never a dog that had both diseases. The IMS said her physical exam was suspicious for cushing's - thinning of fur and flaky skin - pot bellied apperance. He said it was difficult to make the dx of cushing's because in July the blood abnormalities could have been from the steroid usage and in Sept. when she was tested for cushing's she was diabetic. Diabetes can cause similar liver enzyme and cholesterol elevation and can also lead to false positive cushing's tests. She also had an abdominal ultrasound done which did not reveal evidence of adrenal gland enlargement. He wanted us to switch the insulin to Vetsulin and if she requires dose escalation in the range to suggest insulin resistance we would then treat her for cushing's. She was started on Vetsulin and we had to keep increasing the dose. She was on 10 units twice daily and now weighed 13 lbs. We switched back to humulin N and her dose was back up to 10 units twice a day - she was still unregulated. IMS wanted to start treating the cushing's and she was put on 60 mgs of trilostane and he had us reduce the insulin to 7 units because he anticipated the insulin needs would decrease as we treated the cushing's. After 2 days on the trilo she started vomiting. I thought oh no! here we go again. We stopped the trilo for a couple of weeks and then restarted at a lower dose - 30 mgs. and she did fine. Firtst acth test was done after 10 days on the trilo and her cortisol was coming down but her curve showed her diabetes still unregulated. We had to increase the insulin again - she ended up being on 11 units 2x's a day. After being on the trilo for a few more weeks I did a spot check on her and was shocked to see a reading in the 100's. We reduced the insulin but a few days later she started vomiting and when I checked her the bg was only 70. Gave her something to eat and rushed her to the vet's. Bg had come back up by then so the insulin was reduced to 5 units 2x's a day. This all happened at the end of May 07 and she's been on the same dose since then. It wasn't until June that she really started having good bg's. Her trilo has been adjusted after her acth tests. At one point she was up to 120 mgs. but has been reduced since.
Today her cushing's and diabetes are both under control
. It took us a long time to get where we are today but she is back to being the little terrier she was before all this started. There are still somethings she can't do - like jump up on the furniture - but she does try. She is very happy, alert and full of energy. She is on 30 mgs of trilostane, 5 units of Humulin 2x's a day, fish oil, pet vitamin and cosequin. I also home cook for her and she finally gained some weight. I hope Lady's story can offer hope to all those just starting out on this journey. I'm sure Lady would of never made it if it wasn't for the wonderful vet and IMS who take care of her. Also the wonderful, caring people on the cushing's and diabetes board who have helped us along our way. Hugs to all.
Today her cushing's and diabetes are both under control
. It took us a long time to get where we are today but she is back to being the little terrier she was before all this started. There are still somethings she can't do - like jump up on the furniture - but she does try. She is very happy, alert and full of energy. She is on 30 mgs of trilostane, 5 units of Humulin 2x's a day, fish oil, pet vitamin and cosequin. I also home cook for her and she finally gained some weight. I hope Lady's story can offer hope to all those just starting out on this journey. I'm sure Lady would of never made it if it wasn't for the wonderful vet and IMS who take care of her. Also the wonderful, caring people on the cushing's and diabetes board who have helped us along our way. Hugs to all.
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