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Old 12-02-2010, 03:12 PM
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Default Harry the wonder dog - An Angel 12.05.11

I have a 12 y.o. Irish Setter boy named Harry.
About a year ago, Harry, who had been a very picky eater, suddenly started to eat everything, including dry kibble. His blood panel in December showed mildly elevated Alk Phos.
In February, Harry had a bout of gastritis - blood panel showed further increases in liver enzymes. We noticed also that he was drinking and urinating more. Other values OK except elevated cholesterol. Ultrasound showed normal organs except bilaterally enlarged adrenal glands. The vet and I discussed a potential for Cushing's, but since his symptoms were not too bad, we decided to just observe.
Harry also has proteinuria, and we saw a sudden jump from mild proteinuria to much higher numbers. We ran all sorts of tests, including lepto, tick panel, Lupus, U Tenn Adrenal Panel and Michigan State thyroid panel. Thyroids normal, Adrenal Panel came back hyperestrinismm, no infectious disease nor lupus. Good thyroid functions for a geriatric dog.
We started to treat Harry's hyperestrinism with melatonin and lignans. We also started him on low protein food and benazepril.Harry's coat never grew back after the ultrasound. He started to develop skin infections and cysts. Worsening hunger.
By then, our regular vet referred us to a specialist. The specialist and our vet were more concerned about glomerulonephritis (proteinuria), but we were aware that Harry may be a dog marching towards Cushing's.
Finally, we ran LDDS test - Harry did not show any suppression, showing positive diagnosis for Cushing's. For the first time, Harry's blood glucose level elevated, but still less than 200. No sugar in urine. This was less than a month ago.
Harry had gastritis three weeks ago. We started him on Flagyl, and he had a very allergic reaction (eye swelling, chewing problems). Stopped the drug, problems went away. Then Harry developed a large cyst and nail bed infection. He has been on Clavomox since.
We also started Trilostane last Friday to treat his Cushing's. Dosage was 2mg/kg once a day in the morning. We also ran a full blood panel and urinalysis - which showed normal glucose, kidney values, the same elevation in liver values, continuing elevation in choleterol, no infection in urine.
Harry's back gave out on Sunday, indicating that treatment for excess cortisol was revealing arthritis.
Two nights ago, he started to urinate a bit more.
Yesterday, his thirst and urination became excessive - either he was eating, drinking or urinating NON-STOP.
We took him in to the emergency vet. The vet tested his blood glucose, and his glucose level was 650!! This was a HUGE shock as his glucose level a week before was normal.
Now Harry is taking 9 units of insulin twice a day - we started him last night, and he is already showing some improvement with his drinking and urination.
The ER doctor works at the same office as our internist. We have an appointment with our internist on Monday to evaluate Harry's Trilostane treatment and re-evaluate Diabetes diagnosis / treatment.
We are in utter shock - where is this diabetes coming from? Could it have been Cushing's? I also read that it is difficult to control diabetes in a Cushing's dog. Could Harry's Cushing's diagnosis been faulty? Is he diabetic at all? We are really upset, down and confused, and would really appreciate any helpful insight.
Sorry that this post is so long, but I wanted to give a good background info on our baby.

Last edited by HarrysMom; 04-10-2011 at 09:15 AM.
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Old 12-02-2010, 03:26 PM
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Default Re: Harry - Diagnosed with Cushing's and Diabetes

Hi Yunhee,

The LDDS test can give a false positive. Has he had an ACTH test done recently?

In dogs who are diabetic, the LDDS is not always so reliable and the ACTH is preferred. Also, the Cushing's could be strictly atypical as it sounds like some of the other hormones were elevated per the UTK panel.

Diabetes is difficult to control in a dog who has Cushing's disease that is out of control. When they have an excess of hormones, including cortisol, the blood sugar is driven higher. So it takes a LOT of insulin to treat a Cushing's diabetic and sometimes you just can't give enough to get the blood sugar levels down.

So you're treating for Cushing's, which is good.

And given that the blood sugar is so high while on Trilostane, I think Harry truly is diabetic.

I actually might be more concerned about being sure the cortisol-related Cushing's disease is a solid diagnosis. The two diseases looke so much like each other in terms of symptoms that it can be very difficult to differentiate between the two. And the testing is complicated in a diabetic dog.

I would have them do an ACTH test now to re-evaluate the Cushing's diagnosis. And I'd be interested to know what Dr. Oliver's (U. Tenn.) recommendations were about treating with Trilostane vs. Lyosdren.

I know Trilostane can make some of the other hormone levels go higher - not sure if estrogen is one of them.

Plus any other concurrent disease - and it seems like there was an awful lot of stuff going on with him when he was tested - can affect the results of the LDDS.

So long story short, I'd double and triple check the Cushing's diagnosis. I have not seen a dog with Cushing's only have such seriously elevated blood sugar so I tend to think the diabetes diagnosis is solid.

Natalie
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Old 12-02-2010, 03:41 PM
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Default Re: Harry - Diagnosed with Cushing's and Diabetes

We did ACTH done in April, and it was negative. We did not do this when we went for the LDDS test. Our internist said that she prefers LDDS, and Harry's LDDS numbers were 3.5, 4.0,4.1. No suppression at all. His ultrasound at the time of LDDS also showed bilaterally enlarged adrenal glands. His previous two ultrasounds by a different radiologist also showed such bilateral enlargement.
Harry also had other signs of Cushing's, including pot belly, hunger, PU/PD, rear end weakness, poor, thinning coat, skin discoloration and infections. Our internist has been watching him for a while, and she said that he is increasingly looking Cushingoid.
Dr. Oliver recommended lignans and melatonin, but these did nothing to improve Harry's symptoms.
We did not talk to Dr. Oliver, but our internist thought that Harry's earlier hyperestrinism diagnosis was a precursor to full Cushing's, and we should treat PDH first. She apparently likes Trilostane more than Lysodren to treat PDH. We are scheduled for ACTH on Monday.
Wouldn't this ACTH not show Cushing's since he's been on Trilostane for a few days?
I am just shocked that his blood sugar woud spike from 160 to 650 in a week with such severe symptoms.
Thank you, Nathalie.

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Originally Posted by k9diabetes View Post
Hi,

The LDDS test can give a false positive. Has he had an ACTH test done recently?

In dogs who are diabetic, the LDDS is not always so reliable and the ACTH is preferred. Also, the Cushing's could be strictly atypical as it sounds like some of the other hormones were elevated per the UTK panel.

I actually might be more concerned about being sure the cortisol-related Cushing's disease is a solid diagnosis. The two diseases looke so much like each other in terms of symptoms that it can be very difficult to differentiate between the two. And the testing is complicated in a diabetic dog.

I would have them do an ACTH test now to re-evaluate the Cushing's diagnosis. And I'd be interested to know what Dr. Oliver's (U. Tenn.) recommendations were about treating with Trilostane vs. Lyosdren.

Plus any other concurrent disease - and it seems like there was an awful lot of stuff going on with him when he was tested - can affect the results of the LDDS.

Natalie

Last edited by HarrysMom; 04-10-2011 at 09:15 AM.
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Old 12-02-2010, 03:52 PM
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Default Re: Harry - Diagnosed with Cushing's and Diabetes

I know that Dr. Oliver tends to prefer lysodren treatment in a dog with elevations of other hormones because Trilostane can elevate those hormone levels further.

I am glad he's having an ACTH - that should help clarify the picture.

It's certainly possible that he has both Cushing's and diabetes. A lot of dogs do. And I feel more comfortable with a Cushing's diagnosis if there are obvious visual symptoms.

Our dog's diabetes was kicked off by prednisone treatment, which is not very different from having high levels of cortisol from Cushing's disease. He went from normal to heavy drinking and urinating pretty much overnight even though the pred dose was really small. We took him off the med and the drinking and urinating didn't stop - poof, diabetes diagnsis!

Since Harry's blood sugar has been on the rise for a while, it wouldn't be surprising at all to find that he has both.

Let's see what the ACTH says. If his cortisol is in a good range, then you shouldn't have problems getting the diabetes under control.

If he never had increased cortisol levels, I would expect the lysodren to be taking the cortisol levels too low, which would also show up on the ACTH. And they should time the test to coincide with the lysodren being given as it has a pretty short half life.

Natalie
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Old 12-02-2010, 04:27 PM
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Default Re: Harry - Diagnosed with Cushing's and Diabetes

Nathalie,
That was our thinking. If Harry is not Cushingoid, then Trilostane will lower his cortisol level too low and that it will show up in his ACTH test.
So far, he is eating well and seems to be panting less. Before starting the treatment, Harry would be absolutely nuts in the evening, begging incessantly. He stopped doing that, but he is still eating extremely well.
Thank you for your input.
I will update the group after Harry's appointment on Monday.

Last edited by HarrysMom; 04-10-2011 at 09:15 AM.
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Old 12-02-2010, 05:21 PM
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Default Re: Harry - Diagnosed with Cushing's and Diabetes

I have another question.
Since starting Trilostane, Harry's arthritis is acting up. We were thinking about giving him Tramadol. Is it OK to give this to a diabetic dog taking insulin and Trilostane? I just want to be cautions. Harry also takes Denamarin (Sam-E), so I was going to wait until tomorrow to start Tramadol (hoping this morning's Denamarin will have been processed out of his body by then).
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Old 12-02-2010, 05:49 PM
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Default Re: Harry - Diagnosed with Cushing's and Diabetes

ITs fine for diabetic dogs but i dont know the interaction with the other drug. I would ask your vet.
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Old 12-02-2010, 06:53 PM
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Arrow Re: Harry - Diagnosed with Cushing's and Diabetes

Hi Yunhee and Harry,

I'm not equipped to make any suggestions, nor even observations, in this tricky situation! Except for one thing. You are obviously dearly devoted and dedicated to Harry's well-being. Good for you! I'll be watching your thread.

Wishing you and Harry all kinds of success with treatment, whatever it turns out to be. Hope Harry starts feeling better soon. I KNOW he's a very lucky dog to have a doGMum like you!

Oh, and a big, fat welcome to this forum - the best one I know on canine diabetes.

Thu, 2 Dec 2010 17:52:25 (PST)
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Old 12-02-2010, 09:37 PM
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Default Re: Harry - Diagnosed with Cushing's and Diabetes

Carol, thank you for such a kind welcome. I am so glad that I found you guys. Give me a lot of comfort. I also belong to your sister site, K9Cushings, and folks there have been very helpful.

Last edited by HarrysMom; 04-10-2011 at 09:16 AM.
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Old 12-02-2010, 09:39 PM
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Default Re: Harry - Diagnosed with Cushing's and Diabetes

Another question for the group.
Do I need to measure Harry's glucose levels everyday now since his number at the ER was over 600? The ER vet did not mention anything about it - she said that she just has Harry on low dosage of Humilin (I think), and that this 9 units twice a day will significantly stabilize Harry until Monday when he sees his internist. Harry is still drinking and urinating more, but not like yesterday when he was going crazy. So far, he's had 4 insulin shots, and he seems OK and still eating well. BTW, Harry weighs 85 lbs.

Last edited by HarrysMom; 04-10-2011 at 09:16 AM.
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