New to site, looking for treatment options for possible Cushing's diagnosis

[lyriclover]

Hello, we are owners of Muffy, who turns 11 today, a female Jack Russell Terrier. She has been displaying symptoms of Cushing's for a while now, high ALKP tests for about a year, but we/her vet have been monitoring it. Within the last few months, she has become more aggressive with one of our other dogs (we have 4 total) and has (we think) started fights which she has been seriously injured by bite wounds from our boxer. We keep them crated now when we are gone and they seem to get along the rest of the time. However, recently healed from this, she has begun the typical signs of seriously increased drinking, urinating all over the house, increased panting, etc. Her latest bloodwork last week showed ALKP of 2,000, and glucose of 411. Her vet suspects Cushing's and diabetes?? We are discussing tx options and she is to call me back soon. Any suggestions, need more information? The Cortisol test from October results are: 1.4 ug/dL; <.7; <.7; Time 1 925; Time 2 125; Time 3 525. I am not sure what these mean but will ask Dr. I thought she said at the time that it ruled out Cushing's but with recent developments, she is leaning toward that AND diabetes??? Any help would be appreciated!

[Roxee's Dad]

Welcome to you and Muffy and a very special

Happy Birthday Muffy



The Cortisol test from October results are: 1.4 ug/dL; <.7; <.7; Time 1 925; Time 2 125; Time 3 525.

Could you please post the normal ranges for these results. Their will be plenty that will come to welcome you and help you and Muffy through this.

I also wanted to ask if Muffy's thyroid has been checked. Often times newly formed aggression can be a result of a thyroid condition.




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[lyriclover]

Thank you!! Yes, they were w/in normal ranges: 1.4 (normal 1-5); second test <0.7 (normal 0-1.4); third test same as 2nd. However, at that time her Alkaline Phosphatase (ALKP) was 839 (normal is 23-212); Now it is 2,000!!

[lyriclover]

I don't see any T4 thyroid tests in her lab results, but since her daughter Tigger (our other JRT) does have this issue and is on Levothyroxin, I would think that our vet would have checked that. I will ask her.

[Roxee's Dad]

Is she on anything for diabetes? We have a few members with pups that have both diabetes and cushings.

The high ALKP is one of the tags that raise suspicions of cushings, high water intake and frequent urination can also be diabetes. So could be both, but further testing will need to be performed. LDDS, and an ACTH to confirm cushings. Are their any plans to do an high definition ultrasound? With a high def US, your vet would get a good look at the internal organs and especially the adrenal glands.

I am sure a few of our members that are experiencing both cush and diabetes will stop by and share their experiences.

Give that Muffy a Happy Birthday Belly Rub from us :D

[Roxee's Dad]

Here is a link to our information and resources section regarding Thyroid and behavior issues.

http://www.canine-epilepsy.com/thyroiditisbehavior.html


Edited to add:
If Muffy does turn out to have diabetes, we also have a wonderful sister site for diabetic dogs and quite a few of our members belong to both.

http://www.k9diabetes.com/forum/index.php

[Budsters Mom]

Hello and Welcome from me too!:)
I am sorry for the reason that brought you here, but so glad you found us.You have come to the right place! There are many K9Cushing's angels standing by to help and stay with you every step of the way. They love details, test results, any information you can get your hands on. The more the better. We will do all we can to help.
So again welcome to you and Muffy. :)
Birthdays are huge around here, so Happy Birthday Muffy!

Hugs,
Kathy and Buddy

[lyriclover]

Thanks all. Just got off the phone with the vet. She is more concerned with possible diabetes at this point, to get that under control, so we will be doing a fasting blood test this week, along with the ACTH stim test for Cushing's disease. She did not see a Thyroid test in her lab work and said we could test for it, but it wasn't usually a cause for her symptoms. The Low Dose Dexamethasone Suppression (LDDS) test we did in October came back normal, which surprised us all, but now that her ALKP levels are 2,000 (norm 23-212) she wants to do the ACTH test. The treatment costs for Cushing's are kind of scary, especially since her earlier escapades with the boxer the last few months have totaled about $2500 in emergency vet bills.....but, of course, we will do what we can to keep her comfortable.

[frijole]

Since the acth test is expensive and both diabetes and cushings have similar symptoms I'd hold off on the cushings test to see if the diabetes cures all. Get that under control and perhaps the symptoms go away. A thought anyway... Kim

[lyriclover]

That is a possibility, but the Cushing's symptoms have increased over the last year, and her blood glucose was normal (116) at the end of March of this year. It has jumped to 411 now (normal 70-143).

[StarDeb55]

Welcome to you & Muffy! I'm sorry to hear that Muffy may be dealing with the "double whammy" of diabetes & Cushing's. I do want to comment on the diabetes aspect.


She is more concerned with possible diabetes at this point, to get that under control, so we will be doing a fasting blood test this week

Your vet is dead on correct. The diabetes has got to take priority as it can be life threatening, if not brought under control. As a medical lab tech with 30+ years experience, your baby's glucose would be considered a critical result in a person. Do you know if your vet checked her urine for the presence of ketones? If a urinalysis was done, then the ketones were checked. If ketones are in the urine, Muffy may be at high risk for diabetic ketoacidosis. Cushing's needs to be put on a back burner for now. Cushing's develops at a snail's pace, literally taking years to do its damage to the internal organs. Diabetes alone could easily explain the elevation in the alk phos. IMO, if Muffy were my pup I would put the emphasis on getting the diabetes diagnosed & under control. One tip-off that Cushing's might be in play is if the diabetes is difficult to get regulated on standard amounts of insulin.

Please keep us posted. We are here to help in any way we can.

Debbie

[frijole]

The elevated alk phos and the urination and diluted urine could be from diabetes and not cushings is what I was saying - happens all the time. As Deb just said, if you focus on treating the diabetes and find it hard to regulate then you could also be dealing with cushings. There isn't a rush to treat it but the diabetes needs to be addressed. (as you know) Kim

[k9diabetes]

Hi! :)

I am the administrator of the sister site for canine diabetes and encourage you to join there if you haven't already. www.k9diabetes.com is the main website with lots of information on diabetes and the forum is at www.k9diabetes.com/forum.

Given the normal Cushings results 8 months ago, I would not do anything with Cushing's disease at this time. It is very difficult to diagnose Cushing's accurately in a newly diagnosed diabetic.

And with blood sugar of 411, there's no question your dog has diabetes. While Cushing's can theoretically raise blood sugar, I have (1) never seen it actually occur, and (2) would expect the elevation in blood sugar to be mild in a dog with normal insulin functioning.

Also, keep in mind that the enzymes tested are "liver enzymes", not "Cushing's disease" enzymes. They tell you something is bothering the liver, but that can be many different things, many not a big deal once some other condition like diabetes is controlled.

One of the few upsides of canine diabetes is it will pretty much tell you whether your dog has Cushing's disease because if she has Cushing's, her blood sugar will not regulate well. So you can start insulin and see how she does and that will help tell you whether Cushing's should remain a concern.

So I think an ACTH at this point would not be very reliable and would be a waste of money better spent on her diabetes regulation.

Have you considered testing her blood sugar at home? We have tutorial videos on where and how to get a sample and can recommend a couple of meters that work well with dogs. That will save you a lot of money in terms of monitoring her blood sugar.

Also, I wouldn't wait to start her on insulin. And checking for ketones is wise as that is one thing that can be fatal before treatment gets underway.

Natalie


Thanks all. Just got off the phone with the vet. She is more concerned with possible diabetes at this point, to get that under control, so we will be doing a fasting blood test this week, along with the ACTH stim test for Cushing's disease. She did not see a Thyroid test in her lab work and said we could test for it, but it wasn't usually a cause for her symptoms. The Low Dose Dexamethasone Suppression (LDDS) test we did in October came back normal, which surprised us all, but now that her ALKP levels are 2,000 (norm 23-212) she wants to do the ACTH test. The treatment costs for Cushing's are kind of scary, especially since her earlier escapades with the boxer the last few months have totaled about $2500 in emergency vet bills.....but, of course, we will do what we can to keep her comfortable.

[molly muffin]

Hi and welcome from me too.
It looks like the LDDS test was negative for cushings when done. I wouldn't pursue the ACTH until you've had time to address the diabetes first, which is the most important. I would think that some aggression can come from out of control blood sugar too. The K9Diabetes group would know more about that. I would definitely encourage you to join there too.
It is possible that once the diabetes is controlled that the cushings symptoms will go away and that could be a non issue. Especially with negative LDDS testing so far.

Sharlene and Molly Muffin

[lyriclover]

Thank you all. That gives me a lot to think about. The only thing that I am unsure of is, for the past year, her blood sugar has been normal each time they tested but her liver enzymes have been elevated, and increasingly so. That makes me think it would be cushing's, and maybe even contributing to the diabetes, but of course I am no doctor, and it seems that they are two separate things. Maybe we will hold off on the ACTH test for now and concentrate on regulating her blood sugar. But, then if she has Cushing's obviously that is going to be a problem in and of itself. This is all so confusing....I'm trying to learn as much as possible. Thank you all for your input, help and support! I don't know if they did ketone testing, but the vet was emphatic about further blood tests to verify the diabetes and brought up the ketone thing. I don't know anything about it. This will definitely be an educational experience. She just doesn't feel well it's obvious. The poor thing is just not herself. Drinking constantly, peeing all over everywhere, panting, heavy breathing, lack of energy. We have to do something soon to get her feeling better. So is it possible for Muffy to have such high readings of ALKP (375, 895, 1203 and 2000 quarterly) and have normal blood glucose levels and it still be diabetes, since her blood sugar was normal just 2 months ago?

[lyriclover]

So is it possible for Muffy to have such high readings of ALKP (375, 895, 1203 and 2000 quarterly) and have normal blood glucose levels and it still be diabetes, since her blood sugar was normal just 2 months ago?

[k9diabetes]

I am not saying Muffy has cancer... But as an example of high liver enzymes not being Cushing's, I knew a dog who was already diabetic and whose insulin needs were dropping while the liver values were going up. Vet kept pushing Cushing's, which made no sense with low blood sugar. It turned out that he had a liver tumor. So remember that high liver enzymes does not mean Cushing's disease.

[goldengirl88]

Happy Birthday Muffy and welcome:
I have an 11 1/2 year old Jack Russell Tipper with Cushings. She has been on treatment since August. Since she developed this disease I have been more aware of other dogs with it. There are many Jack Russells with this disease that I have seen. It seems to really affect the terrier group. God Bless you and good luck
Patti

[lyriclover]

We held off on the ACTH Stim test. It seems obvious now that she's diabetic:
6/17/2013 Urine Appearance Normal
6/17/2013 Urine Color 0.000 Normal
6/17/2013 Urine pH 5.000 Normal 5.000 - 7.500
6/17/2013 Urine Occult Blood 0.000 Negative
6/17/2013 Urine Protein 30.000 Normal 0.000 - 30.000
6/17/2013 Urine Bilirubin 0.000 Negative
6/17/2013 Urine Ketone 0.000 Normal 0.000 - 0.001
6/17/2013 Urine Glucose 1000.000 Above Normal 0.000 - 0.001
6/17/2013 Urine Urobilinogen 0.000 Normal 0.000 - 2.000
6/17/2013 Glucose 349.000 mg/dl Above Normal 70.000 - 143.000 mg/dl

[Budsters Mom]

Yes, from her Glucose level, it certainly looks like she's diabetic. If she was my dog, I would hold off on Stim test also and get her diabetes under control first.;)
Hugs,
Kathy