Do you guys have any advice on what questions to address exactly regarding Cushing's and Diabetes? Don't want to miss anything.
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Do you guys have any advice on what questions to address exactly regarding Cushing's and Diabetes? Don't want to miss anything.
I think my best suggestion is to make sure to take copies of all available labwork along with you as you visit the specialist. Daisy has had a lot of abnormalities over time, and it’ll be good for the new vet to be able to evaluate the changes — both positive and negative. Since we’ve especially been concerned about those most recent monitoring ACTH results, for sure you’ll want to point those out.
Overall, we’re seeking confidence in the Cushing’s diagnosis, as well as finding optimal medication doses for both the diabetes and Cushing’s. As far as the Cushing’s, be sure to list out all the symptoms you’ve been seeing over the past couple of years, including the white spots on her skin.
I totally leave the insulin dosing up to the specialist, since I know nothing about that. As far as the Vetoryl, in addition to determining an appropriate total daily dose, I’d ask the specialist whether it would be better to dose Daisy twice a day since she’s diabetic. As I believe we’ve mentioned earlier, many specialists believe that’s it’s better for diabetic dogs to split the daily total into two doses given twelve hours apart.
That’s all I can think of for now. Good luck, and please let us know how things go!
Marianne
So we had the appointment with the specialist today. It was good and bad. As far as cushing's, since they are a sister hospital of the hospital where daisy was hospitalized and where they did her ultrasound, they offered to do an adrenal scan for free, because the previous hospital for some reason didn't focus on the adrenal glands during the u/s. That was nice of them to do that for me, and like it was mentioned to me before, the adrenal glands are normal sized, which she says makes Cushing's unlikely, but doesn't rule it out.. sigh.. it seems like nothing is ever conclusive! But in a way that's good news I guess, doesn't explain some of the symptoms Daisy has been having though. And why was the low dex test positive for cushing's? Anyway as of now, she said to not restart the Vetoryl.
As far as Diabetes, she really didn't tell me anything new. Maybe I didn't get the best specialist, but I feel like I didn't take anything away from this apt that my regular vet didn't tell me.
I'm glad that they performed another ultrasound for free! And to read that Daisy's adrenal glands are normal in size.Quote:
Originally Posted by anotherk9lover
Exactly what symptoms is Daisy displaying right now? And regarding the positive result from the LDDS test, any non-adrenal illness such as uncontrolled diabetes, can yield a false positive response from the LDDS test.Quote:
Originally Posted by anotherk9lover
I'm sorry the visit with the specialist wasn't as beneficial as it should have been, but the bright side is that it looks like Daisy doesn't have Cushing's, that's definitely one good thing!Quote:
Originally Posted by anotherk9lover
Hugs, Lori
So how certain is it that there is no Cushing's if the adrenals are a normal size? Because from what the doc said it's about 80-90%, not 100%. The symptoms were constant infections that she had of her skin, the clogged comedones on her back, some fur thinning on her back. She stopped jumping up on sofas and anything really for a few years now, things like that. My vet was fairly certain in his suspicion of cushing's. I guess we made a mistake in testing her so soon after hospitalization. (~3 weeks). Also Daisy really stresses out when she's at the vet, so maybe that could've also contributed to high cortisol? no idea, no one seems to have certain answers. Now they're suggesting that we retest her again for the entire day test, as if the time and money is just growing on trees.. sigh.. Sorry, it's just all been pretty frustrating. I don't like how little information this specialist provided to me regarding Diabetes. It's like she expected that I ask her for all the info, instead of providing it to me. But any questions that I did ask, she just gave me vague answers, and then told me that she doesn't have time for certain things like discussing skin infections etc. Even diet for diabetes she didn't give me any in-depth insight on that, she really didn't provide much of anything. It wasn't a great experience, not sure why my vet referred us to her. If it wasn't for the free adrenal scan, I would be really annoyed with this appointment being a rip off.
After encouraging you to see the specialist, I’m furious that she was so useless. I was mad enough on your behalf, but when I got to this part, I really thought I’d explode!
She doesn’t *have time* to discuss skin infections, when they can be central issues for dogs with either diabetes or Cushings? Are you kidding me????Quote:
But any questions that I did ask, she just gave me vague answers, and then told me that she doesn't have time for certain things like discussing skin infections, etc.
I’m so sorry that this was your experience, but now we’re stuck with figuring out where you go from here. I do believe she’s correct that the normal size of the adrenal glands does not rule out Cushing’s 100%. It’s uncommon, but not a total rule-out. As far as repeating Daisy’s LDDS test, yes, we could hope that it might be more accurate now than it was just three weeks after her acute hospitalization. But any time that a dog is suffering from additional illness, it makes the possibility of a “false positive” more likely. Here’s a quote from a laboratory that provides diagnostic blood testing.
Our experience here is that a diagnostic ACTH may be the preferred choice in diabetic dogs because it may be a bit less likely to give false results. But as the quote above demonstrates, both of the diagnostic tests can be skewed. And obviously, Daisy’s normally adrenal glands throw another question mark into the mix.Quote:
Specificity of LDDS is poor (51%) in dogs with non adrenal disease and concurrent illness (particularly diabetes mellitus and renal failure.) Positive test results should always be interpreted in light of history and clinical signs.
b) Determination of whether animals with diabetes mellitus have concurrent hyperadrenocorticism may be difficult. In such cases both the ACTH stimulation test as well as the low dose dexamethasone suppression test have been reported to produce false positive results. In most instances a combination of both tests in addition to an ultrasonographic examination of the adrenal glands are necessary for complete diagnostic evaluation. Please contact the laboratory to discuss the approach to such cases.
I do have one more suggestion for you to consider, although I realize I totally struck out re: the particular specialist you saw on Monday. A renowned endocrinology expert, Dr. David Bruyette, has established a consultative service that vets from anywhere in the world can use. Dr. Bruyette was previously the director of a specialty hospital in Los Angeles, was an advisor to Dechra re: the development of Vetoryl, and helped pioneer groundbreaking pituitary surgery for the treatment of enlarged Cushing’s macrotumors. Given the nature of his specialty practice, I’m confident that he and his staff are well-versed in diabetic treatment, as well. Over the years, a number of our members here have consulted with him about difficult cases. Per his current website, for a fee of $200, your vet can submit all of Daisy’s records and receive a month’s worth of consultative advice. Additional months of service would cost $150. Here’s a link to his information page. You can show this to your vet, and see whether he thinks this is a service that could be useful to you all.
https://www.veterinarydiagnosticinve...ices-subscribe
In the meantime, it’ll be interesting to see what happens during a time period that Daisy isn’t taking the Vetoryl. Do any of her symptoms worsen, or does she remain pretty much status quo?
Marianne
Regarding the bad breath, she thinks it has to do with her dental condition, she suggests a deep cleaning under anesthesia. But I really don't want to do that! Not only is it expensive, but I'm too scared to put daisy under for that. A friend of mine lost a dog to a heart attack because of anesthesia during a teeth cleaning. It's not something I want to risk unless there's just no other way.
haha! you're cute Labblab :) thanks for being willing to explode on my behalf! :D I know you meant well, and it's great that you had a good experience with a specialist, unfortunately mine wasn't quite that. She seemed to want to refer Daisy out to all other specialists like derm, ortho, etc. It's honestly ridiculous. I just want to find one very knowledgeable vet who can help us manage everything without needing to see 10 different specialists. Heck! Most humans wouldn't do that for themselves. We tend to do a lot more for our pets than for humans.
It seems like neither test is very conclusive LDDS or ACTH, with diabetes. Therefore I don't really see a reason to repeat this test again, just to be told that it's not 100% certain. We haven't seen any issues since daisy has been off of Vetoryl, which has been a month. But then again, she never had super clear signs of Cushings, I'm not ever sure what exactly they are? The drinking and urinating that has started with her diabetes, and managed fairly well at this point.
Daisy's skin issues have been going on for several years, as well as her not jumping up on furniture, so the specialist was saying if that has been going on for years, then at this point we would expect to see some changes in her adrenal glands, as opposed to someone who just started showing symptoms. And since there's no issue with the glands then Cushing's is less likely. Who knew that this disease would be such a mystery to diagnose! I'm just very thankful that the Vetoryl didn't suppress her too much if she infact DOESN'T have cushings.
What is everyone doing for skin though? Those who get skin infections/yeast infections from Cushing's, are there any helpful products that you have found that I can maybe utilize. I hate using antibiotics on daisy constantly. Her urethra area has folds around it which traps moisture, and tends to be prone to yeast infections, redness and itching. Any recommendations for that?
So glad to hear that nothing has really worsened for Daisy since stopping the Vetoryl, and I agree this makes the Cushing’s diagnosis seem more questionable. As far as skin infections, my nonCushing’s Lab girl went through a year when she suffered from repeated staff infections all over her back. We never could isolate a cause, and still don’t know to this day what triggered them. Oral antibiotics did clear them up, but they always returned after we finished a course of antibiotics, and I also didn’t feel good about keeping her on them long-term. So I did some reading and found that, for many skin infections, regular bathing with topical antiseptic shampoos can work even better than oral meds.
I saw a recommendation online by a derm specialist for of a line of products made by Douxo, and especially their chlorhexadine shampoo and spray for treatment of bacterial and/or fungal infections. To begin with when the infection was acute, we bathed every 2-3 days. As it resolved, we spaced out the baths but also got their chlorhexadine spray to directly apply to spots in between. It took at least a couple of months to feel as though we were really getting the upper hand. But over time, the lesions were fewer and finally cleared up altogether. That was about five years ago now, and I still use that shampoo when I bathe my girl, just to nip any recurrence in the bud.
You may already have tried various shampoos without success, but this is a specific product that did work well for us. So fingers crossed for you if you decide to give it a try, too.
Marianne