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Thread: Thoughts on Possible Cushings? (Kiwi has passed)

  1. #1
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    Default Thoughts on Possible Cushings? (Kiwi has passed)

    I have a 12yr old male diabetic Schnauzer named Kiwi. Yes, I said it, diabetic. He has been well maintained for about 2yrs on 12iu of NPH insulin 2x a day with Nutro low calorie food (high fiber and low carbs, incredible food for either weight control or diabetes). He lost a boatload of weight when he was first diagnosed and I changed to the Nutro, going from 32 to 26lbs. But then he stabilized in weight and everything was going along fine. More recently however I have noticed what I would call some degree of negative body composition change. His spine has become more prominent as have his ribs. He still weighs the same though. I have tried feeding him more and will continue doing so but that makes for a hard time controlling his glucose. I took him to the vet the other day and she was beyond herself that he would take so much insulin. But really, what can I do, that is what it takes in his case. We did an X-Ray and chemistry. For the most part everything was either normal or in-line with aging. I am questioning Cushing's though. 1. Due to what appears to be muscle atrophy (spinal prominence), 2. He drinks like crazy, 3. He requires that ungodly level of insulin. Vet isn't crazy about my theory and wants to do ultrasounds and a bunch of other expensive tests that I don't think are particularly indicated given what we have found thus far. With respect to the labs:

    Urine specific gravity was 1.033 No Reference Range (RR) noted on labs
    T4 1.1 RR 1.0-4.0
    MCV 78 RR 59-76
    ALP 297 RR 5-160
    AST 56 RR 16-55
    ALT 79 RR 18-121
    GGT 4 RR 0-13

    I thought the ALP result was interesting with respect to the Cushing's theory. Vet said it isn't really quite high enough, but she also mentioned cirrhosis which make zero sense to me with a GGT/ALT low and AST just over the reference range. I'm thinking maybe of doing a LDDS but am not sure whether this really conforms to the sort of profile of Cushing's.

    Mark
    Last edited by Mark4124; 07-30-2018 at 10:47 AM.

  2. #2
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    Default Re: Thoughts on Possible Cushings?

    Hi Mark, and welcome to you and Kiwi. I’m afraid I have only a moment to post right now, but I wanted to quickly ask you to please edit your info so as to include the normal reference range for each of those lab values. Thanks so much, and I’ll look forward to talking with you more very soon!

    Marianne

  3. #3
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    Default Re: Thoughts on Possible Cushings?

    Done, abbreviated RR no reference range stated on the specific gravity.

  4. #4
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    Default Re: Thoughts on Possible Cushings?

    Hi Mark,

    Welcome to you and Kiwi from me as well! I have no experience with diabetes but we do have a sister forum that deals with canine diabetes so I'm including a link to that forum: http://www.k9diabetes.com/forum/ If you haven't joined their forum I strongly urge you to as they are a wonderful group of people that are so very knowledgeable about canine diabetes, and in this way you'll have the best of both worlds.

    Lori

  5. #5
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    Jul 2018
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    Default Re: Thoughts on Possible Cushings?

    Thanks and yes, I am on there... was fairly active when he was first diagnosed, stepped away for a time, but now back as things are getting a bit interesting again.

  6. #6
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    Default Re: Thoughts on Possible Cushings?

    Hi Mark,

    Welcome to you and Kiwi!

    You said -
    Vet isn't crazy about my theory and wants to do ultrasounds and a bunch of other expensive tests that I don't think are particularly indicated given what we have found thus far.
    First, I agree with your vet. I don't see anything that says Cushing's with the possible exception of the increased difficulty in controlling the glucose. HOWEVER, that could be related to the diabetes very easily. It is hard for us to accept aging in our babies but a 12 yr old pup is in the mid 60's in human years so you can certainly expect to see conformation changes. Trust me on that.

    Second, and MOST important is the latter portion of your statement saying you don't see the need for testing. Testing for Cushing's is CRUCIAL...not optional; never, ever optional. Canine Cushing's is one of, if not THE, most difficult canine condition to correctly diagnose. It is as much a process of ruling out as ruling in. The fact that Kiwi already has a serious endocrine disease means that testing is that much more important...and in depth testing to be sure false positives are not being returned because of the diabetes. Diabetes can and does skew Cushing's tests....as can any illness. This is one thing that makes this disease so difficult to diagnose - there are no sure tests, none are 100% accurate, all can be skewed for many reasons. For another, Cushing's mimics other diseases, diabetes included. Hence the ruling out process. So if I were you I would focus on the glucose for now and see if changes in insulin, diet, etc. might not turn things around. If Kiwi can be spared the extra stress of frequent testing not to mention powerful drugs then do all you can to spare her.

    Hugs,
    Leslie
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  7. #7
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    Default Re: Thoughts on Possible Cushings?

    No, no... you are misunderstanding. I don't believe that Kiwi's X-ray and other chemistry justifies a ultrasound and I disagree with the vet that Fructosamine test is going to tell me anymore about his DM than I already know. I certainly think it is critical he be tested for Cushing's before going down that road. I have put in for urine cortisol / creatine as next step. Maybe we can quickly rule out, I'll report back when resulted.

  8. #8
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    Default Re: Thoughts on Possible Cushings?

    ahhh good! Glad to know I was off base! We have seen some real horror stories when vets thought it was just fine to start treatment because the ALP was high and they are supposed to be the professionals. So for a parent just starting down the cush path to think along those same lines is an easy thing to have happen. I can take a breath now.
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  9. #9
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    Default Re: Thoughts on Possible Cushings?

    Urine Cortisol 16.4
    Urine Creatinine 126.2
    Ratio 41

    Interpretation >= 34 Possible Hyperadrencorticism

    I'm curious as you what you all think of this result. Interesting also in light of the ALP and also the difficulty controlling his sugar. He does drink alot and gets hot easily, always has, but then he is also a diabetic.

    As per next steps... what are the advantages/disadvantages of the ACTH stim test v the LDDS?

    Thanks,

    Mark

  10. #10
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    Default Re: Thoughts on Possible Cushings?

    Hi again, Mark — I’m sorry it took me so long to get back here!

    Anyway, in response to your question, the LDDS is generally considered the “gold standard” for Cushing’s diagnosis. However, one big caveat is that it is more vulnerable than is the ACTH in returning “false positives” in dogs who are suffering bodily stress from nonadrenal conditions. For this reason, the ACTH is often recommended for dogs who have concurrent physical issues. In your case, I’d opt for the ACTH.

    Also, since you’ve been active on the diabetes forum, folks over there may have already provided this link to you. But I’ll add it here, as well. It’s a blog column authored by Dr. Mark Peterson that discusses the challenges involved in the dual diagnosis of Cushing’s in addition to diabetes. As you’ll see, he places a fair amount of weight upon the presence or absence of skin/coat problems. He also provides his own definition of insulin resistance. So if you’ve not see this already, take a look for the sake of interest.

    https://endocrinevet.blogspot.com/20...edium=facebook

    And definitely let us know how you decide to proceed.

    Marianne

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