Jack is possibly insulin resistant. :-/

Jack now has Addison’s Disease due to not having enough cortisol. He had Cushing’s due to too much cortisol, but apparently the Mitotane killed too many cells in the adrenal gland, so now it’s not producing enough cortisol. He’ll be on an injection once a month for the rest of his life. We have to give him Prednisone to help restore cortisol. My poor guy, he is acting hungry and tired all of the time. I bought all of the testing supplies but still haven’t been able to get enough blood for the test strip. We got the Freestyle Libre 2 reader and sensor last week, it seems that the readings only go up to 400, so I have no idea how high his sugars are. Every time we check them, it’s at the max level of 400 on the reader. Once it did show 378 and another time 379. But other than that, it just shows HI and when I transfer the data, it shows he was exactly at 400 for all of the other tests. So I’m pretty sure it doesn’t read over 400. The vet believes he may be insulin resistant. I was thinking of purchasing the genteel device to use for testing. But what if that doesn’t work either? Then I’ll be out $70 on that. I already have the meter, test strips, lancing device and lancets not being used. It isn’t about the money, but I’ve spent close to $4k since he was diagnosed in January. My only other option would be to bring him to the vet to get tested once a week, they charge me $40 each time. But then that’s just sporadic testing and I’ll never know how his levels are at any other time. Even if I do test him and his levels are still high after taking 18U of insulin, what would I do? I already feel like he’s on a high dose. He seems miserable, he doesn’t want to play. He only gets up to eat, drink or go outside. We switched insulins from Vetsulin to Prozinc. We’re now at 18U twice a day and his reader still just shows HI. :-/ We’re injecting into the back of his neck area because that’s the only place we can get enough skin to tent. I feel like I’m failing him.

Cushing’s to Addison’s Disease

So what we were worried about happening happened. Jack began the toxic meds (Mitotane) last month to kill some cells in the adrenal gland so they wouldn't produce excess cortisol. But we had to keep an eye on him because if it kills off too many, it could be life threatening from not having enough cortisol. Yesterday Damian texted me at work saying Jack threw up 5 times. We took him to the vet, they ran tests, he's now transitioned from Cushing's Disease to Addison's Disease. We have to stop the toxic meds immediately and give him another med (Prednisone) that restores some cortisol. His diabetes still isn't under control and we've gone from 5 units twice a day to 17 units twice a day. They ran a test that shows his average glucose over the past 3-4 weeks and they said it was pretty high. Me and Damian haven’t been successful in getting enough blood for the test strips so the vet prescribed a glucose reader gadget called Freestyle Libre 2. It will send the readings to my phone after they attach it to his neck with tape. The sensor works for 2 weeks, so we’ll use this route instead of doing a glucose curve that would mean a day full of needle sticks! We are trying another insulin to see if it makes a difference. We’re close to $4k since November for our boy and he still has a long road ahead. Prayers are needed and appreciated. All I can think of now is how we stopped paying him lots of attention years back, how we got a cat when we barely had time to spend with him and then his dad leaving him behind. It all just breaks my heart. But I will try and let the good memories consume me instead of the negative. I’m just really worried and the first place we all go is “I should’ve done this or that more...”. This is hard. 

Additional info on Cushing’s & Addison’s Disease

https://www.akc.org/expert-advice/health/addisons-disease-in-dogs-symptoms-treatment-prevention/

Update on Jack 3/24/21

3/22/21 - after 7pm Jack vomited. 3/23/21 - had multiple accidents on the kitchen floor, wasn't interested in eating breakfast and he was drinking a lot of water again. Damian texted me around 1pm saying Jack threw up 5 times. I called the vet, they wanted us to drop him off so they could squeeze him in to be seen. They ran some bloodwork, he was dehydrated, his cortisol was really low and he had low sodium and high potassium. All of this was an indication that the adrenal gland is now under producing cortisol, which could be fatal. We were instructed to stop the mitotane, hold off on the pimobendan (heart meds) for the night and only give insulin if he kept his food down for 90 mins after dinner. We need to keep him out of any stressful environments, him getting stressed activates some other hormone which isn't good for him at this time. They also ran a test with his blood work, fructolose(?) or something like that, it will tell us how effective the insulin has been. Which I'm thankful for because I feel like he is on a super high dose.

Jack's medicine for Cushing's

Jack was prescribed Mitotane. It's a drug used to treat cancer of the adrenal glands. He doesn't have cancer, they're looking to destroy some cells in the adrenal glands so they aren't able to produce as much cortisol. Tricky part is if you kill off too many, it could be fatal. So we have to watch for warning signs - stomach upset (acting sick), vomiting and diarrhea are the top common. Those symptoms are the same that he has with his Pancreatitis episodes. This is so scary. They prescribed him Presnisolone 5mg and we are to give him 2 tablets if he begins showing these signs then call the vet immediately. The drug is pretty much a chemotherapy drug. It's so toxic that you have to wear gloves to give him the capsule. Knowing that I'm putting this in my man's body is so difficult. His first dose was yesterday evening. This mmorning he threw up his undigested breakfast. I don't want to freak out because it was one dose and his first. I'm going to hope and pray that this is one of the Pancreatitis episodes.

Update on Jack - Cushing's and Diabetes

Jack had his ultrasound yesterday. They did not see a tumor on the adrenal glands, there wouldn't have been concern of cancer, they're just narrowing down the reasons for high cortisol levels. After the ultrasound they completed a cortisol blood test, which did confirm the Cushing's diagnosis. His blood sugars during fasting were 565. We're going to increase his insulin from 5 units twice a day to 8 units twice a day. We are going to start on a medication called Mitotane. This is the scary part. The Mitotane will help reduce his cortisol levels by destroying parts of the adrenal glands. But it can be life threatening if it gets too low. And the symptoms of that are pretty much the same as his Pancreatitis episodes. It's all so overwhelming.

Below is some info that I found on the Mitotane research I've done so far. I don't have all of the answers yet, but I'm compiling a list of questions to discuss next week with the Dr. My comments are in italic.

Mitotane and trilostane therapy are effective and relatively safe in dogs with adrenal-dependent hyperadrenocorticism. Dogs with adrenal tumors however, tend to be more resistant to mitotane and trilostane than dogs with pituitary-dependent hyperadrenocorticism. This is why we didn't want a tumor!

Dogs with Cushing's disease have elevated levels of cortisol, which increases triglycerides and cholesterol. To help combat these increases, a food that's lower in fat (less than 12 percent on a dry matter basis, or DM) and moderate in crude fiber (8-17 percent DM) is reasonable. But as you'll see below, it's preferred that you give the Mitotane with a food that is high in fat.

The basis for increased panting in dog's with Cushing's disease is multifactorial. First, Cushing's disease results in increased fat deposits in the abdominal cavity and around the chest. This might explain the fatty deposits he began getting a few years back. I'll have to reach out to his prior vet and request his records.

Second, an increase in liver size impedes the diaphragm from being able to expand with ease. Mitotane, also known as o,p’-DDD (brand names: Lysodren®, Lisodren®) is an anticancer medication that is toxic to the adrenal gland cells and is used to treat hyperadrenocorticism (Cushing’s disease) or adrenal gland carcinoma. Its use in dogs and ferrets to treat adrenal disorders is ‘off label’ or ‘extra label’. Many drugs are commonly prescribed for off label use in veterinary medicine. In these instances, follow your veterinarian’s directions and cautions very carefully as their directions may be significantly different from those on the label.

Mitotane is given by mouth in the form of a tablet. It should be given with food, preferably one high in fat. Your veterinarian may provide you with a high fat pet food, or you can give the medication with a little corn oil, butter, or cheese. Wear gloves when administering this medication and do not allow the medication to come into contact with your skin, eyes, or mouth. Wear gloves when handling your pet’s urine, feces, or vomit, as the drug may be present.

The following medications should be used with caution when given with mitotane: central nervous system (CNS) depressant drugs, fentanyl, insulin, midazolam, phenobarbital, selegiline, spironolactone, or warfarin. Your veterinarian will monitor your pet to be sure that the medication is working by monitoring clinical effects and performing regular ACTH response tests. Your veterinarian may also monitor liver and kidney values, blood cell counts, blood sugar levels, and blood electrolytes. Regular monitoring at home for adverse/serious side effects is very important in addition to regular monitoring by your veterinarian.


Recommended Facebook Groups: Support group for owners of dogs with Cushing’s disease Dogs with Cushing’s support and information Canine diabetes support and information

Jack's lab results...

We took Jack to the vet yesterday because he just hasn’t seemed like himself lately. He’s been drinking a ton of water, going outside like once an hour and then heads straight back to the water bowl. It’s just a vicious cycle and had us concerned. The vet said they can run the labs in house but it would just be negative vs positive and if they send them off, they’ll get actual numbers back to help us with his diagnosis. So I got the call on my way home today. The doctor was on the phone with me for my 30 minute drive. Jack’s glucose shouldn’t be higher than 114, his was 630. Then he said “I wish this was as simple as me saying ok, that’s it, come in and I’ll show you how to administer the insulin shots, but that’s just the first thing we found.” Then my heart sank. • Sodium is low (signs of kidney disease) • Potassium is high (can indicate kidney failure • Protein is high (relates to liver, kidneys and infectious diseases) • ALP, which should be no higher than 160 was 2017 (indicating Cushing disease) • Triglycerides were 379 (norm is high of 150) • Lipase was 544 (normal high is 250) indicating pancreatitis • cPL was 627 (shouldn’t be higher than 200) indicating pancreatic inflammation • T4 was low (indicating hypothyroidism) • They mentioned that his kidneys appeared to be stressed They are definitely diagnosing him with Type II diabetes which will require 2 shots of insulin per day and possibly Cushing disease. He was already diagnosed with a heart murmur and Pancreatitis. Our next step is to have an ultrasound done this week to look for an adrenal tumor. If one is present, he said we may consider declining treatment for any of the conditions as the expectancy is 2-3 months. If a tumor is not found, we’ll begin aggressive treatment of diabetes and Cushing. My poor little guy. :( Phoebe saw that I was upset when I got home and she made sure to work her magic and cheer me up in addition to lots of hugs. I love that kid. Update 1/14: Ultrasound is now scheduled for Jan 22nd so we're going to start him on insulin today to try and get his glucose levels down.

Jack has a heart murmur. 😔

We found out today that Jack has a heart murmur. A 3 of 6. He’ll need an echo so they can confirm the issue and treat with medication if necessary. We had asked about getting his teeth cleaned but they said the heart murmur needs to be addressed first so they’ll know if he can handle the sedation for teeth cleaning. 😢😔

Such a RUFF life!

Jack - before grooming...and after